MADISON, Wis. — When EMS and law enforcement respond to the same incident, teamwork is essential. While most collaborations lead to positive outcomes, some situations highlight how things can go wrong, providing valuable lessons for the future. In the EMSpire Midwest session presented by Doug Wolfberg, four case studies illustrated critical interactions between EMS and law enforcement, showing how actions (or inactions) can affect patient outcomes. Through these real-world cases, cleverly named in a “Big Bang Theory” style, a Wolfberg favorite, he also offered 10 key lessons for EMS professionals to carry forward.
Case 1: ‘The Ambulance Ejection Collaboration’ – Julian Coleman, Syracuse, New York
“Scene safety principles don’t allow us to abandon a patient. Our duty to treat doesn’t end because a situation becomes challenging.”
Overview. 48-year-old Julian Coleman, while being transported by a BLS crew in Syracuse, New York, reportedly became agitated and the crew called for police assistance, claiming he had assaulted one of them. The police ordered a compliant Coleman to leave the ambulance on the side of the road. Soon after, he collapsed on the sidewalk, and despite efforts to revive him, Coleman never regained consciousness and later died from what his family indicated was an anoxic brain injury.
The incident led to civil suits against both the ambulance service and the police, alleging violations of civil rights and abandonment. While no criminal charges were filed, the family’s claim underscored concerns about the duty of care EMS owes to patients, even when situations become challenging.
Discussion:
- Misuse of scene safety. Wolfberg questioned whether the alleged combative behavior by the patient justified the crew’s decision to have him removed. He argued that patient abandonment was likely in this case, given the crew enlisted the police to have the patient removed from the ambulance mid-transport, and failed to continue care for him after removing him from the ambulance. Wolfberg emphasized that scene safety principles did not permit EMS to abandon the patient under these circumstances.
- Law enforcement role. Wolfberg argued the police officers likely breached a duty of care by facilitating the patient’s removal and actively depriving him of care in the progress, instead of helping ensure his safety.
- Failure to use other tools. The EMS providers could have managed the situation by utilizing law enforcement support, like having officers ride along or following the ambulance. Wolfberg stressed that they should have used de-escalation techniques or sedation if necessary, or EMS soft restraints, instead of resorting to abandoning the patient on the roadside.
Case 2: ‘The Handoff Passivity’ – Earl Moore Jr., Springfield, Illinois
“Our primary role is to provide care to the patient, and that has to remain our focus, even when things seem chaotic.”
Overview. In December 2022, EMS was called to assist 35-year-old Earl Moore Jr., who was experiencing alcohol withdrawal and hallucinations. Once on scene, they placed Moore in the prone position on a stretcher and secured him tightly with straps. This case gained EMS notoriety as paramedic Peggy Finley was caught on body worn camera video telling Mr. Moore, “You’re gonna have to walk because we ain’t carrying you, because I am seriously not in the mood for this.” This statement, along with other actions during the incident, became a focal point in the case, highlighting the lack of appropriate patient care and compassion.
|More: Video: Is deeply disturbing patient care murder?
The two EMS providers involved in the case were charged with first-degree murder under Illinois law. Although this may seem surprising, Illinois’ statute allows for such a charge when someone’s actions result in a death where they knew their actions would cause death or serious bodily harm. The case has raised important questions about restraint, patient care and the responsibilities of EMS providers when working alongside law enforcement.
Discussion:
- Negligence and gross negligence. Wolfberg strongly asserted that the EMS crew’s actions went beyond negligence and crossed into gross negligence. The EMS providers completely failed in their duty of care, especially by placing the patient in a prone position with tight restraints, when the video evidence clearly showed the patient with pronounced lethargy.
- Prone restraint criticism. Wolfberg was highly critical of the EMS crew’s decision to transport the patient in the prone position, and then not assessing the patient’s vitals during transport (as confirmed by audio recording of EMS-to-hospital communications), noting that the medical examiner found compressional asphyxia as the cause of death. He pointed out that this should have been obvious to any trained EMS provider.
- Police vs. EMS roles. Wolfberg criticized the police involved for not intervening to stop the improper restraint and ask EMS to properly perform their patient care duties, but EMS still bore the brunt of responsibility.
Case 3: ‘The Inactivity Conspiracy’ Tyre Nichols – Memphis, Tennessee
“We have a duty to act, and that doesn’t change just because law enforcement is involved. The patient must come first.”
Overview. The tragic case of Tyre Nichols became widely known after video footage revealed that he had been beaten by Memphis police officers during a traffic stop. EMS arrived on the scene shortly after but did not immediately assess or treat Nichols, leaving him without care for approximately 16 minutes. Nichols, who had suffered severe injuries, later died in the hospital. The cause of death was determined to be blunt force injuries to the head.
Though several police officers were charged with both federal and state crimes, the EMS providers involved did not face criminal charges. However, their failure to provide timely care highlighted the need for a clear understanding of their role in such incidents. EMS must always promptly access the patient and prioritize patient care, regardless of law enforcement’s involvement in the scene.
