Medical risks, aftercare and the duty of care

Joan Ivey arrived at the Bayview Avenue laundromat at 19:51 on February 17, four minutes after Ruiz used his conducted energy weapon. Coutu had already sat Tyler Ostrowski up against the side of the patrol car, with his hands cuffed in front of him because his left wrist was swelling, and was talking to him. Ivey's first measurements are in her report, which she shares with the class with Ostrowski's names removed: heart rate 134 beats a minute, breathing fast, skin hot and sweaty, temperature 38.6 degrees, confused about where he was, and pain and deformity of the left wrist. One probe was lodged in his clothing; the other had penetrated the skin just below his left collarbone.

'Every one of those numbers worried me more than the probe,' Ivey tells the class. 'Fast heart, high temperature, confusion, after a period of agitation and probably stimulants. That is a person whose body is under extreme stress. The weapon cycle lasted five seconds. What his body had been doing for the half-hour before that is what could have killed him.' She and her partner put him on a monitor, gave him oxygen and took him to Port Ardent General, where he was kept under observation for about six hours.

The duty of care

Once police take a person into custody, they take on a legal duty to protect that person's health and safety, including getting them medical care when they need it. In Canada, this duty arises from the common law, provincial policing legislation and service policy, and coroners' inquests have repeatedly examined deaths in police custody and made recommendations about medical assessment and monitoring. In Ontario, a death in custody leads to a mandatory coroner's inquest in many circumstances, and the Special Investigations Unit investigates deaths and serious injuries involving police. In practice, the duty means officers must watch for signs of medical distress, call for medical help early, never leave a restrained or exposed person unmonitored, and pass on what they know to whoever takes over.

After a less-lethal weapon is used, the duty of care is more demanding, because the weapon adds risks of its own and the person is often already stressed, injured or intoxicated. Port Ardent's policy, like most, requires medical assessment by paramedics or at hospital for every person exposed to a conducted energy weapon, and for anyone who has been struck with a baton or impact munition, has a known medical condition, or does not recover as expected after OC spray. It also requires officers to tell custody staff, in writing, which weapon was used, when and for how long.

Medical red flags

Some signs mean a person needs urgent medical care after any use of force, and especially after a less-lethal weapon. They include difficulty breathing or saying they cannot breathe; chest pain; loss of consciousness, even briefly; confusion that is getting worse; a very high temperature or hot, sweaty skin with extreme agitation; seizures; vomiting; a head injury, particularly with intoxication; severe pain that suggests a fracture; and any person who suddenly goes quiet and still after a struggle. That last sign is one of the most dangerous, because officers may mistake it for calm, when it can mean the person's heart or breathing is failing.

Desjardins spends time on a term students may see in older reports: excited delirium. For years, it was used to describe people who were extremely agitated, overheated and sometimes violent, often after taking stimulant drugs, and who sometimes died suddenly during or after restraint. The term has been widely rejected by medical organizations. In 2023, the American College of Emergency Physicians withdrew its 2009 paper that had supported it, and other major medical bodies have said it is not a recognized diagnosis and has been used to explain deaths that may have been caused or contributed to by restraint and force. Medical guidance now describes the underlying condition as hyperactive delirium with severe agitation, and treats it as a medical emergency requiring paramedics as soon as possible. 'Whatever word you use,' Desjardins says, 'the point is the same: a person in that state is a patient first. The more force and restraint you add, the higher the risk.'

Positioning and restraint after force

The most important aftercare step is often simply how the person is positioned. A person who has just been exposed to a conducted energy weapon or OC spray, who has been struggling, who is overweight, intoxicated or in a state of severe agitation, is at risk of positional asphyxia if they are held face down, especially with weight on their back. As the arrest course explained, officers should get the person onto their side or sitting up as soon as it is safe, avoid any pressure on the back, chest or neck, and watch their breathing constantly. A person who says 'I can't breathe' must be treated as a medical emergency.

At Bayview Avenue, Ostrowski was handcuffed during the cycle and sat up within about thirty seconds of falling. Coutu cuffed his hands in front rather than behind once she saw his wrist, which policy allows for an injury. Ruiz checked him for other injuries while Coutu kept talking. 'Six months later, the thing I'm proudest of on that call is the thirty seconds,' Coutu tells the class. 'Getting him up and breathing.'

