Two paramedics in Illinois were charged with first degree murder of their patient, a 35-year-old man reportedly experiencing alcohol withdrawal. The paramedics did not put a Berretta to the man’s head and pull the trigger nor did they stab him repeatedly with a Bowie knife. Police body camera footage shows they were rude to him, called him stupid, refused to help him walk to the stretcher (the police assisted the man), tied him face down on the stretcher, aggressively tightened the straps, and then drove him a mile to the hospital. Shortly after arrival at the hospital, he was declared to be in cardiac arrest. He was not breathing and his heart had stopped. The ED staff did CPR. They could not resuscitate him.
Paramedics in Illinois charged with murder after patient dies
According to the medical examiner, the patient died of ““compressional and positional asphyxia due to prone facedown restraint on a paramedic transportation cot/stretcher by tightened straps across back and lower body in the setting of lethargy and underlying chronic alcoholism.” When people are placed prone and someone sits on their chest or holds or straps them down too tight, their chest cannot expand. If their chest can’t expand, they can’t breathe, and they suffocate. They die of hypoxia -lack of oxygen. For a medical examiner to declare a person died of “positional asphyxia” it must be be determined that the patient had both an inability to escape from the position he was found dead in and that all other causes of death are ruled out. Positional asphyxia under the care of EMS is an entirely avoidable death. Death can occur within 5-6 minutes if a person is not able to adequately expand their chest. Reportedly the Illinois case involved an ambulance ride of only a mile.
RESTRAINT ASPHYXIA – SILENT KILLER
To the tight straps restricting his breathing, factor in the man is in alcohol withdrawal, which can weaken him, in addition to causing hallucinations and tremors. Patients in alcohol withdrawal are often dehydrated and their hearts are usually beating excessively fast. None of these symptoms help a person breathe against tight restraints on their chest. Typically for someone in severe alcohol withdrawal, I will give them IV fluids and the large amounts of the benzodiazepine Ativan. Alcohol withdrawal by itself can be fatal if not treated.
I have been in EMS for over 30 years and have written extensively about what I have seen. As a person with a forum, I often feel a duty to portray our better angels and show the world the grace and empathy with which most people in EMS treat their patients. That said, we clearly have a dark side — a side I have been uncomfortable discussing. In one of my novels, Diamond in the Rough, I wrote about an EMT who steals from patients. He comes to recognize the errors of his ways and his moral failings (for which he pays a steep price despite his ultimate redemption). There are characters – fellow employees – in the book, who helped shape him in the wrong ways. Culture, particularly the culture to which new EMTs are first introduced, can have lasting impact on the caregiving that EMT will perform and on the type of caregivers that EMT will train in the future.
These two paramedics in Illinois are not foreign. I have seen their spirits in others I have worked with. I have seen EMTs verbally abuse patients countless times before.
“I am not playing with you now,” one of the medics says to the patient. “You’re going to have to walk because we ain’t carrying you.”
I have heard those same words a hundred times.
A standard mantra in EMS is know your ABCs. Not Airway, Breathing, but Ambulate Before Carry.
Shocking? No. Walk up four flights of wobbly wooden stairs and find an obese patient with a chest cold, not half as bad as yours who says he’s too sick to walk, and who insists he needs to be carried. A common response. “You can walk. There’s nothing wrong with your legs.” A more diplomatic response might be. “Try to walk, if you can. We’ll help you. It would be dangerous for us to try to carry you on these stairs, unless we can’t avoid it.”
Ever heard of a patient going into cardiac arrest while being walked out by an EMS crew? I have. Several times. The trick isn’t carrying every patient, it is recognizing who is sick and who isn’t. If you don’t do a full assessment on your patient before making the choice to walk them, you are putting your livelihood every much at risk than you are when you are subjecting your back to a heavy carry.
Verbal abuse aside, I have seen EMS people exert more force than was necessary to control a situation. An old EMT who worked for us, use to carry a night stick. I never saw him hit anyone with it, but I saw it grasp it tight. One of my first partners always clenched a patient’s arm and would say, “Come on, buddy, let’s get moving.” Not every patient reacted well to that bullying. We are not cops, but some of us act like them.