Discussion:
- Failure to provide care. Wolfberg noted that the EMS providers were passive and failed to take control of the medical situation, noting that it took them 16 minutes to begin any meaningful care or intervention. Once the EMS providers arrived on scene, they had a duty to act regardless of the patient’s custodial status. Whether or not Tyre Nichols was in police custody, EMS still had the responsibility to promptly intervene, assess and provide necessary medical care.
- Ethical and legal failure. He pointed out that even though the police were responsible for Nichols’ injuries, EMS failed in their ethical and legal duties by not intervening sooner to provide critical care. He underscored the importance of stepping in as patient advocates in any scene involving law enforcement.
Case 4: ‘The Positional Acquiescence’ – Trey Ellinger, Baltimore
“When we ask for help from law enforcement, we must ensure that our patient care responsibilities remain clear and uncompromised.”
Overview. In this case, EMS responded to a call involving a 29-year-old man, Trey Ellinger, who was reportedly trying to harm himself and acting erratically. On scene medics asked the police to restrain Ellinger with handcuffs. After being sedated, Ellinger self-shifted into a prone position and was later found to be unresponsive. Though several minutes later, efforts were made to reposition him, Ellinger died later that day due to a combination of drug intoxication and the events that unfolded.
This case brought attention to the delicate balance between EMS and law enforcement roles, particularly regarding proper patient positioning and the use of restraints. EMS asked for police assistance, but the situation evolved in a way that highlighted the need for clearer protocols on when and how restraint should be used during medical transport, and need to continually monitor patient positioning and promptly readjust the patient from a prone position to a position of safety.
Discussion:
- Improper request for handcuffs. Wolfberg argued that EMS should never ask police to make specific decisions about how to restrain a patient, as that is law enforcement’s domain. EMS should have requested help managing the scene but left the method of restraint to the police.
- Failure to reposition the patient. While the EMS crew and police recognized that the prone position was dangerous, Wolfberg noted that they failed to reposition the patient quickly enough, resulting in a delay that may have contributed to the patient’s death. He called this a clear failure of both EMS and police to uphold their duties.
- Shared responsibility. Wolfberg highlighted that both EMS and law enforcement shared responsibility for ensuring the patient’s safety, as he was both an EMS patient and individual in police custody. He argued that both agencies had an obligation to ensure the patient was not left in a harmful position, and the failure to act promptly demonstrated a lack of interagency accountability.
Key lessons learned
Wolfberg’s presentation distilled the lessons from these four cases into 10 takeaways for EMS professionals:
- Collaborative training. Joint training exercises between EMS and law enforcement should be scenario-based and focus on interagency cooperation. Knowing how each side operates helps ensure smoother coordination during real incidents.
- Access to patients in custody. EMS must ensure unimpeded access to patients, even when they are in police custody. The presence of law enforcement should not prevent EMS from providing appropriate care.
- Patient assessment is foundational. Every intervention must stem from a proper patient assessment. Whether the patient is agitated or calm, understanding their condition – and documenting it thoroughly – is crucial to determining the right course of action.
- Stay in your lane, but work together. While collaboration is key, each profession has its own expertise. EMS providers should maintain control over patient care decisions, while law enforcement focuses on scene safety.
- Clarify custodial status. It’s vital to know if a patient is in police custody. This affects who has the authority to make certain decisions affecting the patient.
- Use of restraints. If law enforcement restraints are in place, police officers should remain present to manage them. EMS should not accept responsibility for a patient in handcuffs or other law enforcement restraints without law enforcement remaining on scene.
- Patient advocacy. EMS professionals have a duty to advocate for the patient. This means clearly communicating the patient’s needs and ensuring their care is prioritized.
- Always assume you’re being recorded. In today’s environment, assume that any incident may be recorded. This should guide behavior and decision-making, ensuring that EMS is seen providing competent and compassionate care.
- Develop and train on interagency protocols. Agencies must work together to create clear protocols for situations involving both EMS and law enforcement. These protocols should address everything from restraints to patient assessments.
- Scrutinize the term “excited delirium.” National organizations have moved away from the term “excited delirium.” EMS should instead focus on the clinical presentation of hyperactive delirium with severe agitation and ensure all interventions are clinically justified.
Conclusion
The relationship between EMS and law enforcement is often beneficial, but these cases highlight the importance of understanding boundaries and responsibilities. Patient care must remain the top priority, and EMS providers should advocate for their patients even in challenging situations. Doug Wolfberg’s presentation reminds us that, as EMS professionals, we are accountable for our actions, and clear communication and collaboration with law enforcement are essential to ensure
These lessons underscore the delicate balance that EMS providers must strike when collaborating with law enforcement and navigating complex scenes. By focusing on patient care, maintaining clear communication, and staying within their scope, EMS professionals can ensure that they fulfill their duties, even in the most challenging of circumstances.
