In carrying out death sentences, Oklahoma follows a 32-page manual that lays out the execution protocol in minute detail.
The manual spells out everything from setting the time and date of execution to the manner in which it will be carried out. It includes how a prisoner will be moved from death row to the execution chamber, what clothes they’ll wear and how much can be spent on a last meal — $15.
It also details the method used to administer the lethal quantity of drugs.
The warden recruits a paramedic or someone similarly qualified to insert the IVs, three people to administer the cocktail of drugs and a doctor to serve as attending physician. None of their names are disclosed.
The prisoner, dressed in scrubs and tennis shoes, is restrained on the execution gurney.
The paramedic inserts an IV catheter into each arm and ensures the veins remain open until the execution by slowly infusing a sterile solution. If the paramedic is unable to start the IVs, the physician starts them or starts a central IV line instead. If a central IV line can’t be established, the physician performs what’s called a “cut-down procedure,” in which the vein is exposed surgically to allow for the line to be established.
At that point, state officials, media and the inmate’s witnesses are escorted to the viewing room. The warden asks the inmate if they wish to make any last comments.
After any comments, the warden orders the lethal drugs be administered until the attending physician pronounces the person dead.
In the three-drug procedure, a dose of each lethal drug is given simultaneously in each arm.
First, Midazolam, a sedative, is injected in to both lines, followed by a saline flush.
The physician monitors the inmate’s level of consciousness to ensure they are unconscious before the next drug is administered.
No earlier than five minutes after the first drug is administered, vecuronium bromide, a muscle relaxer, is injected in each line followed by another saline flush.
Finally, potassium chloride is injected in each arm, again followed by a saline flush. Pottasium chloride stops the heart and causes death by cardiac arrest.