On May 1, 2023, NYPD officers responded to a New York City subway train after Daniel Penny, a former Marine, held Jordan Neely, a homeless man, in a chokehold for 6-minutes. When officers arrived, Neely was unresponsive. Police and EMS were unable to resuscitate Neely and he was pronounced dead at the hospital. Penny is standing trial for manslaughter and criminally negligent homicide.
Neither Penny’s response to Neely’s erratic actions after boarding the train, nor his assessment or treatment of Neely are the focus of this article. Instead, this incident is an opportunity to review the assessment of a person who is unresponsive and the importance of delivering chest compressions as soon as possible and using an AED.
Police bodycam footage, shown during Penny’s trial, shows the initial response of multiple officers to the subway train, including officers claiming they could “feel a pulse” and rubbing Neely’s sternum to illicit a response. It is also reported that officers didn’t want to give mouth-to-mouth to Neely because of concerns about getting sick.
Here are seven important CPR reminders for bystanders, including police officers and firefighters, who don’t have medical training or tools for basic or advanced life support:
1. Do look for signs of circulation
If a person is unconscious and not responding to verbal commands, look for signs of circulation like movement, coughing or normal breathing. Look for signs of circulation for no more than 10 seconds.
2. Do NOT check for a pulse
Confirming the presence or absence of a pulse is notoriously difficult for medical professionals let alone bystanders or first responders in a chaotic situation, like a train car. Do not delay the delivery of chest compressions to check for a pulse.
3. Do hands-only CPR
If there are no signs of circulation, immediately begin chest compressions. Place your overlapping hands with interlocked fingers in the center of the patient’s chest. Push hard and push fast. Continuously perform chest compressions until relieved by EMTs or paramedics, or an AED is available.
The purpose of chest compressions is to circulate blood to the patient’s brain and heart. Don’t delay the start of chest compressions or interrupt chest compressions to check for a pulse or attempt mouth-to-mouth ventilation.
4. Do use an AED as soon as possible
AEDs are available in many public buildings, businesses and often carried by police officers. It is unclear if an AED was available on the train or the subway station when police officers responded.
An AED automatically checks the heart’s electrical activity and if certain types of lethal heart rhythms are present delivers a shock to stop the lethal heart rhythm and give the heart’s electrical rhythm an opportunity to return to normal.
Once an AED is available follow its instructions to apply the pads, analyze the heart rhythm, deliver a shock and resume chest compressions.
5. Do NOT pause to ventilate
Mouth-to-mouth or mouth-to-mask ventilations have not been an American Heart Association expectation of bystanders since 2008. Instead, deliver hands-only CPR, with high-quality chest compressions – hard, fast and about 100 per minute.
Police and fire chiefs, supervisors and CPR/first aid instructors need to make sure police officers and firefighters without additional medical training know that hands-only CPR and AED use are lifesaving and not to delay treatment due to uncertainty about delivering ventilations, because mouth-to-mouth is not expected, required or helpful.
6. Do consider naloxone
Naloxone reverses the effects of an opioid overdose. It is not a treatment for physical asphyxiation. Give naloxone for known or suspected narcotics overdose.
Typically, naloxone is not given to patients who have no signs of circulation, but recent research from California has shown that paramedic administration of naloxone during cardiac arrest resuscitation improved clinical outcomes. First responders authorized to administer naloxone should follow their local protocols for administration indications.
7. Do take charge and advocate for the patient
In the bodycam video, we see multiple officers check Neely for a pulse, speak to him and attempt to stimulate him with a sternum rub. However, it is unclear which officer is in charge of the incident and more importantly, which officer is advocating for a quick assessment of Neely for signs of circulation and then directing other officers to begin hands-only CPR and retrieve an AED. It is best for the patient, as well as the officers on scene, if one officer is clearly in charge and obviously advocating for the patient through vocal commands and action.
