The tragic death of George Floyd has propelled a nationwide conversation on police restraints and procedures along with the differential treatment of white versus non-white citizens.
One welcome outcome has been the decision by many police departments to ban chokeholds, or carotid restraints. The San Diego City Police Department announced on June 1 that the . Within 2 days, 15 law enforcement agencies within San Diego County, the fifth largest in the country, followed suit in banning the chokehold, as well as other departments across the country. While some agencies such as the New York Police Department banned chokeholds as early as 1993, a wave of change is now occurring in the face of public anger and scrutiny over police procedures.
Chokeholds as used in law enforcement typically involve some combination of arms or batons putting pressure on the subject's neck and should be distinguished from the knee-on-neck that Minneapolis police officer Derek Chauvin applied to Floyd, a more aggressive and rarely sanctioned technique.
In the typical chokehold, pressure applied to the carotid arteries bilaterally causes a loss of consciousness, either by direct occlusion of blood flow to the brain or by pressure on the carotid bodies resulting in a reactive vagal vasodepressor response. More rarely, anterior neck pressure (for example, by a baton across the front of the neck) may occlude the airway, sometimes with fracture of the trachea.
When carefully applied in a controlled, martial arts setting, the chokehold rarely results in medical complications. In the more uncontrolled law enforcement situation, there may be a potentially violent or aggressive detainee and/or an under-trained law-enforcement professional, often suffering a "fight or flight" adrenaline response. This may result in excessive or poorly performed technique and increases the risk of anoxic brain injury, stroke, cardiac arrhythmia, or trauma to neck structures. The latter may include carotid dissection, tracheal collapse, or bony fracture.
While Chauvin was using a very different technique on George Floyd, this unfortunate incident illustrates the excessive force that can occur in the heat of the moment. The detainee was already handcuffed and yet neck compression was forcibly applied, apparently long past the subject's loss of consciousness and despite protests by onlookers and fellow officers.
It is impossible to know the true numerator or denominator of medical complications from carotid restraints, as most cases go unreported except in a very anecdotal fashion. Nevertheless, there are many reports of deaths occurring from police chokehold, including in San Diego County, as well as across the nation.
Within San Diego County, for abolition of the chokehold. While the current widening circle of bans on the chokehold are encouraging, in reality this easily announced policy change only scratches the surface of police procedures that require intensive re-evaluation.
The wide availability of cell phone videos has exposed long-standing police procedures to fresh scrutiny, revealing the difficult, emotionally fraught environment in which law enforcement must work and the occasional tragic results. The current crisis offers the opportunity for a wide-ranging conversation on law enforcement procedures. Hopefully through improvements in training, we can reduce emotional reactivity by law enforcement (even in the face of sometimes deliberate civilian provocation) resulting in needless medical injury, while optimizing de-escalation, enhancing professionalism, and improving community engagement.
A step in the right direction was a that allows use of force only when necessary. "In the totality of circumstances," this bill, which also encourages alternative de-escalation procedures, may sound like common sense but is actually the strictest law of its kind in the nation. A law like this, properly applied, would have prevented Floyd's death. There is still much work to be done.
, is a general neurologist in San Diego. He is the medical director for stroke at Scripps Mercy Hospital Chula Vista and is a fourth Dan black belt in taekwondo. He also is the editor-in-chief of the San Diego County Medical Society's magazine, The San Diego Physician.