Guilford County’s EMS director says a paramedic and EMT on the scene when Marcus Smith stopped breathing followed protocol when they loaded him onto an ambulance before administering CPR.

When Greensboro police Chief Wayne Scott hastily obtained a court order to release police body-camera video capturing the death of a man in police custody who was experiencing a mental-health emergency, a Guilford County paramedic and EMT unexpectedly found themselves in the glare of public scrutiny.

“This was a unique case to us,” Guilford County Emergency Services Director Jim Albright told Triad City Beat. “There were so many officers, so many videos.”

A Nov. 30 determination by the state Office of the Chief Medical Examiner that 38-year-old Marcus Deon Smith died of a homicide due to “prone restraint” administered by the police — along with the presence of drugs and alcohol, and a history of hypertension — sparked street protests as well as angry condemnation directed at city council members. Smith’s parents have accused the four officers, who that evening applied a controversial restraint known as hog-tying on their son, of murder.

The officers have returned to regular duty after an internal investigation found that they followed directives. The Guilford County District Attorney made an initial determination that the officers bore no criminal liability, but Assistant District Attorney Stephen Cole indicated in an interview with City Beat that the decision might not be final.

While the conduct of the police officers remains the primary target of public scrutiny and official review, the saga has also focused critical attention on two medical responders — a paramedic and an EMT — who were at the scene when the officers applied the restraints, and who later transported Smith to the hospital in an ambulance.

“Everyone that took care of Mr. Smith had the same desire to see a positive outcome,” Albright said. “We are terribly sorry…. This is a tragic loss of life.”

Videos released by the city show Guilford County emergency medical personnel on the scene even before police officers hog-tied Smith through a restraint known as the Ripp Hobble. A paramedic can be seen observing as an officer says, “We definitely need to Ripp-Hobble him so he doesn’t bust my window out and fly out on the way to the hospital. Is anybody willing to help me do that?”

By this time, Smith’s feet are on the window of the squad car, and an officer says, “No, no, no, no.” An officer opens the door. The paramedic, who is standing near the car says to an officer: “He’s going to have to be restrained for us to take him,” or words to that effect.

The officer, who has just radioed in, responds: “No, I just told them that we’re not taking him in your truck.”

Less than a minute after officers take Smith to the ground, the paramedic can be seen preparing a stretcher, as one of the officers addresses Smith, saying, “You okay? You still with us?” After a moment the paramedic turns towards Smith and says, “Hey!”

The officers remove the restraints, and the paramedic kneels to check on Smith as the EMT shines a flashlight on him.

“I just need to get him to the truck,” the paramedic says.

After the medical responders load Smith into the ambulance, another video shows Smith receiving mechanical chest compressions.

Yet another video includes the voice of an officer apparently speaking to a superior on a cell phone as he looks towards the open back door of the ambulance.

“We’re working downtown — the folk festival,” the officer says. “We had a gentleman extremely delirious, running around high. We called EMS. He started trying to kick out the window. EMS got here. We pulled him out. We Ripp-Hobbled him. Within about a minute he stopped breathing. They’re doing CPR right now…. No, he is not breathing, nor a pulse…. All we did is try to get him in a car. We got him in a car. He started kicking a window. We took him out; we put him down. We Ripp-Hobbled him for not even — I mean, it’s all on camera — but not even a few minutes. I would even say — nobody was on top of him or anything. We Ripp-Hobbled him, and he stopped breathing. We were talking to EMS about getting him to the bed. Fire is coming…. As soon as we noticed he stopped breathing, we un-Ripp-Hobbled him.”

When Graham Holt, who represents the Smith family, showed the video at a community meeting at Shiloh Baptist Church on Dec. 3, audience members reacted in horror, with some exclaiming out loud. Some of the indignation was directed at the police officers, but others condemned the medical responders.

“Why didn’t they start CPR? Why didn’t they start chest compressions?” veteran civil rights activist Louis Brandon asked while watching the sequence from when Smith was found to be unresponsive to when he was loaded into the ambulance. “All of them are trained in CPR.”

One woman told members of city council the following day: “For me, watching this video was like watching a public lynching, with the police and EMS standing around. What was it that made it possible for four police officers to kill a man, with EMS and other officers standing by? And no one said, ‘Stop,’ when he was grunting and struggling to breathe while they adjusted the strap? And no one administered CPR right away? When they found he had no pulse and no immediate intubation?”

While city council members took heat for the actions of the police officers and for public statements by Chief Scott, Mayor Nancy Vaughan made a point to remind audience members at the Dec. 4 meeting that medical responders work for the county, not the city.

While emergency medical responders frequently interact with law enforcement and firefighters, Albright said they typically don’t take control until they can be assured that everyone is safe.

“Until we can assure safety to our providers, it’s a law enforcement event,” he said.

Albright said emergency medical services are protocol driven, and first responders work in a “very dynamic environment.”

“We did assess him,” Albright said. “We needed to move him to a lighted environment where we could fully assess him. We had to move him on a stretcher. We had to secure him to the stretcher. By policy, before lifting him, he has to be secured.”

Albright said Guilford County’s ambulance service is nationally accredited. The paramedic who responded to the scene on the night of Marcus Smith’s death received a minimum of 1,200 hours of training, while the EMT received a minimum of 190 hours. Those are the required program lengths for the two positions.

Albright said the two emergency medical responders’ performance on the night of Smith’s death will be submitted for peer review — a confidential process designed to promote continuous improvement. Albright said Guilford County Emergency Medical Services “routinely reviews low-frequency, high-risk events.”

“We’re dealing routinely with people at the end of life,” he said. “We deal with acute, traumatic death and chronic conditions. We deal with death routinely.

“We’re terribly sorry to this family that the outcome was what it was,” Albright concluded. “We’ll have plenty of opportunities to reflect on this outcome. I’m not sure we could have changed the outcome.”


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