Trea Ellinger, a Baltimore man, died after being sedated and restrained by medics, sparking questions about responders' actions and the dangers of lying face down during restraint, according to an investigative report.

The death of Trea Ellinger has prompted scrutiny over the conduct of emergency responders and their adherence to protocols, particularly regarding the use of sedatives and the risks associated with prone restraint. While the autopsy attributed Ellinger's death to an overdose, independent experts argue that positional asphyxia could have played a significant role. Amid ongoing debate and lack of charges against first responders, Ellinger's mother is demanding clarity and accountability for the actions taken that day.

Trea Ellinger died last July after a series of events that began when a 911 caller reported a man lying in the street, speaking incomprehensibly and acting combative. Police officers responded and body camera footage shows them handcuffing Ellinger and laying him on his side. Shortly after, paramedics injected him with midazolam, a sedative used in accordance with department policy, and then placed him on a stretcher.

Ellinger was initially on his side, but he turned onto his stomach while first responders affixed the stretcher straps. Experts have pointed out the dangers of lying face down in a prone position, as it can obstruct the airways and restrict breathing. Despite these risks, responders did not act urgently when Ellinger moved onto his stomach.

According to the investigative report produced under a state law requiring the Maryland Attorney General's office to investigate all in-custody deaths, four minutes passed before medics even discussed repositioning Ellinger. Another minute elapsed before a medic noted that Ellinger's lips were turning blue and acted to reposition him.

At that point, Ellinger was unhandcuffed and placed on his back. He then received chest compressions before being transported to the hospital, where he later died. The investigative report released in May and provided to Baltimore prosecutors in April resulted in a decision not to bring charges against any of the first responders involved.

The death has also drawn attention to the policies and practices of the Baltimore City Fire Department. The department declined to comment on the specifics of Ellinger's death, citing potential future litigation. However, internal policies do direct medics to place a patient in a supine position (face up) as soon as practical.

Independent experts have suggested that the combination of sedation and prone restraint could have contributed significantly to Ellinger's death. Gail Van Norman, professor emeritus of anesthesiology, highlighted that midazolam could depress respiration, which can lead to cardiac arrest particularly when combined with airway restrictions caused by the prone position.

Lori Ellinger, Trea's mother, has questioned the findings of the autopsy, which concluded that he died from overdosing on an antidepressant and methadone. She is particularly concerned about why paramedics opted to use an injectable sedative in her son's case. Ellinger had a history of substance abuse, for which he was taking methadone to manage opioid cravings, and had been diagnosed with mental health issues, including bipolar disorder and schizophrenia.

Eric Jaeger, an emergency medical services educator, noted that Ellinger might still be alive if he had been placed face up on the stretcher. Jaeger's assessment added to the calls for a closer look into the actions and decisions of the first responders on the scene.

Adding to the complexity, the Maryland attorney general’s investigation focused solely on the actions of the police officers and did not scrutinize the medics or other first responders. This has left a gap in accountability for the part of the response team directly responsible for Ellinger’s medical care.

In the hours leading up to his death, witnesses saw Ellinger disoriented and stumbling around downtown Baltimore, falling repeatedly. Despite his erratic behavior, Lori Ellinger reported visiting her son at his rehab facility the day before, where he seemed in good spirits.

While the death of Trea Ellinger officially remains attributed to an overdose, his family continues to seek clarity on the decisions made by the emergency responders that day. No charges have been brought against the first responders, and the family has not yet filed a lawsuit. Nevertheless, the case remains a focal point in discussions about the protocols and responsibilities of emergency medical services in handling similar situations.