Years ago I was on the ambulance one night with June, another volunteer, and we got a call out to the Red Apple for a drunk guy.
He was a big strapping kid, maybe still in his teens, barechested and drunk out of his mind.
He was quarrelsome and uncooperative, slurring and reeling, a couple hundred pounds of piss and vinegar and brawn.
And June started talking to him, calling him “honey,” I think, and telling him it was important for him to get in the rig and pretty soon with our assistance that’s where he was going, climbing up and laying down on our gurney, mumbling and flittering on the edge of unconsciousness.
As we set about our work.
Plug this tubing into that regulator, get a sheet to cover him up, start filling in the paperwork, get out the blood-pressure cuff for the first set of vitals, tell the driver we’ll be ready to take off in just a moment.
The regular busy work for that point in the call.
And that’s when I noticed. The shirtless young man, with the lean abdomen, it was flaccid. It wasn’t moving.
“He’s not breathing!” I shouted, all professional bearing gone, as I leapt up to grab the bag valve mask and June plugged in its tubing and turned up the flow rate. We clamped the mask hard against his face and counted out loud to appropriately pace our squeezing of the bag.
That went on for maybe two minutes.
Or maybe 10 seconds.
I just knew I was counting and praying and time was standing still.
And then he breathed.
And then he was fine. One more drunk guy in the back of the rig, sleeping it off.
And June and I sat down and cried. We had seen people die, we had been to horrible wrecks, we were not particularly new at this, but the dance with death for this particular young man, the near loss of who he was and who he might become, because he stopped breathing in our bus, on our watch, it shook us.
I thanked God that I noticed, and I swore I would notice for the rest of my life. And I do to this day. Out running on my lunch hour, passing a sleeping man on a bench, I check for respirations. I awaken beside my wife, in the still of the night, and check for respirations, as I do in the morning leaving for work, walking past my sleeping children.
That has played on my mind in the week since we learned about Daniel Prude.
As he is being restrained, the officers are using techniques mandated by the New York State Division of Criminal Justice Services. The holding down of the head and the knee between the shoulder blades are exactly what the state requires officers be taught. They were following their training. But training isn’t to replace judgment, it is to augment it. Not to make you a robot, but to make you a more capable person.
And in those moments on Jefferson Avenue, the officers involved did not engage their judgment, they only followed their training, and then only part of it.
Good judgment, and police practice, would have moved Daniel Prude into the police car or ambulance as soon as he was handcuffed. That would have forestalled everything bad that followed.
But the part that haunts me is that, as he is being restrained, no one – neither police officer nor nearby ambulance medic – is monitoring his basic medical condition. Nobody is watching his respiration. Nobody is seemingly even curious as to why a physically strong and recently active man is becoming unconscious on the pavement.
Did they think he was falling asleep?
Did the police officers forget their first aid training? Did the paramedic and emergency medical technician standing there forget their role and the most basic lessons of their craft – the simple ABC of airway, breathing and circulation?
How did those professionals gathered around have a man die right in front of them – lose his respiration and some time later his pulse – and not notice?
If the paramedic and at least one of the officers knew about excited delirium, and blamed it for his “coding,” why did they not watch out for it before it happened, in order to prevent it and respond immediately to it when it did?
And when one of the officers finally became curious about Daniel Prude’s condition, and he was found to be without pulse and respiration, why does the paramedic seem to lollygag her opening of the defibrillator pad, talking to an officer, while her partner is on the ground doing chest compressions?
And then, when the video shows Daniel Prude on the ambulance gurney, his abdomen is full and round, even though in the earlier video he is obviously a trim man without a gut. That’s because they did the breathing part of CPR wrong. The air went into his stomach instead of into his lungs. That would have happened because they either didn’t get the head angle right with a bag valve mask, or they got the esophagus instead of the trachea when they intubated him.
Either way, it shouldn’t have been that way.
And either way, they should have watched their patient.
Because, of all the many things that went wrong, of all the many failures that ultimately killed Daniel Prude, the failure to monitor his basic medical condition is a significant one.
For years I’ve been haunted by what could have happened if I hadn’t noticed my patient stop breathing. Rochester and America are torn apart right now, and a family is in mourning, because a group of officers and medics didn’t notice that their patient had stopped breathing.
Because, when it came to patient care, they all forgot their training.