Last week two emergency medical services (EMS) employees of Lifestar Ambulance Service in Springfield, Illinois, were charged with first-degree murder. Peter Cadigan and Pegy Finley, their certification levels were not disclosed in the article, were called by law enforcement to transport a man by the name if Earl Moore Jr., 35 years old, to St. Johns hospital, he was reportedly suffering ‘hallucinations secondary to a medical condition.’
The coroner’s office ruled Moore’s death a homicide secondary to “compressional and positional asphyxia.” The two care providers allegedly placed Moore onto the gurney in the prone position and then secured him to the gurney with the straps. How long have we been educating prehospital personal of the dangers of this position? Over 25 years? This position puts unnecessary pressure on the chest and impedes ventilations. To make matters worse it appears in the body cam footage, which can in part be viewed in this WCIA News story https://www.youtube.com/watch?v=qRJrffLJKoU, it looks as though the one of the care providers roughly positioned his upper body on the gurney also placed his arms above his head, and then the crew appears to have wrapped him in a blanket prior to placing the securing straps.
It is reported that Moore was suffering from withdrawals from alcohol, and our concern potentially the most severe form of withdrawals being the Delirium tremens (DTs). As per Medscape, minor withdrawals will manifest with “tremors, anxiety, nausea, vomiting, and insomnia.” When a patient is suffering from visual and auditory hallucinations that is considered to be severe withdrawals, which can progress to seizures. And finally, if the patient presents with “agitation, global confusion, disorientation, hallucinations, hypertension, diaphoresis, and autonomic hyperactivity” that is considered to be a case of the DTs.
I would be curious to see the unedited version of the body camera footage to see if the care providers performed a patient assessment. The prehospital treatment for the DTs would consist of intravenous (IV) fluids and sedation with a benzodiazepine, which in my experience the drug of choice when a patient needs to be chemically restrained in the prehospital setting. Physical restraints in the prehospital setting should only consist of using soft-restraints of all four appendages and each appendage should be assessed for circulation, motor, and sensory function continuously through the transport to ensure that the restraints are not too tight. Once the patient arrives to the hospital thiamine, magnesium, and intravenous ethanol infusions may be administered.
If convicted of first-degree murder the two are facing a minimum of 20 years and maximum of 60 years in prison.
References:
Stunson, M. (2023, Jan. 1). EMS Workers Caused Man’s Death by Improperly Restraining Him in Ambulance, IL Cops Say. The Charlotte Observer via EMS WORLD. Retrieved from https://www.hmpgloballearningnetwork.com/site/emsworld/news/ems-workers-caused-mans-death-improperly-restraining-him-ambulance-il-cops-say.
Toohey, S. M.D. (2021, Aug. 4). Delirium Tremens (DTs). Medscape. Retrieved from https://emedicine.medscape.com/article/166032-overview?icd=login_success_email_match_norm.
WCIA News. (2023, Jan. 11). Body camera footage of two Springfield EMS workers charged with murder released. Retrieved from https://www.youtube.com/watch?v=qRJrffLJKoU.
