Epilepsy Foundation » Advocacy » Foundation Repeats its Call for Universal Protocols, Better Seizure Management Training for First Responders 

Statement from the Epilepsy Foundation December 9, 2005

Foundation Repeats its Call for Universal Protocols, Better Seizure Management Training for First Responders

Responding to recent deaths and serious injuries of people with epilepsy during the course of emergency medical services by first responders, the Epilepsy Foundation today, following up an earlier statement, called again for the universal adoption of protocols and training requirements to ensure that first responders properly identify and respond to persons experiencing seizures.

In July, the Foundation issued a statement calling for better training and development of universal protocols that do not include forcible restraint. This statement was issued in connection with a recent report to the Foundation of a fatality, apparently as a result of the mishandling of seizures by local emergency response personnel. At the time, a lawsuit was filed in federal court in Nashville, Tennessee concerning the wrongful death of the individual, Federico Becerra, Jr.

Today, the Foundation, upon learning of a disturbing jury verdict in a similar case, is reaffirming its position. This case involves the tragic and avoidable death of an Arizona State University student with epilepsy, which occurred when EMTs, misinterpreting behaviors associated with his seizure as combative, forcibly restrained him while he was handcuffed behind his back. They then left him in a prone (face-down) position for approximately 20 minutes. On November 17, 2005, the jury in this case found these EMTs were not responsible for the death of the student, John Jardine, IV. Attorneys representing Mr. Jardine's family argued and presented expert testimony that this prone restraint caused Mr. Jardine to die of asphyxiation.

The incident began when fellow students called 911 after witnessing Mr. Jardine having a seizure in class. When the EMTs arrived on the scene just after the seizure halted (knowing that the call had been dispatched as a seizure), Mr. Jardine was confused (common soon after a seizure), and apparently did not comply with EMTs' orders to remain seated. The EMTs then forced Mr. Jardine to the floor, applying pressure to his shoulders, arms and legs to immobilize him, and strapped him face-down on a gurney. He was still handcuffed en route to the hospital when the EMTs noted that Mr. Jardine had stopped breathing and had no pulse. The handcuffs could not be unlocked, as the key remained with a security guard on campus. Mr. Jardine was pronounced dead by emergency room physicians shortly after his arrival at the hospital.

The attorney for the EMTs argued they were simply following accepted practices. But if that is so, "accepted" practices are indeed not good enough.

As noted in the Foundation's prior statement, there are too many other cases like this one involving deaths caused by unregulated restraint practices, such as hog-tying, prone restraint and/or choke holds, used by paramedics and other first responders. These practices can frequently lead to asphyxiation, and continued patient struggling after restraint application can cause cardiac arrest. Indeed, as discussed in the accompanying background paper, the fact that these types of restraint practices may lead to death is well-documented in the law enforcement and mental health fields. See in particular the excellent study prepared by Protection and Advocacy, Inc., "The Lethal Hazards of Prone Restraint: Positional Asphyxiation" (2002), available at www.pai-ca.org/pubs/701801.pdf. Ironically, forcible restraint is known to cause people having seizures or those in the post-seizure confused state to involuntarily resist – thereby leading to charges of combativeness or the use of increased restraint methods.

Unfortunately, first responders all too often employ forcible restraint methods as a means of subduing persons who may appear to be combative, but are actually displaying typical symptoms of a seizure. Epilepsy (defined as chronic seizures), which affects 2.7 million people nationwide, is a common neurological disorder and is a frequent reason for a call to emergency lines for assistance. Accordingly, avoidable injuries and deaths will persist unless action is taken to educate and train first responders.

"Incidents of people harmed by an aggressive response to seizures appear to be on the rise," according to Gregory L. Barkley, M.D., founding director of the Henry Ford Comprehensive Epilepsy Program and member of the Epilepsy Foundation's professional advisory board. "While most law enforcement and emergency response teams do an outstanding job of responding to seizures, the fact that some people are being harmed or even dying as a result of a call to 911 is not acceptable. We need to ensure that better and less dangerous methods are used to handle the person having a seizure so that public safety is enhanced, not diminished. People need to know that if they call 911 because a brother or father or friend is having a seizure, they can be sure that their loved one will be helped and not harmed. Better training without the use of forcible restraint and the imposition of universal standards for all personnel handling people having seizures is an absolute must."

Barkley further said that emergency medical teams and law enforcement personnel can reduce the risk of an injury and a fatal outcome by remembering a few key points when responding to reports of a seizure or someone acting strangely.

  • When a report comes in about someone acting strangely or creating a disturbance, always consider the possibility that a seizure is taking place or has just occurred.
  • Check for a medical identification card or bracelet indicating that the person has epilepsy.
  • If family members or bystanders say that the person has epilepsy, assume that the observed behavior is seizure-related.
  • Seizure activity in the brain may affect speech, consciousness, and movement to such an extent that a person cannot respond or interact normally during the seizure or immediately afterwards.
  • Seizure symptoms may in rare cases include running, spitting, shouting, screaming, flailing movements or abusive language. Remember that these actions are involuntary, not under conscious control.
  • Confusion and disorientation may last for some time after a seizure ends, but will gradually improve.
  • Actions during a seizure are undirected and not under conscious control. Arrests solely on the basis of seizure activity may be discriminatory.
  • People who are in the midst of a seizure or who have just had one should not be forcibly restrained because such restraints may injure them. In addition, people in these circumstances may misinterpret the actions of medical personnel as an attack on them and they may react to protect themselves by forcibly resisting, placing themselves and medical personnel at risk for injury.
  • People with epilepsy who are taken into custody for any reason should continue to get their medication. Failure to take medication on time could produce fatal rebound seizures.
  • Placing someone who is having a seizure, or has just had a seizure, face down, in a choke hold and/or hog-tying them, can obstruct breathing and cause death.
  • People with epilepsy who have a seizure while in custody should receive prompt medical attention.
  • People with epilepsy are normal, law abiding people with an episodic medical disability over which they have no control. They deserve to be treated with respect.

The Epilepsy Foundation's affiliates also offer courses for police departments and other first responders. The Foundation is also updating and expanding its public safety and first responder education materials. The location and contact information for the Foundation's local affiliates can be found at /aboutus/AffiliateLookup.cfm.

About the Epilepsy Foundation

The Epilepsy Foundation (http://www.epilepsyfoundation.org), a national, charitable organization, founded in 1968, is dedicated to supporting children and adults affected by seizures through research, education, advocacy and service. The national office, in Landover, MD, supports nearly 60 affiliated Epilepsy Foundations throughout the nation.