Weapon-specific aftercare

For conducted energy weapons, policies generally require medical assessment of everyone exposed, and hospital assessment for anyone who has had a long or repeated exposure, who is in a high-risk group, who has a probe in a sensitive area, or who shows any red flag. Probes are treated as sharp biohazards. Only officers trained to do so may remove probes from non-sensitive areas, and probes in sensitive areas, including the face, neck, groin, breast and hands, are left for medical staff. The wounds are cleaned and covered, and the probes are kept as evidence. Following the Braidwood recommendations, Canadian policies emphasize calling paramedics early in medically high-risk situations and having a defibrillator available.

For OC spray, aftercare is the decontamination process from lesson 7: fresh air, upright position, cool water and monitoring, with paramedics called if breathing does not improve. For batons and impact munitions, officers must check for fractures, internal injuries and head injuries, and anyone struck on the head, neck, chest or abdomen, or with significant pain, needs medical assessment. In every case, officers must record what they saw, what care they gave and when, and who took over.

At Port Ardent General, the emergency physician who treated Ostrowski, Dr. Anika Rao, removed the probe from below his collarbone, cleaned the wound and ordered blood tests to check for muscle breakdown and other effects of his agitation and drug use. His wrist was X-rayed and found to be broken, and was set in a cast. His temperature and heart rate gradually came down. At about 02:00, once he was medically stable and calmer, a psychiatrist assessed him under Ontario's Mental Health Act, and he was admitted for several days of treatment.

The red-flag list used for teaching is: breathing difficulty, chest pain, unresponsiveness, worsening confusion, high temperature, seizure, vomiting, head injury, and sudden quiet after a struggle. A fast heart rate or a deformed wrist still needs care, but neither on its own is on the list of signs that a person's life may be in danger.

The screening flags Ostrowski's high temperature and confusion, which is exactly why Ivey treated his overall condition as more serious than the probe or the broken wrist. It flags no red flags for Petrie after decontamination, although he still needed monitoring. And it flags the training case, in which a person who had been struggling suddenly went quiet while lying face down. Haddad tells the class that this is the scenario she drills most in requalification, because it is the one that has killed people in custody in both countries.

Handing over care

The duty of care does not end when the person is in a cell or at hospital. Officers must pass on what they know: which weapon was used and how many times or for how long, how the person was restrained and for how long, what injuries were seen, what the person said, whether they took drugs or alcohol, and any red flags. In Port Ardent, this goes on the prisoner's custody record and is read by the custody sergeant before the person is placed in a cell, as the arrest course described. At hospital, officers tell the triage nurse and the treating doctor directly.

Ivey adds that paramedics need the same information. 'If you tell me he was exposed for five seconds and sat up within thirty, that helps. If you tell me he was exposed three times and was face down for two minutes, that changes everything I do.'

Officers' own wellbeing

Aftercare also applies to officers. An officer who has used a less-lethal weapon, especially one that caused an injury, may feel shaken, worried about the investigation or replay the moment for weeks. Ruiz tells the class that he did not sleep well for several nights after Bayview Avenue, mostly because he kept wondering whether Ostrowski's injury could have been avoided. Port Ardent's peer support team contacted him the next day, and he spoke with the service's psychologist twice. 'Nobody told me I'd done anything wrong,' he says. 'But I still needed to talk it through.' Haddad tells the class that checking on the officers is part of every supervisor's job after a use of force, alongside checking on the person.

Officers can also be injured during these incidents, for example by OC drift, by a fall during a struggle, by contact with a probe or wire, or by the person they are trying to control. Those injuries must be reported, treated and recorded, both for the officer's health and because they are part of the full picture of what happened.

Joan Ivey also tells the class about the information she wishes officers always gave her when she arrives. 'Tell me what you saw before the force, not just after,' she says. 'How long was he running around? Was he hot to the touch? Did anyone see him take something? Did he hit his head on the way down? Those details change what I watch for in the ambulance and what the emergency doctor tests for, and sometimes they save a life.'