References
Primary:
Department of Justice Pamphlet: Positional Asphyxia - Sudden Death
Secondary:
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Recap
Parts One through Four of this review paint a bleak, depressing picture. It actually looks as though Derek Chauvin might be guilty.
Eh, set all that aside. Let's just say George Floyd became unresponsive because of Fentanyl and a sinful heart. Maybe Floyd really was violent; he certainly was kinetic at least part of the time. Thomas Lane said his knee was scratched.
Officer Chauvin may have been distracted by bystanders, several of whom now gathered on the sidewalk in front of him. Officer Thao moved to control the space, keeping himself between these bystanders and the scene. The bystanders are not visible from Lane's position near the back door of the car; from the video, they can be identified only by voice. The most distinct voice was that of a young black man named Donald. Donald harangued the police, in particular Tou Thao, for about six minutes as George Floyd lay dying, to these and similar effects:
Get him off the ground, bro. Get him off the ground. You're being a bum right now. ...he's enjoying that. He's enjoying that shit. He's enjoying that shit. He's a fucking bum bro. He's enjoying that shit right now bro. You could have fuckin' put him in the car by now.
I already knew that! Bro I've trained with half these dumbasses at the academy bro. You know that's bogus right now bro. You know its bogus you can't look at me like a man 'cause you're a bum bro. He is not even resisting arrest right now bro.
...think that's cool though. You're a bum, you're a bum bro, you're a bum bro, you be mad, you sitting there stopping his breathing right now.
I'm not scared of you bro? Fuckin' pussy ass fool bro.
He's not responsive right now bro? No bro look at him he's not responsive right now bro. Bro are you serious?
Is he breathing right now? Check his pulse! Check his pulse! Check his pulse! Stop! Check his pulse!
That's bogus bro, bro you know that's bogus. What is that? What do you think that is? You call what he's doing OK? You call what he's doing OK? You call what you're doing, you call what he's doing OK?
He's not fucking moving! Get off of his fucking neck bro! Get off of his neck!
You gonna let him kill that man in front of you bro? Bro he's not even moving! ...sit there with your knee on his neck You're a real man for that, bro. He's in handcuffs bro. You da man, bro.
Don't touch me! Don't touch me! Do not touch me! Do not touch me!
You just rubik-cubed that man, bro.
An identifiable Female Voice also joined in:
(What's he doing now?) Is he talking now?
Get the fuck off him. Bro, get the fuck off of him!
...pass out!
(Fuckin') what the fuck!?
Get off him! What are you doing? Get off him bro!
Finally, a white woman named Genevieve crossed the street and approached the scene, briefly glimpsed by Lane's bodycam. Genevieve arrived with a rapid purposeful stride and rapid speech. Chauvin and Thao harshly warned her away; Lane and Kueng echoed their senior officers' command. Genevieve, who self-identified as an off-duty EMT-Firefighter with the Minneapolis FD, continued to interfere with the officers:
...I'm a...
Has he checked his pulse? Check his pulse. Check his pulse. Let me see a pulse!
(Thao: ...a firefighter?) Yes I am, from Minneapolis. Check his pulse!
He's not moving!
Check his pulse right now...
What's your badge number, asshole?
In the end, Tou Thao had no choice but to advance upon Donald, Genevieve, and the other bystanders, shouting and waving his arms like a madman. Donald, who self-identified as a journeyman MMA fighter, was lucky Thao didn't touch him.
Why Was Everybody So Upset?
For a while after George Floyd went to the ground, he struggled and shouted with every exhalation. This ruckus got the attention of every person on the block.
After about four-and-a-half minutes, Floyd began to succumb to respiratory distress. His breathing became shallower and less frequent; his shouting gave way to faint, creaking groans of agony. The first person to take notice of this change was Thomas Lane:
Floyd: "(unintelligible) kill me. (unintelligible) kill me. I can't breathe."
Kueng (remonstrates with bystander): "We tried that for ten minutes."
Lane: "Roll him on his side?"
Chauvin: "(inaudible) staying where we got him."
Lane: "OK. I just worry about the...excited delirium or whatever."
Chauvin: "That's right, we'll (wait for the ambulance)"
Lane: "OK. It's close."
Excited delirium, you will recall, is police euphemism for death by asphyxiation under restraint. Thomas Lane saw the danger and spoke. Donald was next to speak: "Get him off the ground...You could have fuckin' put him in the car by now." Anybody could see at that point that George Floyd was well and truly beat.
About a minute later, Floyd became unresponsive. Again, Thomas Lane spoke: "...he's passing out." This time, Lane wasn't first to speak, and he sure wasn't the only one to speak.
It doesn't matter why George Floyd became unresponsive; everyone agrees that he did. And nobody can deny what happened next: nothing.
Chauvin's posture did not change; most of his weight still bore down on George Floyd. He sat there like a sphinx for at least three minutes and forty seconds (Floyd probably lost consciousness about twenty seconds before his body stopped twitching, so the real time of death was about four minutes before Chauvin got off him). This has led some to say that Chauvin didn’t “murder“ Floyd, he just sat on him a little too long. Fair enough: imagine you are an on-duty lifeguard, and you see a child lying motionless at the bottom of the pool. How long should you wait before you react? Should you be worried that the child might be a threat? Should you ask around to see if anyone knows exactly why the child is lying motionless at the bottom of the pool?
