Death in Custody

Behavioral emergencies involving agitated individuals are among the most challenging calls we face. In the past few years, there have been multiple tragic deaths that have exposed gaps in how these encounters are managed and led to serious legal consequences for EMS providers and law enforcement. We need to revamp the approach.

“Death in Custody” is an evidence-based continuing education course for EMS providers, law enforcement and emergency department physicians and staff. Drawing on the latest emergency and psychiatric literature and law enforcement guidance, it examines why these deaths occur and how to prevent them. Utilizing footage of actual incidents to inform our discussion, we’ll discuss the controversy around the term “excited delirium,” the dangers of prone restraint, the role of sedation, and the impact of bias on providers in high stress situations. A restructured framework for managing these emergencies focuses on three elements:

1. de-escalation to reduce the need for restraint and sedation,
2. a reframed strategy for restraint, and
3. a more rigorous structure for sedation.

Together, these are designed to reduce the risk of death for patients and liability for responders who care for them.
Note: This course includes video of real incidents that some viewers may find distressing.

Eric Jaeger, JD, NRP, is a nationally recognized educator on enhancing safety in the management of agitated patients and reducing the risk of death in custody. He is co-author of "Handcuffs and Unexpected Deaths — 'I Can't Breathe' as a Medical Emergency" in The New England Journal of Medicine and “Revamping Our Approach To Behavioral Emergencies” in the National Association of EMS Physicians blog. He served on a panel of experts convened by the Police Executive Research Forum (PERF) that developed new guidance for law enforcement: “15 Principles for Reducing the Risk of Restraint-Related Death.”

He is a graduate of MIT and Boston College Law School. A paramedic for more than 20 years, he served as an EMS educator and intercept paramedic at Exeter Hospital in New Hampshire. He’s been featured in national media coverage, including by the Associated Press and PBS Frontline. He has presented at NAEMSP and EMS World, as well as at state conferences in Colorado, Connecticut, Texas and Alaska. He has taught EMS and law enforcement audiences nationwide, including at Cleveland Clinic. His training and experience as an attorney combined with his clinical experience as an RSI paramedic uniquely position him to address the challenging medical, legal, and ethical issues surrounding safe physical and chemical restraint.