Great point. Let’s dissect a few things on deaths of those in restraints.

First up: “if you can talk, you can breathe”

It takes extremely little respiratory effort to talk—and it’s a function of exhalation.

Give it a shot. Exhale completely. Speak.

See? Not hard.

1/x https://twitter.com/doramilaje726/status/1266029114697420801

We often consider “speaking in full sentences” as reassuring, but those who speak in short, chopped, forced words to be likely to decompensate.

When it hits that level, we often have just minutes to act before someone reaches a critical point.

2/x

But let’s go further—because deaths following restraint aren’t always due to hypoxia (lack of oxygen). In fact, many aren’t, or are caused by a combination of hypoxia and a number of internal and external factors that can lead to a lethal heart rhythm.

3/x

Our hearts run on electricity—those are the *beep* *beep* *beeps* that you hear on hospital monitors+when Derek Shephard flatlined FOR NO GOOD REASON AND I SWE..

errr...sorry.

Electrical signals make our heart squeeze and relax. The latter time period can be a bit dangerous 4/x

As our heart relaxes, there’s a time period called the QT interval where things can get a bit out of hand. If there’s <just the right combination of disturbance>, it can contribute to the heart’s rhythm going haywire.

5/x

Maybe think of it like a suspension bridge that starts to shake and then shakes crazy out of control, like all the videos of the Tacoma Bridge Collapse.

It’s not a completely genuine comparison, but this is my Twitter thread, not yours. It’s close enough, jerk.

6/x

Anyway, a bunch of things can prolong this QT interval, making the possibility of badness greater. Things like:

Lactic Acidosis, which might be a function of...hypoxia, a prolonged struggle, repeated taser administrations, restraints...
Medications
Drug Use
Olives

7/x

We talk a lot about deaths due to excited delirium, a syndrome of psychomotor agitation and dysautonomia. These patients are at true risk of death, in large part due to the factors above.

8/x

Often, these are the same factors present in in-custody deaths or deaths surrounding CED use or pre-hospital ketamine administration. It’s not just *one thing*, it’s a perfect storm of badness that puts someone’s life at risk.

9/x

Knowing this risk is important because we can take steps to recognize the multiplicative nature of contributors to restraint deaths+make alterations to save lives

Furthermore, it reinforces the importance of Law Enforcement access to AEDs (shameless plug: http://bit.ly/HarrisonAEDs 

So...listen.

Deaths associated with restraints are not uncommon, and each one is a potentially avoidable tragedy.

Hypoxia, acidosis, medications, the environment...so many things can contribute to a perfect storm, but recognition and modification can save lives.

11/x

But there is never an excuse for the callous+inhuman actions displayed by the officers involved in the death of #GeorgeFloyd

We have the moral obligation to be our brother’s+sister’s keeper.

And if we are not our brother’s keeper, at least let us not be his executioner.

12/12