I don’t think the way the Illinois pair acted on the scene sprang originally from their darkened souls. Someone in their past surely demonstrated similar behavior and taught them that it was okay to treat patients like this.
I remember years ago a young man I knew who had started working for our company and was just starting paramedic school, showed some of his classmates pictures of a drunk he and his partner had beaten up after he had become rough with them. Pretty damn quick he was kicked out of paramedic school and fired from his job. That behavior wasn’t tolerated, but someone (more experienced) he had worked with had given him the impression that it was.
One night I was called to assist a crew who had a combative patient in the back of the ambulance. The scene was outside the Civic Center where the Grateful Dead was touring. An immense crowd had gathered outside the coliseum waiting for the gates to open, getting drunk and high. No sooner had I entered the back of the ambulance, then a paramedic from another division, who was there as part of the standby, came in through the side ambulance door. While I was taking a defensive posture, trying to calm the patient, who was obviously having a bad trip, and keep him from kicking the two EMTs, this medic immediately wrapped the man in a headlock, while calling him a litany of names. His partner who joined in put his knee on the man’s chest and roughly tied the man to the stretcher in an awkward, painful position. It wasn’t so much the physical restraining of the patient, as the violence behind it that upset me. I always pride myself on my ability to talk someone down. It helps that I am six-seven (back then I was closer to six-nine). If I can’t calm them sufficiently, then after getting help holding someone down, I will go with chemical restraints (sedation). It is much better for both patient and crew to have someone calmed by medicine than struggling against physical restraints. I told the medic afterwards I thought his use of physical force was excessive, and he seemed genuinely hurt like I should have been praising him for saving us a potential beating.
It is true that back then in my earlier days, the police were not often on scenes, and the fire department had not yet become first responders. It was often just us, and the uniforms we wore then were the same navy blue as the Hartford police wore (We now wear light blue or grey if you are a training officer). Today, if there is a question of a violent patient, we are usually told to stage (delay entry) for police. That was not the case then, so self-defense was more actively taught and many EMTs prided themselves on knowing martial arts.
What follows are not excuses for the accused medics, but they are factors that contribute to shameful events. Many in EMS are underpaid, overworked, subject to violence, verbal and physical, perpetrated upon them by their patients, and are often treated without respect by everyone from hospital nurses to their own bosses. Add to that stresses from family life, financial and personal, and some providers are powder kegs, waiting to detonate.
It is hard to sit there and take it. The fact that it is your job doesn’t make it much easier to absorb. A few years ago, I transported a young drunken pregnant woman from the scene of a motor vehicle accident. She complained of neck, back and body pain. Because of her advanced pregnancy (she was wearing a tank top and her baby bump was prodigious), I knew the hospital would work her up as a trauma. In addition to putting a cervical collar on her neck, I put an IV into her forearm. While I warned her I was putting the IV in, no sooner did I insert the IV catheter in her vein, then she screamed and moved her arm, which caused me to clamp down to get her to stop moving to prevent blood from flowing out of the catheter. “Stop! You’re hurting me!” I couldn’t get her to hold still, and while I managed to screw the IV lock on to the end of the catheter and get it taped down, there was still a fair amount of spilled blood on her hand. I tried to wipe it off with a 4X4, but she swung her arm away from me and started rubbing her face, transferring blood to her cheek and forehead. “I don’t like you! You hurt me!” She wouldn’t let me touch her to clean the blood off her face.
At the hospital, all the way through the corridors to the trauma room, the now bloodied young woman shouted and pointed at me, “This man hurt me! Don’t let him touch me! I don’t like you! You’re a bad man!”
I shook my head as it seemed everyone –patients in the waiting area, nurses, doctors, an old woman on a hallway stretcher, the housekeeping staff, other EMTs pushing stretchers, all stopped what they were doing to look judgingly at me. And I’m thinking, “I don’t need this in my life. Why am I even still doing this anymore? Why am I subjecting myself to this spectacle? What is the point? This isn’t what EMS is supposed to be about.”
