Today in California, Governor Newsom announced that he would like to do away with the “carotid hold”—a restraint technique taught to police and a modified version of which killed George Floyd.
https://www.sfgate.com/bayarea/article/News-calls-for-end-to-carotid-hold-15320522.php
Some consider the carotid hold and a chokehold to be synonymous but police departments have differentiated by saying that a chokehold comes from the front and brings with it a possibility of cutting off the airway while a correctly done carotid hold only compresses the carotid arteries, leaving the airway intact.
So, why was the kneeling that we all saw performed by a police officer in Minnesota a type of carotid hold? Because anything designed to compress the carotid artery—which will cut off blood flow to the brain and cause unconsciousness quickly—is this type of “hold.”
And while people are already arguing whether or not this applies to the case of George Floyd, if you watch the video, it is clear that while Mr. Floyd is lying prone on the ground with his head turned to the side, former officer Chauvin is kneeling on the side of his neck directly on his carotid artery. Only occluding one (instead of both sides) would certain prolong the process of cutting off blood to the brain and causing unconsciousness, but a person could certainly still lose consciousness. And here’s the important part: once Me. Floyd loses consciousness, his neck relaxes and any attempt he was making to protect his airway is compromised. So at this point, it is likely that Chauvin had not only cut off the supply of blood to his brain causing unconsciousness but was also cutting off the air supply to his lungs as Mr. Floyd’s neck relaxed and changed position.
The bottom line is this: no oxygen getting to the lungs, no blood getting to the brain. From this point, it only takes seconds (maybe as little as 10) for a person’s heart to stop. So Mr. Floyd then experienced a cardiac arrest, as confirmed by the autopsy. His heart had stopped. The only thing that would have saved his life is CPR and immediate intervention by health care professionals. A delay of more than 3 minutes guarantees at the very least a brain injury and at the very worst the outcome we have.
Why am I so fixated on this issue, you might be thinking??? A few reasons.
- The goal of a correctly performed carotid hold is unconsciousness. Why should this ever EVER be the goal of the police?
- A correctly performed carotid hold should last for less than 30 seconds and once the “goal” of unconsciousness is met, the subject then needs to be correctly positioned in order to not sustain further injuries and he now needs medical attention.
- It is very difficult to perform a carotid hold correctly, which is why some view it synonymously with the choke hold (which purposefully cuts off your air supply by applying pressure to your trachea).
- But accidentally slipping into a choke hold, which seems like it would be very easy (especially if the subject is struggling) is not the only medical danger of of a carotid hold. Applying pressure to the carotid arteries can cause tearing of those arteries (called a carotid dissection) or it can loosen atherosclerotic plaques in the arteries which then shoot into the brain, causing one or more strokes. Let’s look a little closer at these 2 medical complications, shall we?
- Carotid dissection: this is where the artery tears from the rough pressure being applied to it. It can also happen from having your neck adjusted at the chiropractor, vigorous exercises, etcetera… you probably won’t know this has happened right away because despite the fact that we call it a dissection, it is not normal for all the layers of the artery to tear and for you to bleed spontaneously or prolifically into your neck. Usually, only one layer out of three tears, and the body’s response is to send in all your clotting products to fix the small tear. This is the problem, though! In trying to fix itself, your body creates a loose “clot” of platelets and other things which easily break off from the inside of the artery. Because the arteries carry blood to the head at a pretty substantial pressure, this clot, or embolism as we call it, will go up into the brain traveling as far as it can in the arteries until it gets stuck. Everything beyond it then is NOT receiving oxygenated blood flow. You are now having what we call an embolic ischemic stroke. Since it is being caused by a carotid dissection, you could actually have many at the same time as multiple thrombi cut off the blood flow in different arteries in your brain. This complication could start occurring days to a week after the event which caused it— and the early symptoms are quite hard to recognize sometimes..
- Like a dissection, the second complication is also an ischemic stroke at the root— but the cause of ischemia in this case is from broken off pieces of atherosclerotic plaques in the carotid arteries. This is the mechanism for how heart attacks occur as well and was the driving force behind trying to get people to call strokes “brain attacks.” I am glad that never caught on, but I understand why they tried.
- In the end, my thoughts keep returning to this: a medical professional would never screw around with someone’s carotid arteries—why should the police who are not trained to understand the permanent harm they can do.
- The closest we come to purposefully compressing the carotid arteries is a technique for lowering a dangerously high heart rate called carotid massage. Even during this procedure, our goal is not to block blood flow to the brain though—we are trying to “massage” or activate the bundle of nerves surrounding the carotid artery below the jawline which will trigger your heart rate to go down. This procedure is almost always done by a doctor, although an ICU nurse may be trained for this, and it can cause the type stroke I mentioned above. This is a procedure of last resort. And you can listen over the arteries with a stethoscope for a carotid “bruit” which would indicate turbulent blood flow and most likely significant atherosclerosis that is a direct contra-indication to carotid massage. In this case, we would not use this procedure in this patient.
https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots
First, do no harm. The ethical principle that guides healthcare professionals. we struggle every day to do no harm, as patients kick punch & bite us. As patients berate us verbally, as families demand care for their ill loved ones that we know will prolong their suffering but provide little chance of recovery. We do it with a smile and a gracious heart. Because we are taking care of human beings. People who suffer and make mistakes just like we do. People who celebrate life’s victories and milestones just like we do.
When will the police start doing no harm? Carotid hold & other violent restraint techniques need to end.