|
September 21, 2024 PERF releases new report on avoiding restraint-related deaths
PERF members, Use of force continues to be the defining issue in policing. The recent incident involving Miami Dolphins player Tyreek Hill demonstrated the level of scrutiny that police tactics often receive, and a single mishandled incident can reduce community trust; some can even have fatal consequences. Many of the most controversial, high-profile cases – such as the deaths of Elijah McClain in Aurora, CO, Daniel Prude in Rochester, NY, and George Floyd in Minneapolis – involved police restraint. While police are called upon to restrain people for a range of reasons, a common one is that an individual needs medical care because they are a danger to themselves or others. In May, the Associated Press published a lengthy series of articles about deaths related to police restraint. The AP found that “over a decade, more than 1,000 people died after police subdued them through means not intended to be lethal … [and that in] hundreds of cases, officers weren’t taught or didn’t follow best safety practices for physical force and weapons, creating a recipe for death.” The public now has higher expectations for first responders as they handle these situations. For example, two paramedics and a police officer were recently convicted of criminally negligent homicide and each sentenced to incarceration for their roles in the death of Elijah McClain, an outcome I don’t think we would’ve seen a couple decades ago. Some states have responded by banning the use of the term “excited delirium.” However, prohibiting a term does not give officers any guidance about what they can and should do to mitigate the risk of restraint-related death.
assembled brought various areas of expertise to the meeting, including cardiology, emergency medicine, medical toxicology, pathology, psychology, paramedics, policy, and tactical policing. We sought to find common ground and develop practical guidance for officers in the field. Today, we release that guidance: 15 Principles for Reducing the Risk of Restraint-Related Death. This report deals broadly with “medical-behavioral emergencies” (MBEs), a term we use to describe incidents in which police frequently misinterpret a medical issue (often drug-induced or drug-enhanced) as a behavioral problem. Importantly, however, much of the guidance included in the report can and should be employed during any incident where police may need to restrain a person. The following are the report’s 15 principles: Learn to Identify Warning Signs of Medical-Behavioral Emergencies. Police need to view people who may be experiencing MBEs as patients in need of medical care and respond accordingly. Plan and Develop Protocols for a Coordinated Medical-Behavioral Emergency Response. Stakeholders must meet and develop policies and protocols; they should also train together. ICAT (Integrating Communications, Assessment, and Tactics) Principles Apply to Medical-Behavioral Emergencies. Officers should employ the Critical Decision-Making Model and the principles of time, distance, and cover. De-escalate Wherever Possible, but at a Minimum – Don’t Escalate. Even if de-escalation is not working, officers should be aware of and refrain from actions that will escalate the situation. Evaluate the Need to Restrain Immediately. If a person needs medical help but is not at an immediate risk of self-harm or harm to others, police should not restrain until an ambulance is on-scene or nearby. Multiple Electronic Control Weapon (ECW) Applications May Increase the Risks Associated with Restraint. This fact is noted in the manufacturer’s own warnings. A Supervisor or Other Leader Needs to Take Charge. One designated officer needs to manage the many moving parts of MBEs. Designate a Patient Safety Officer. One officer needs to focus on nothing other than monitoring the subject’s breathing and consciousness during and after restraint. Prone Restraint Carries Potential Risks and Should Be Limited. As soon as a person is controlled, police must make every effort to move and keep the person in a position that promotes free breathing. Not Following Directions Does Not Always Mean Willful Non-Compliance. Police should recognize that people experiencing MBEs may not be capable of following directions, and repeatedly yelling commands will only exacerbate an already stressful situation. The Goal is Control, NOT Complete Immobilization. A controlled subject does not need to be completely immobile – repeatedly demanding that a restrained person “Stop Moving” is counterproductive and dangerous. The Ability to Speak Does Not Mean a Person Can Breathe. A person can talk and still be in physiological distress, so statements about trouble breathing must be taken seriously. On-Scene Coordination and Collaboration Between EMS and Law Enforcement Is Crucial During MBEs. Each entity plays a critical role; deference must give way to safety if EMS observes police engaged in unsafe practices. Police Must Keep Emotions in Check and Be Ready to Step Up and Step In. When emotions run high, rational thinking runs low, and these incidents have a high potential for stress. Commit to Learning from Every Incident. Agencies must be willing to “Monday-morning quarterback” incidents that ended poorly to determine where improvements can be made. The guidance in our report is not complicated, and the report, by design, can be read quickly. Every chief, sheriff, trainer, and officer should take the time to read these principles. Having collectively reviewed hundreds of restraint-related fatalities, the SMEs involved in this project agreed that although the principles presented are simple and already in place in many police agencies, officers fail to practice them time and time again. Following the principles in this report can save lives. I know that officers don’t want to see people die needlessly, and this guidance helps them do all they can to prevent these deaths. We are very grateful to the experts who traveled to Decatur to share their knowledge, and to the Howard G. Buffett Foundation for supporting this important project. I hope this report will prevent tragedies, while also saving some careers of those police officers and other first responders trying to manage these challenging situations. Best, Chuck |