A suspect in handcuffs is a person under care. If a person under care becomes unresponsive, that's an emergency just like a child drowning in the pool. There is no amount of time to wait. The first responder must immediately check to make sure the person is breathing and start a medical response. This concept is fundamental in all first-responder training, even in the minimal first-aid training required of lumberjacks and bus drivers. It is also common sense, an instinct deeply evolved in humans: a person who does not speak or move might not be breathing.
The minimum possible standard of care for an unresponsive person is to place the person in the recovery position and monitor the person's airway and breathing. This has to be done right away, and kept up until care of the person can be transferred to someone more qualified. It's not rocket science; any garage mechanic would figure it out without being told.
Derek Chauvin delayed for four minutes. This is unheard of. No reasonable person would believe it without proof.
So much for Chauvin's duty of care. What about his use of force?
There are some who say Floyd doomed himself by heedlessly continuing to struggle. If he only stopped being a nuisance, of course the officers would have de-escalated.
Floyd did, in fact, stop being a nuisance. He died. Chauvin, if anything, continued to escalate after that. Some of the facial and mucosal injuries reported by the ME were probably inflicted post-mortem.
Chauvin applied handcuffs, prone restraint, bodyweight on the spine, and the wrist flexion hold simultaneously. Other than sticks and guns, that's about the maximum possible force a police officer can apply to a resisting suspect, and I don’t see how it can be justified unless the suspect is holding on to somebody with his teeth.
Chauvin continued after George Floyd became unresponsive. Against an unresponsive person, no police use of force is ever justified. It doesn't matter why the person is unresponsive, or what kind of person he is, or what he did before, or what you think he might do in the future. It is illegal to use force against an unresponsive person, full stop, no exceptions.
Chauvin applied continuous, maximal force for four minutes after Floyd became unresponsive. That's what the video depicts.
It doesn't appear violent. It's not kinetic or noisy. You don't see a hail of blows, or a weapon, or spatters of blood. Nothing seems to move. Yet is is precisely in this lack of motion that the violence consists. Breathing is motion; Chauvin restrained Floyd so as to prevent that motion. It doesn't look like much, but it's every bit as violent as a beating or a shooting.
What Was Chauvin's Plan?
Chauvin barely spoke at any time. When Lane suggested "Roll him on his side?" Chauvin said he would hold Floyd "where we got him" until the ambulance arrived. This implies some expectation or intention that Floyd would survive.
But then the ambulance didn't arrive, and Floyd became unresponsive. Chauvin's plan, if that's what it was, could not possibly work. Unresponsiveness means the person must be assessed for signs of dying, and if these signs are found then the life support plan goes into immediate effect.
Chauvin's plan - maximal restraint with bodyweight until the medic arrived - did not change when George Floyd died.
Chauvin could not have failed to notice that a person under his care and within six inches of his groin had stopped even trying to breathe. In case Chauvin somehow failed to notice, he was reminded of his duty dozens of times by the bystanders and by Thomas Lane. Chauvin knew Floyd was dying, and he didn't change his plan.
There was nothing sudden or unexpected about the death of George Floyd. The death was gradual and predictable.
It was according to plan.
Why Didn't The Medic Act?
About three minutes after George Floyd fell silent, the first medic, a man named Smith, arrived on scene. Medic Smith walked up, bent over, and palpated Floyd's neck for several seconds. Then he stood and casually walked away.
This was a great disappointment to Donald, who must have hoped that the medic would take care of Floyd:
Donald: "...do that, bro? Are you serious? Bro are you serious?"
...
Donald: "You gonna let him kill that man in front of you bro? Bro he's not even moving!"
Was Medic Smith's conduct ethical?
An on-duty medic assumes a legal Duty To Act, a duty to provide medical care when care is needed. However traumatic and terrible the case may be, the medic is nevertheless committed to do his part. He can't just say, hey, I don't want to deal with this. A medic who refuses or fails to act may face civil and/or criminal penalties.
Against this, a medic has a primary ethical duty to keep himself and his teammates safe. Not perfectly safe; medics take risks all the time in the line of duty, and there remains an element of heroism in the practice of emergency medicine. But any risks taken must be reasonable, and some risks are unacceptable no matter how dire the need for care may be. A medic has a formal duty to err on the side of caution.
Just about the worst risk that any first responder can face is an active shooter. In that situation, a police officer has a duty to get a weapon in his hands and move towards the threat with all deliberate haste; to risk his own life without hesitation. Live or die, if he does his duty he'll be hailed as a hero. A medic's duty is the opposite: he must keep himself in one piece until the dust settles. If a medic takes an unacceptable risk - tries to play the hero - he is understood to be selfish and stupid. If he gets hurt doing that, he's not a hero; he's a scandal, a burden on his teammates, a waste of precious resources. If one medic gets hurt, the team loses the services of three; to ride on that gurney is the ultimate shame. Thus medics are, if not risk-averse, at least highly risk-aware.
