When was Freddie Grey Injured: a Neurological Perspective

Mr. Freddie Grey who was arrested in Baltimore on April 14th, 2015, was seriously injured while in police custody, immediately hospitalized and subsequently died at the University of Maryland Shock Trauma Center on April 19th. Six Baltimore City Police officers have just been charged with a variety of offenses from manslaughter to second degree homicide in connection with Mr. Grey's death. Although several witnesses independently recorded video footage of Mr. Grey's arrest, there is no consensus on the details of how and where he sustained his injuries.  Were the injuries sustained during a 'rough ride' in the back of a police van or were they inflicted before Mr. Grey was first placed in the paddy wagon?  I believe that viewing the issue objectively from a neurological perspective can help to peel away some of the uncertainty about when he was injured.

The videos that are publicly available show Mr. Grey lying face down on the pavement, screaming in pain with two police officers kneeling beside him. The officers then lift Mr. Grey, one under each arm pit, to transport him to a police van that was parked nearby.  Once Mr. Grey had been lifted into a standing position, it is clear that he was unable to use his legs; this is not a merely an astute observation on my part but was also noted on the audiotape by several of the witnesses at the scene. He was then dragged to the back of the police van with his legs trailing limply behind him. According to the police, Mr. Grey was placed in the back of the van but not restrained by a seat belt. After moving less than two blocks from the site of the arrest, the van stopped and Mr. Grey had his legs placed in shackles and he was positioned face down on the floor.  Approximately 45 minutes later and several stops later, Mr. Grey was unresponsive and not breathing.  After his death, an autopsy found that his spinal cord was completely severed in the upper neck and three adjacent vertebrae were fractured.

It seems highly improbable that Mr. Grey sustained his spinal injury because he was not restrained by a seat belt during a two block ride in the back of a police van; it is almost inconceivable that he caused the injury to himself by violently banging his head against the side of the van.  The video evidence suggests that he already had a spinal injury when he was first loaded into the van; therefore, he was injured sometime between his arrest and the time of the first video images of him lying face down on the ground flanked by two police officers.  If one accepts that his spinal injury was sustained before he was placed in the van, how did his overall condition deteriorate from one in which he was able to respond and interact (though not able to use his legs) to where he was unresponsive and not breathing?  I believe that his catastrophic decline was because of respiratory failure or neurogenic shock as a direct result of his spinal injury.  Injury to the upper cervical spinal can paralyze the diaphragm and also affect the function of the respiratory muscles of the chest; respiratory failure is a common cause of death in acute cervical spinal cord injuries.  Mr. Grey's complaints about finding it difficult to breath may have been the first indication that his breathing was compromised as a result of the spinal injury.  Severe respiratory failure, if untreated, will lead to low blood oxygen levels, loss of consciousness and eventual death.  Neurogenic shock, also associated with acute spinal injuries, leads to profoundly low blood pressure, inability to deliver blood (and oxygen) to vital organs, and eventual death.  It is not clear which of these two conditions (respiratory failure and neurogenic shock) was responsible for Mr. Grey's decline into a state of unconsciousness; it is possible that both contributed.  All the information we have related to Mr. Grey's arrest and tragic death suggest that his spinal injury was inflicted before he was placed in the police van and his decline into unconsciousness over the course of less than an hour was as a direct result of that injury.