I’ve been spit on multiple times by patients. There was a recent news story about the police officer who was videotaped punching a man on a stretcher. His unacceptable excuse — the man had spit on him.
Being spit upon elicits a visceral reaction that you have to struggle to control. Once, when I had a bad chest cold that should have kept me in bed, but the company needed ambulances of the road and I needed the hours to pay my bills, I had an inkling to hawk up a big gob of green phlegm and retaliate against a drunken man (a loser of a barroom fight) who jawed and spit at me. I didn’t act on it, but I thought about it. Maybe he saw it in my eyes. He ceased his spitting, but soon continued his verbal abuse. “You’re a piece of shit,” he said. “You all think your better than me. Fuck you. You’re garbage!” And on and on.
In EMS we are mostly alone in the back of the ambulance. Patients can say what they want without recrimination. They can often get away with physical violence (and always get away with verbal violence) as well. Assault against EMTs, while in some jurisdictions are against the law, they are almost never prosecuted. I know a female paramedic who had a patient pull his penis out and masturbate while leering at her. When he was done, she had to hand him a towel to clean himself up.
In 2020, according to the CDC, 3,000 EMS workers were injured by assaults seriously enough to require treatment in an Emergency Department,
https://www.cdc.gov/niosh/topics/ems/data.html
In a 2016 survey of EMS personnel, 65% reported at least one incident of being physically attacked on the job by either a patient or family member. The study found that EMS workers have a rate of violence against them twenty-two times the national average.
International Survey of Violence Against EMS Personnel: Physical Violence Report
When I started in EMS, it wasn’t uncommon to transport violent patients in a prone position, or even “hog-tie” them. As the dangers of this become known, it was eventually forbidden. I remember during Hurricane Katrina, when I went to Mississippi to help out local EMS, I was flabbergasted at a scene where the area fire department, placed a combative spitting crack-using patient face down between two backboards. I stopped them and instead medicated the patient with Valium. Under the rules of engagement of my deployment to Mississippi, I could operate under Connecticut protocols. The local medics said they rarely, if ever sedated violent patients. Even at the ED, I was questioned about my decision. Another medic I knew, who eventually left the field due to burnout, was liberal in his use of sedation. He used it not just for physical violence, but for verbal violence. “I don’t need to be subjected to abuse. You keep talking foul mouth trash to me, and you are taking a nap,” he said.
I believe many EMS providers who struggle with these patients leave the field. They get burned out by the unremitting degradation. Some become police offices, others get 9-5 jobs and are much happier. The problem is many, who get used to making overtime pay, find they can’t go elsewhere, nor for financial reasons can they cut back on their hours. They are dependent on overtime to make ends meet. They are trapped in a world without help. And while many companies now offer employee assistance programs, few act on them, viewing seeking help as a sign of weakness. Many find solace in drugs and alcohol. In thirty years on the street I have seen many handsome young men come into the field, with bulletproof smiles, only to see them gradually get broken down by the years, and turn into yellow skinned asities-ridden prematurely old men, who die in ICUs of liver failure, commit suicide or are otherwise found prematurely dead at home like the medic I just mentioned. Rest his soul.
While I believe in individual responsibility, I also believe if you look at most problems, there is a system failure behind it. I am sure the Illinois pair did not intend to cause physical harm to their patient. I don’t think they belong in electric chairs. But they should be, if the facts are as they have been reported, banned from ever working health care again, and surely they should be made to atone for the death they likely caused through negligence and antipathy. But just punishing them won’t solve the problem, anymore than putting a drug dealer in jail will stop fentanyl deaths. These incidents will keep happening unless we address the darker spots of EMS culture.
If someone displays cruelty, they need to be remediated or dismissed. Unfortunately, many organizations have invested too much in training individuals and are facing severe personnel shortages that often lead them to keeping on problem employees they shouldn’t.
If you are an EMT or a paramedic and you see somebody treat a patient like these medics did, you need to speak up. You need to make it clear that it is not okay to dehumanize your patients even if other patients have dehumanized you. Don’t back down from this. Ever.
Shine light on the dark places.