A real life shooting video

[mycrofft]

Before I post this, I want people to take off their anonymous/gallivanting internet hat and cram on the detached/professional one. I've contacted the mods and if it veers, it's gone.



In 2011, a patrolman from a local police apartment waited for, then apprehended a parolee riding in a pickup truck whom it was reported was carrying at least an eight inch diameter throwing star; he was involved in a domestic dispute the prior evening and he was about to be "violated" (re-arrested for breaking his parole conditions as well as any alleged crimes for which he was not yet standing trial).

Exiting the truck (there were apparently another man [driver] and a woman inside as well), he did not raise his hands or get on the ground as ordered; this may have been because he had tangled himself in the passenger side seatbelt and was stuck or trying not to fall. It could also be interpreted as trying to flee but was stuck in the angle of the door and cab..

As a result, the arresting officer discharged his sidearm over ten times, striking the subject multiple times, at relatively short range (my guess, around sixteen feet). The subject was secured, EMS was called, but eventually he was declared.

Recently, after the findings of the police department were made public (understandable shooting), the subject's family's attorney (they are suing the PD et al) then released with their permission the dash cam, with sound, of the incident, from just before the truck drove up, to after EMS arrived and worked on the subject/patient.

I am posting this because it is so educational about what happens in a real shooting, what may be happening before you get on scene, and the complications which arose from this all; in fact, a woman leaves the house and starts to get into the shooting scene despite shouted commands to get down on the ground and stay back.



OK, here's the link. PLEASE IGNORE any comments with the video on Youtube unless you want to consider them as data, not fodder for either the family's or the police's side.

http://www.youtube.com/watch?v=StW9LvK7LT8

 

[mycrofft]

Some tips and obs:
1. Look at the shadows to see what's happening behind and right of camera.
2. At beginning, patrolman almost stops his car at the stop sign.
3. Watch the time markers.
4. Look over your shoulder for the kids, this is graphic.

 

[Veneficus]

Without assigning fault or blame, I always like to hear cops give multiple conflicting orders.

"Hands up! Don't Move."

Or when 3 cops are shouting 3 different things to one person.

Not sure why the medics did what they were doing. That guy was dead.

 

[DesertMedic66]

Not sure why the medics did what they were doing. That guy was dead.

Because they are in California

 

[Aprz]

From the video alone, I felt the cop reacted too quickly. Kinda made me sad to watch and rewatch that part.

Edit1: I am watching the rest.

Edit2: The cop said "I am looking for the knife he had when he came out". I wonder if they are gonna find a knife. I'm around 5:20 I think.

Edit3: I believe EMS/FD showed up around 7:30 (I am going back and forth from watching the video). Looks like they went to CPR right away.

Edit4: Looks like they stopped doing CPR for a long time (felt like a minute or more to me) to get him on the backboard. Not that it matters with traumatic arrest, right?

Edit5: EMS/FD leaves around 12:20.

 

[ffemt8978]

Remember, this is NOT the place to dicuss the right or wrong of what happened. Keep it EMS related, please, or it will disappear.

 

[JPINFV]

in fact, a woman leaves the house and starts to get into the shooting scene despite shouted commands to get down on the ground and stay back.

If the police... shot... a family member of mine in front of my house, the only way to prevent me from rendering aid would be to arrest me.

 

[Veneficus]

If the police... shot... a family member of mine in front of my house, the only way to prevent me from rendering aid would be to arrest me.

With so many shots I am not sure what aid could be rendered.

 

[Aprz]

Yeh, I think this guy was toast before EMS/FD arrived.

 

[JPINFV]

With so many shots I am not sure what aid could be rendered.

Maybe "aid" is too specific of a word. I, however, doubt you'd just shrug your shoulders and walk back inside for some tea.

 

[mycrofft]

I can't find the findings link, but if I recall, Mr. Duenez was hit six times, including the head, extremities, torso.