When Medic Smith checked George Floyd's pulse, Floyd was in cardiac arrest. In the movies, cardiac arrest is barely an inconvenience: someone yells CLEAR and there's a jolt, a moment of suspense, and then we all have a bowl of strawberry ice cream. In real life, resuscitation is unlikely, especially in the pre-hospital setting. But it is true, there are medical treatments for cardiac arrest, and it may surprise you to know that all those treatments are available to medics in the field. The equipment for cardiac arrest consists in a gadget that resembles a boom box, and two medium-sized duffel bags for all the tubes, needles, drugs and hand tools. If a medic attempts resuscitation in the field, the best time and place to do it just might be immediately where the patient is found. All that's needed is clear weather and a firm surface for CPR; pavement is fine. If Smith's top priority was to resuscitate Floyd, he could have attempted it right there on the spot.
Here's what Medic Smith had to go on when he arrived, more or less in order as he found it:
The patient is a large black man, located horizontally under two vertical police officers in the middle of a busy street.
Traffic control is...okay.
Scene is dynamic; many people moving, shouting etc.
Signs of struggle: patient's pants pulled down, shoes and other objects strewn about.
The patient is prone in handcuffs: positional asphyxia?
The patient is under maximum restraint with bodyweight; his neck is hyper-rotated and compressed: positional asphyxia?
The patient is unresponsive.
The patient is in cardiac arrest.
Based on this, Smith's best guess was that George Floyd's cardiac arrest was due to asphyxiation plus struggle, which is a particularly bad case of cardiac arrest.
When the heart starves for oxygen, it turns blue and its muscular contractions become weak and ineffectual. But the electrical control system of the heart - the sinoatrial node - keeps firing its regular electrical pulses for several minutes. This is referred to as PEA: Pulseless Electrical Activity; it looks pretty normal on the heart monitor, but there's no pulse. Electric or chemical shocks will not fix PEA. The problem is lack of oxygen in the heart muscle.
A plan of aggressive re-oxygenation - intubation plus pure oxygen plus continuous chest compressions - has a fighting chance of restarting a heart in PEA. But the chance of long-term survival is about one percent at best, and nonexistent if the cardiac arrest has gone untreated for a minute or two. Even if you are lucky enough to regain a pulse, the brain will be dead. By the time asphyxiation stops the heart for a minute or less, it kills the brain forever.
The numbers for any kind of trauma-induced cardiac arrest are comparably grim, holding out no hope in most situations. There are exceptions; every once in a while a trauma cardiac arrest ends in a save with a good outcome. When these cases are reviewed, they are always found to be miracles: a patient in exceptional health; medic on scene to witness the cardiac arrest and immediately start advanced life support; transport time less than five minutes; no errors in assessment or communication; and plenty of luck beyond that.
If the situation seems unlucky, a medic has some discretion to simply declare death in the field, at which point there is no duty to act. Of course duty is not to be set aside lightly, and medics tend to err on the side of action. But there comes a point where "resuscitation" is nothing but beating on a corpse. It's futile and undignified for everybody involved.
Based solely on the information he had about the patient - struggle, asphyxiation, cardiac arrest - Smith might well have acted on the spot, with aggressive measures to oxygenate the blood. The chance of a good outcome would be negligible, but worth a try.
However, Smith had other information, other considerations impinging on his duty to act: the scene was not safe. A bunch of shouting, excited people might not be safe. The middle of a busy street might not be safe.
A police officer, caught in the act of abusing a corpse, is not safe. It's difficult to overstate how bonkers this is. It's like finding a severed human hand in your happy meal; you'd never expect it, you can't explain it, and it comes as a dreadful shock: an intimation of evil.
Officer Chauvin did not greet Medic Smith. Chauvin sat there in that eerie tableau with the body of George Floyd and the other officers under his command, while Smith made sure Floyd was dead. Now, suppose Medic Smith had decided to act on the spot. How might that have gone?
First Smith would have to tell Officer Chauvin to get off the patient. Then Smith would have questions. He would want to know things like, how long has this person been unconscious? You can see why Smith didn't want to tell Chauvin what to do or ask Chauvin any questions. Officer Chauvin was an armed, dangerous, swivel-eyed lunatic with fresh blood on his hands. Having figured all this out, Smith's first priority was to get himself, his partner, his patient, and his apparatus away from the scene: "load and go".
They loaded Floyd's body into the ambulance. Officer Lane was selected to accompany Floyd.
Lane moves into the ambulance and picks up a gurney strap.
Lane: "Where are we going?"
Medic: "Mm. Just gonna be down the street."
The medic gets out a handcuff key. His voice shakes.
Medic: "You guys want to shut the door, let's get out of here. We're going to go down the street."
Lane: "You want me in here or no."
Medic: "Yeah."
Lane: "Okay."
The rear doors of the ambulance are shut from the outside.
Medic (to partner): "Go down, um, something...forty-second. Let the...tell Fire where to go."
Medic's partner exits through the ambulance side door.
(Forward to Part Six: What Did Chauvin Do?)