Sudden Death in Custody: EMS Protocol Development
Updated: Sep 22
In EMS we must do the hard work to better understand sudden death in custody. A key priority is the development of new and revised protocols concerning the assessment and management of individuals in law enforcement custody.
Protocols must be developed to address the following:
Responsibility to Intervene
An individual in custody is a patient from the moment EMS arrives on scene.
EMS has a responsibility to intervene if an individual is being restrained by law enforcement or other EMS providers in an unsafe manner.
The prone position is inherently dangerous. An individual kept in the prone position for any extended period of time is at HIGH risk of sudden death.
This is true regardless of whether there is any weight on the individual's back or side.
Every effort should be made to move an individual out of the prone position immediately.
Restraint by EMS
NO physical or chemical restraint may be applied by EMS unless:
EMS has independently assessed that restraint is medically justified
EMS should not routinely rely on law enforcement representations regarding the appropriateness of restraint
EMS has conducted a medical assessment of the patient
Assess the patient's vital signs
Look for and treat if found any medical cause for the patient's combativeness. e.g. hypoglycemia
All necessary equipment is immediately available to assess and care for the restrained patient, including in the event of a sudden deterioration of the patient's condition.
Restrained patients must be monitored continuously. Anticipate the possibility of a sudden deterioration in the patient's condition.