I'm interested how they follow the familiar path of action wherein you secure the suspect before anything else. In stressed times you fall back on policy, protocol, and safety. In this case, it makes things look like they repelled help (albeit just the approach of a distraught significant other).

The whole approach and shooting takes seconds. Once things get going, it is all adrenaline. Wounds are from various angles and into various sections of the body. Of course in this case the subject was doomed once the firing started, but with a much smaller caliber and heavier clothing (say, .25 short auto Saturday Night Special like Astralite and heavy winter clothes) this might have been potentially survivable with fast action.

The fallout from this? Restraining orders against the subject's family members who demonstrated around the PD and threatened them; lawsuits against PD and officer; the PD's website shut down due to threats from hackers ("Anonymous"). Not to mention one man dead.

It would be interesting to hear what the responding EMS folks were saying to one another on the trip to the hospital.

 

[DavidM]

I guess my question would be what is the Police's protocol immediately after a shooting like that?

It seemed like it was clear that they had secured the scene after 2 or 3 minutes but they didn't make any effort to begin treatment of the patient prior to EMS arrival.

I'm not saying it would have made a difference in this particular case. I mean that was a lot of shots a close range. But it seems like at least one of the officers should have made an attempt to revive or at least check the man who was shot once the scene was under control. But then again I guess that isn't their job/protocol?

 

[EpiEMS]

TL;DR version: 10 shots fired, several hitting the subject, he's unconscious/unresponsive, far as it looks. The first officer who arrived on scene says it's "ok to bring the medics in" at about 4:20. The same officer starts exposing the patient at roughly 6 minutes in. EMS makes patient contact at 7:40. Unconscious/unresponsive established at 7:45, compressions starting at 7:50. Looks like he's collared at 8:30?

EMS comments --> questions:
1. Why didn't PD start BLS algorithms? Lots of hands-off time between initially establishing unresponsive/unconscious and determining pulseless and apneic. And then again before starting compressions.
2. Looks like a lot of hands-off time once EMS arrived. Should they have focused more on compressions?
3. How was the compression depth? Looked kind of shallow.
4. How long did it take them to attach a monitor or AED? I didn't see one being connected, but that could just be the resolution. Same applies to starting ventilations and getting a definitive airway. Looks like the first time a BVM appears is around 11:55?
5. I didn't see EMS establish an IO for drugs (I thought that'd be protocol for an arrest)? I imagine they started bilateral large bore IVs for fluid, but again, I'm a BLS provider.

Note: I stopped watching once EMS left with the patient.

EMS protocol thoughts:
1. The only reason to collar and board a penetrating trauma patient is for transport and ease of performing BLS/ALS care: viz. http://www.ncbi.nlm.nih.gov/pubmed/20065766.
2. Perhaps it would've been better to have a rapid transport by PD in the back of the police vehicle: Viz. http://www.ncbi.nlm.nih.gov/pubmed/21166730
3. The most applicable standard I can see here prior to EMS arrival is TCCC. Maybe PD should be trained with a focus on TCCC.
4. Maybe skipping the manual defib would be ok -- perhaps an AED is all the patient needs until en route?

 

[Veneficus]

1. Why didn't PD start BLS algorithms? Lots of hands-off time between initially establishing unresponsive/unconscious and determining pulseless and apneic. And then again before starting compressions.

I think the correct answer is that it is not the primary role or responsibility of the police.

As was said, people in stress will revert to their training. They did just that. They are not primarily medical providers, they did their job.

My answer, he's dead. It wouldn't matter.

2. Looks like a lot of hands-off time once EMS arrived. Should they have focused more on compressions?

In the textbook world, in the absence of cardiac activity, yes. There should be less hands off time.

In reality, this guy did not die of VF secondary to an MI or other easily reversible cause. He likely died of Hemorrhage and multiple organ failure in a very short time. There probably was not a realistic reason to even start resuscitative efforts.

If by some chance they wanted to effect a save tossing him unceremoniously on the cot and driving to the hospital was the only reasonable option.

