It seems that more and more in-custody deaths are being caught on camera. It’s hard to determine if the frequency of in-custody death is actually increasing, or if we are more aware of the incidents because of the increase in recording equipment that is present all around us.
In this recent case from Texas, a prisoner dies after fighting with corrections officers. In the video we can see the prisoner being given a sedative, which I applaud. Early and appropriate sedation is important in the management of acute psychotic episodes, especially if they involve the abuse of a stimulant.
Obvious airway distress
As the video progresses, we can see the prisoner lose consciousness and begin breathing in a manner that is inconsistent with life. At no point in the video do we see any lifesaving interventions being performed.
As with the Eric Garner case, in all likelihood early airway positioning and BVM assistance could have resulted in a different outcome. Of course we don’t know that the end result would have been a positive one, but in any case, it is obvious to me that the prisoner is dying.
We have an opportunity for improvement. Let’s not let it go to waste.
Safety officer for high-risk activities
I think it’s time we take a page from the fire department manual and incorporate a safety officer for high-risk activities. This safety officer’s job would be to oversee the safety of activities for which there is a high risk of injury or death.
In this case, officers entered the cell of a prisoner for an extraction. This type of action is planned and practiced repeatedly. I recommend the addition of a safety officer who is trained and experienced in medical care and law enforcement operations. Had such a safety officer been present, they would surely have called for an intervention at the point we see sustained agonal respirations.
A safety officer needs to have the authority to observe and intervene in any activity for which they see unacceptable risk to the patient or caregivers. Potential activities to assign a safety officer include physical or chemical patient restraint or certain medical procedures like RSI or conscious sedation.
I’m sure there are other activities for which quality improvement should include implementation of a safety officer.
A fire department safety officer’s job is to keep a big picture view and make certain that firefighters are not being put at unnecessary risk. They work alongside the incident commander and function as a “check” on the orders of that commander. In many departments the safety officer has the authority to call a “time out” or for the immediate cessation of activities. In this case, when the prisoner’s breathing became inadequate, a safety officer could have called for an immediate intervention and for the prisoner’s respirations to be assisted.
Ideally, the safety officer role would be filled by a member of the team who is knowledgeable about all activities the team is performing. He or she should also have the knowledge and authority to intervene with any interventions necessary should the subject being restrained become a patient.
