Administration and Leadership, EMS Insider, Operations

Use of Force on Persons in Medical Emergencies

With the number of violent encounters between citizens and police on the forefront of the news, significant attention has been given to what a law enforcement officer can do to subdue a violent person who may be mentally ill. EMS personnel are often entangled in these encounters while trying to treat mentally ill or cognitively impaired patients. Whether force can be used by police, or chemical restraints used by EMS, is an issue courts have recently considered.

At the EMS Today conference in February, the use of Ketamine in such situations was discussed at length. Often, EMS providers rely on police to subdue a violent patient, sometimes resulting in cardiac arrest subsequent to excited delirium. Other medical emergencies, such as hypoxia and hypoglycemia, may also place EMS personnel in danger when trying to care for patients.

Estate of Corey Hill v. Miracle

In the case of Estate of Corey Hill v. Miracle, the 6th Circuit Court of Appeals considered the proper analysis of use of force by law enforcement where the officer was not making an arrest, but instead used his taser in stun mode to control a subject in need of medical assistance, but who was fighting the EMTs trying to provide assistance. The decedent’s estate brought a §1983 claim against the deputy who employed force to restrain him.

The court initially reviewed the factors articulated in the landmark use of force case, Graham v. O’Connor.  The first factor is the severity of the offense, the second was whether the subject posed an immediate threat to the officer or anyone else present and the third was whether the subject was actively resisting arrest or attempting to flee.

The court noted that these factors, well known by law enforcement officers, do not necessarily fit medical and mental health emergencies, noting that there are two strikes against the officer’s use of force before the analysis even begins. Since Hill had not committed a crime, nor was he resisting arrest, only the third factor applies.

The Case

In June of 2013, Deputy Christopher Miracle was called to assist EMS at a call for a diabetic emergency. A paramedic was able to obtain a blood glucose level of 38, and began attempting to initiate an IV. The patient became extremely combative, ripped out his IV causing blood to spray, and began swinging and kicking at the paramedics as they tried to restrain him. The deputy deployed his taser in drive-stun mode to Hill’s right thigh. Hill calmed down enough for the paramedic to re-establish the IV and administer dextrose. Hill then became alert and apologized for any problems.

Hill later filed suit, alleging that as a result of the taser deployment, he suffered burns on his right thigh, and that his diabetes worsened. In May of 2015, Hill died of complications of his diabetes.


The Michigan federal district court found that Deputy Miracle violated Hill’s clearly established rights to be free of excessive force. The trial court initially granted summary judgment on Hill’s emotional distress claim, but denied dismissal of the remaining claims. Deputy Miracle filed interlocutory appeal.  

The Sixth Circuit addressed the appeal and held that “Where a situation does not fit within the Graham test because the person in question has not committed  a crime, is not resisting arrest, and is not directly threatening the officer, the court should employ the following analysis:

  1. Was the person experiencing a medical emergency that rendered him incapable of making a rational decision under circumstances that posed an immediate threat of serious harm to himself or others?
  2. Was some degree of force reasonably necessary to ameliorate the immediate threat?
  3. Was the force used more than reasonably necessary under the circumstances?

As in Graham, the court went on to say that these questions should guide the answer as to whether, under the totality of circumstances, the officer’s actions were objectively reasonable.

The court ultimately found that in this case, Miracle’s use of the taser was objectively reasonable, noting that Hill was incapable of making rational decisions and posed a threat to the EMTs trying to take care of him. The court rejected an argument that Miracle could have avoided the threat by walking away, noting that this argument ignored the fact that Hill was a threat to himself if left untreated.

This is an important decision that could also affect EMS personnel employed by government agencies who use chemical restraints on individuals presenting as violent patients, or with mental health emergencies. The appropriate use of force by law enforcement, or chemical restraints by EMS, could prevent escalation of these events into officer involved shootings, or excited delirium deaths.

Estate of Corey Hill v. Miracle, 853 F3d 306 (6th Cir. 2017)