3. How was the compression depth? Looked kind of shallow.

Looked that way, but there was likely nothing to circulate.

4. How long did it take them to attach a monitor or AED? I didn't see one being connected, but that could just be the resolution. Same applies to starting ventilations and getting a definitive airway. Looks like the first time a BVM appears is around 11:55?

Attaching a monitor while advisable, is not required in traumatic cardiac arrest. Even if the patient was in VF instead of asystole/pea, cardiac arrest from lack of blood flow, meansthe heart cannot supply itself even for function, recurrent VF prior to pea->Asystole-> death is the only logical possibility.

An airway serves no purpose in this scenario without cardiac activity.

 

[EpiEMS]

In reality, this guy did not die of VF secondary to an MI or other easily reversible cause. He likely died of Hemorrhage and multiple organ failure in a very short time. There probably was not a realistic reason to even start resuscitative efforts.

The data is pretty clear on traumatic arrests is interesting, and suggests futility of lots of efforts. Granted, NAEMSP and ACS say: "Penetrating trauma, particularly if isolated to the thorax, has a better prognosis than blunt or multisystem penetrating trauma." Then again, if our baseline is not even 1 of 20 patients surviving, it's all pretty close to futile.

Ungated paper from Annals of Emergency Medicine based on London HEMS staffed by MDs: https://secure.muhealth.org/~ed/students/articles/annem_48_p0240.pdf 7.9% of their purely penetrating trauma patients survived (95% CI: 2.9 to 12.8%). They conclude: "Victims of penetrating trauma found apneic and pulseless by EMS, according to their patient assessment, should be rapidly assessed for the presence of other signs of life, such as pupillary reflexes, spontaneous movement, or organized ECG activity. If any of these signs are present, the patient should have resuscitation performed and be transported to the nearest ED or trauma center. If these signs of life are absent, resuscitation efforts may be withheld (1 patient breached)."

Seems like a fair conclusion from their study.

AHA guidelines are here: http://circ.ahajournals.org/content/122/18_suppl_3/S829.full

AHA states: "BLS and ACLS for the trauma patient are fundamentally the same as that for the patient with primary cardiac arrest, with focus on support of airway, breathing, and circulation. In addition, reversible causes of cardiac arrest need to considered. While CPR in the pulseless trauma patient has overall been considered futile, several reversible causes of cardiac arrest in the context of trauma are correctible and their prompt treatment could be life-saving. These include hypoxia, hypovolemia, diminished cardiac output secondary to pneumothorax or pericardial tamponade, and hypothermia." And after discussing the provision of BLS and ACLS, they talk a bit about resuscitative thoracotomy: "Resuscitative thoracotomy may be indicated in selected patients. A review of the literature from 1966 to 1999, carried out by the American College of Surgeons Committee on Trauma, found a survival rate of 7.8% (11.2% for penetrating injuries and 1.6% for blunt lesions) in trauma victims who would otherwise have 100% mortality."

AHA also references a position statement made by NAEMSP and ACS's Committee on Trauma. An ungated version is available here for your reading pleasure: https://www.umcsn.com/Documents/Med...N/American College of Surgeons/Appendix A.PDF

 

[mycrofft]

"Maybe skipping the manual defib would be ok -- perhaps an AED is all the patient needs until en route?"

AED won't work as well or at all in a moving vehicle. Also, shocks won't help either exsanguination or a punctured/lacerated heart, lungs, diaphragm, bowels, maybe major vessels.

Once the shots are loose, and the goal of shooting is to stop the subject through lethal force (i.e., kill her/him), it's not easy to change gears; wounded subjects have been known to run or fight. (We had a guy actually trapped in a burning vehicle at the end of a pursuit and he tried to lure in the officers to an assault weapon concealed behind his body in his off-hand).

Note how hard it was for the officer to don gloves over sweaty hands? And difficulty of cutting off clothes with a knife?

