This is more than an impulsive act. It's not like pushing someone in front of an oncoming subway car. He had to think about it. I have NO medical training. But it would not occur to me to use one of those things on someone any more than I would "practice" CPR on a healthy person. This is a 25-year-old who is incapable of following directions, lacks the ability to put himself into the place of others (and she was DRIVING!! wasn't she?? What the hell did he think was going to happen to the ambulance he was riding in when she started flopping around like a dying fish at the bottom of a rowboat, haw haw haw?), and has a sadistic streak. He has to intend for her to die, though, to get a murder charge. Voluntary manslaughter with the maximum punishment is probably the reasonable outcome. Unless there's other evidence he intended to kill her. On the other hand, while he is doing 10 years for voluntary manslaughter (or whatever the max is -- he is sooo clearly a danger to the public that he needs to be behind four walls for as long as possible) this is exactly why volunteer fire/paramedic agencies need to do psych and background tests. This guy probably wouldn't have passed a psych test. I can't tell you the number of volunteer firefighters I prosecuted for arson who also had numerous weenie-waving or peeping convictions. I think that some paramedics must also get into the biz for the wrong reasons. What occurs to me is -- they obviously didn't talk to this guy for very long, there wasn't a job interview even, and they need to change their hiring policies. And the idiot relative who hissed, "He's a good kid!" Well, no. He's not.