All Tied Up In Knots!

It's a hot Friday night in the city and your ambulance and the engine company stationed at your engine house are dispatched to an assault on the street. You are provided with a staging area and you wait there until the police have secured the scene...


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The individual continued to show signs of violence, including banging his face into the ground repeatedly. At some point, he began turning blue, so the deputies called for the fire department. The medics arrived within minutes, but found the patient pulseless and not breathing. Subsequently, he died. The family filed suit, alleging excessive force, wrongful death, assault, battery and negligence. One of the main focuses of the trial was the phenomenon of "positional asphyxia," including testimony from Reay about his previous findings. In response to his testimony, the defense counsel requested a new study be conducted at the University of California, San Diego (UCSD).

The UCSD study identified weaknesses in the methodology of Reay's study and concluded that his results were invalid. The study determined that the blood needs no replenishment after exercise because it already has adequate oxygen. Reay agreed that the UCSD test was valid and some parts of his study appeared to be flawed. As a result, the U.S. District Court, Southern District of California ruled that the "hog tie restraint was not considered deadly force" under this particular case.

The key word to handling any violent patient is "safety." As violence against fire and medical personnel continues to rise, more training is needed on managing violent patients. Fire personnel must learn proper assessment techniques to determine threats and methods for restraining patient to prevent injury to themselves and their patients.


Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, serves as the director of emergency services for Jefferson County, MO. He retired as chief paramedic from the St. Louis Fire Department after serving the City of St. Louis for 24 years. Ludwig has trained and lectured internationally and nationally on fire and EMS topics. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636-789-5660 or via www.garyludwig.com.