An internal investigation by Broward County’s Fire Rescue division concluded that errors by emergency personnel may have caused the death of a Lauderhill man who suffocated after being “hog-tied” by Broward Sheriff’s Office deputies and county paramedics.
This death is from October 15, 2001, so it has been over a decade and everyone in EMS should be refusing to allow patients to be placed in the prone position following restraint. Hog tying should never even be considered.
The responsible way to manage someone who is combative is to chemically restrain the patient. Physical restraint is for the purpose of being able to inject the patient with the chemical restraint.
Should the medics have known better? Yes, but it was a decade ago and there are still EMS agencies that are not aggressive with chemical restraints.
This is the responsibility of the medical director. We are supposed to be trained and equipped to not make things worse. Clearly, we can make things much worse, if we do not have the right education and medication and protocols.
We should not be treating our excited delirium patients like animals in a rodeo. As medical people, we are supposed to be smarter than the patient with the malfunctioning brain.
Diabetes, head injury, stroke, hypoxia, hyperthermia, drugs, psych, et cetera. There are many possible reasons for this behavior. Our job is to sedate the patient with the least harm to everyone involved, including the patient.
Tasers protect everyone, including the patient, so it is safer for everyone if police use a Taser and then EMS sedates the patient. This is not likely to be effective unless aggressive doses of sedative are given.
Given the irrational and potentially violent, dangerous, and lethal behavior of an ExDS subject, any LEO interaction with a person in this situation risks significant injury or death to either the LEO or the ExDS subject who has a potentially lethal medical syndrome.
They point out that a perfect outcome is expected every time.
A perfect outcome is not possible every time.
One of the problems in dealing with excited delirium is that it looks easy, but only when it is done right.
Making the treatment of unstable patients look no more eventful than the treatment of stable patients is what good EMS is all about.
When we make it look easy, some people will claim that we over-reacted. We cannot go back and handle things differently, but we should not want to. Some conditions need to be approached as if they arfe life-threatening. Excited delirium is one of them.
Because it is life-threatening.
Our job is to try to prevent death, not to cause death. If we do not protect our excited delirium patients by aggressively sedating them, we will kill some of our patients.
 ‘Hog-tying’ death report faults Fla. medics
Report cites 9 ‘failures’ that it says cumulatively may have led to man’s death
By Elgin Jones
South Florida Times
April 19, 2012
Article Reprinted at EMS1.com
Dr. Joe Lex is one of the most sought after emergency medicine lecturers in the world. Listen to this and to the rest of his talks that are at Free Emergency Medicine Talks.
 White Paper Report on Excited Delirium Syndrome
ACEP Excited Delirium Task Force
Vilke GM, Debard ML, Chan TC, Ho JD, Dawes DM, Hall C, Curtis MD, Costello MW, Mash DC, Coffman SR, McMullen MJ, Metzger JC, Roberts JR, Sztajnkrcer MD, Henderson SO, Adler J, Czarnecki F, Heck J, Bozeman WP.
September 10, 2009
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