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I think this is a fair take. Aggressive restraint techniques for people experiencing "excited delirium" (i.e. they're high on drugs and about to give themselves a heart attack from overexertion) were common among various police departments. This was probably not wise. Manual restraint by people untrained in medicine is inherently risky for people with compromised cardiopulmonary health (i.e. they're heavily dosed on opiates). Physicians can strap patients who are a danger to themselves to their beds with purpose-designed devices and monitor their vitals; some beat cop with inadequate training is really rolling the dice when they sit on a suspect's neck or back.
The Minneapolis police swore up and down that Chauvin's actions were contrary to department policy. This is probably technically true, but if you told me it was nevertheless common practice and they were covering up a systemic training issue by scapegoating a single cop, I'd find it plausible.
It is not possible to safely restrain a patient. Their are more and less safe ways to do so, and it is tightly regulated - however these regulations essentially exist not to maximize safety, but instead to introduce liability to some poor individual staff member or the facility (for example: making a sleep deprived resident run to the opposite end of the hospital to lay eyes on granny for 2 seconds to make sure she's alive before running back to the other end of the hospital to deal with the emergency surgery they were supposed to be performing. Now if they fucked up and granny's arm was pinched they are liable...).
Places deal with this problem in various ways, with the worst being for-profit psychiatric hospitals, often they elect to "ban" restraints, meaning that they did some math and having staff and other patient's attacked is better for the system than the risk of a poorly managed physical restraint. Often they just sub dangerous amounts of chemical restraints (medications) instead, which is much better at causing invisible morbidity in the long term.
It's extremely easy to have a decompensated patient in the ED who refuses to stop trying to murder the staff, get placed in a restraint bed for 10 days, scream constantly the entire time (and give themselves Rabdo in the process), and manage to choke themselves on a combination of their clothing and spittle and expire when the 1:1 steps out of the room for two minutes because of another fight elsewhere in the ED (for legal reasons this is not a true story).
Physical holds (as the police do) are safer since they are necessarily actively maintained, but aren't great either, especially when their insufficient number disparity and a notable size disparity (as was the case with Floyd I believe).
You can end up with someone like a group of 5 or 6 hundred pound nurses trying to restrain a lineman sized agitated patient and have someone accidentally collapse his trachea in the scuffle, or have a guy tear his scrotum because agitated patients often don't wear clothes and skin can easily caught on stuff during a scuffle.
No restraint is safe.
Restraints are however necessary.
Police have much better training (and practice), significantly higher levels of physical ability and size (which is critical) and more options (including stuff like tasers) and flexibility (generally speaking beating up an agitated but not-sick person a little bit is the best option to facilitate a safer restraint, not an option in healthcare though). It's generally safer (assuming no malfeasance, not making an argument that was present or not present in the Chauvin case).
As another random example - patients who are restrained rarely have vitals monitoring (since most patients by volume are substance, psych, or ED boarded on a stretcher in front of the nursing station to keep a close eye on them).
I can believe that police restraint is safer for generally healthy but uncooperative people, given that hospitals aren't primarily in the business of provisioning well-built men to wrestle criminals into submission. By the same token, police aren't primarily concerned with the finer details of managing overdose patients, and training in this area seems to be spotty. Every source I've found indicates that the knee-on-neck restraint Chauvin used was a bad choice for someone who was obviously high on drugs. Having a nurse on hand to give pointers could have averted a major fiasco, just as nurses could stand to have a few burly guys on hand in a pinch.
My suspicion is that medical support on hand would be of minimal help - front line and psychiatric nurses tend to be extremely burn out and intolerant of certain kinds of bad behaviors and therefore unsympathetic to people like Floyd.
Scene securing also comes first and the crowd made the situation worse IIRC. That's a good example of something a layman doesn't really think about and is not sympathetic to as a complicating factor but is an absolutely critical facet of emergency situations. A well trained nurse is likely going to strongly differ to an officer getting the scene under control before moving onto provisioning medical care.
A poorly trained nurse is probably going to be yelling at him and calling him a shit head.
You'd be shocked at how useless most people are deescalating this stuff even when trained and supposedly well equipped.
Yeah, I meant it more figuratively. Literally embedding nurses with police isn't going to work out for the reasons you mention, and hiring random meatheads without police training to manhandle uncooperative patients could also go very wrong. Police need adequate, medically-informed training in identifying overdosing suspects and adjusting their restraint techniques to minimize accidental death. Instead of a nurse literally standing over their shoulder, they need to internalize the basic knowledge to make the best calls.
Step 1 in any emergency is secure the scene first, even with more "medically informed" training an irritable crowd with an insufficient number of officers and a very large suspect is going to mean that options are excruciatingly limited. I'm not sure there really is anything different to do with more medical training anyway. There isn't any secret sauce for managing overdose or agitated patients. Additionally "I can't breath" or "that hurts" "you're hurting me" is not useful information from a restrained perp or patient, since the fact that they aren't going to be a useful source of information is intimately related to why you are doing it. Excessive struggle (secondary to discomfort) or no struggle at all (secondary to the position being...unhealthy) are not useful pieces of information since most patients will either go crazy or try and wait and save energy.
Obviously their are minor things you can do to make things safer but its never "safe" it's all risk mitigation, and elsewhere in this thread someone noted that this whole thing could easily be Chauvin getting abandoned for following standard operation procedure, or a small miscalculus based on how long it was supposed to take backup.
Now you may say "doc you paint a pretty stark picture, where the fuck are the rest of the people in the medical community agreeing with you?" I have no idea. It was a huge black pill for me. We know this.
I agree that, speaking fully generally, it's very difficult to detain a suspect who is high on drugs in a way that is completely benign when considering all the unknowns in securing a scene and maintaining officer and public safety. This is not a fully general scenario, though, but one with a very specific fact pattern:
Under this specific fact pattern, where officers were well in control and could spare time to contemplate the well-being of the suspect, the refusal to try changing restraint position seems incompetent or negligent. This wasn't some split-second decision made under gun fire, it was simply a bad call by the senior officer, and it led to an unnecessary death.
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Just to steelman the alternative here, people lie, especially when they do not want to be restrained. There are also no gurneys with straps easily available to beat cops. Because people lie, you really can’t take people at their word when they’re claiming distress. If the only available restraint is sitting on the guy, and the guy knows you can’t do that if he says the magic words “I can’t breathe,” a whole bunch of people under such restraint are going to develop breathing problems. And given th fact that a fair percentage of those people will be armed, I think it’s going to cause either more cops being shot or shooting people because restraining is effectively no longer allowed.
Floyd had already been patted down and cuffed. He was uncooperative, but not a threat to the officers or others at the time. He was obviously on drugs, so his compromised physical condition was apparent regardless of his statements one way or another. It's possible for suspects in other, different encounters to lie in order to escape or threaten officers, but that wasn't part of the calculus in this case. The restraint technique Chauvin executed was simply too dangerous for someone with depressed cardiopulmonary function. Whether this was a systemic training failure or just criminal depravity on Chauvin's part is the interesting question. The jury seems to have concluded the latter.
It's probably inevitable that some percentage of people who overdose on hard drugs and then encounter police will end up dying in custody under ambiguous medical circumstances. That said, police should not be employing techniques that are more dangerous than necessary to protect themselves and the public.
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