Multiple wound GS insult: plug holes, establish airway and IV or IO access and boogey while performing those resuscitations. And scene safety right? Except in this case it is futile, the pt is riddled and apparently deceased. NOTHING is going to reinforce the "social contract" with the bystanders and in fact I'd be getting an itch between my shoulder blades until I was out of there.

Sidebar: Am I wrong or was that officer out of bullets? Or pretty darn close (I counted eleven discharges). What if that distraught screaming woman had a gun too? And there were other people in the truck, reported elsewhere though unapparent in the tape it was a male driver and the female we saw arrested. Scene was not safe until they had more officers there and everyone was accounted for.

At least they didn't slap a NRB on him.

 

[Veneficus]

The data is pretty clear on traumatic arrests is interesting, and suggests futility of lots of efforts. Granted, NAEMSP and ACS say: "Penetrating trauma, particularly if isolated to the thorax, has a better prognosis than blunt or multisystem penetrating trauma." Then again, if our baseline is not even 1 of 20 patients surviving, it's all pretty close to futile.

Ungated paper from Annals of Emergency Medicine based on London HEMS staffed by MDs: https://secure.muhealth.org/~ed/students/articles/annem_48_p0240.pdf 7.9% of their purely penetrating trauma patients survived (95% CI: 2.9 to 12.8%). They conclude: "Victims of penetrating trauma found apneic and pulseless by EMS, according to their patient assessment, should be rapidly assessed for the presence of other signs of life, such as pupillary reflexes, spontaneous movement, or organized ECG activity. If any of these signs are present, the patient should have resuscitation performed and be transported to the nearest ED or trauma center. If these signs of life are absent, resuscitation efforts may be withheld (1 patient breached)."

Seems like a fair conclusion from their study.

AHA guidelines are here: http://circ.ahajournals.org/content/122/18_suppl_3/S829.full

AHA states: "BLS and ACLS for the trauma patient are fundamentally the same as that for the patient with primary cardiac arrest, with focus on support of airway, breathing, and circulation. In addition, reversible causes of cardiac arrest need to considered. While CPR in the pulseless trauma patient has overall been considered futile, several reversible causes of cardiac arrest in the context of trauma are correctible and their prompt treatment could be life-saving. These include hypoxia, hypovolemia, diminished cardiac output secondary to pneumothorax or pericardial tamponade, and hypothermia." And after discussing the provision of BLS and ACLS, they talk a bit about resuscitative thoracotomy: "Resuscitative thoracotomy may be indicated in selected patients. A review of the literature from 1966 to 1999, carried out by the American College of Surgeons Committee on Trauma, found a survival rate of 7.8% (11.2% for penetrating injuries and 1.6% for blunt lesions) in trauma victims who would otherwise have 100% mortality."

AHA also references a position statement made by NAEMSP and ACS's Committee on Trauma. An ungated version is available here for your reading pleasure: https://www.umcsn.com/Documents/Med...N/American College of Surgeons/Appendix A.PDF

I'm an old hand at this game

 

[mycrofft]

The data is pretty clear on traumatic arrests is interesting, and suggests futility of lots of efforts. Granted, NAEMSP and ACS say: "Penetrating trauma, particularly if isolated to the thorax, has a better prognosis than blunt or multisystem penetrating trauma." Then again, if our baseline is not even 1 of 20 patients surviving, it's all pretty close to futile.

Thanks EpiEMS!!

 

[mycrofft]

This is an example of arrest being a symptom of death, not the cause. The cause was being shot many times in vital areas. Arrest protocols are worthless when you are exsanguinated, and/or lungs are shot through.

If we remember the great video shared by one of our members earlier this year, the cause of death (arrest if you will) of nearly all GSW subjects is bleeding. Maybe shot directly to the heart or the head might be different, and a usually less-than-lethal wound might precipitate shock, but usually its loss of blood. CPR, AED will not reverse nor address this.

 

[VCEMT]

Where's the "gruesome" part? I just wasted 10 minutes of my life. Where I work, we'd of called him and gone back to the station to sleep.