Nevada Department of Corrections officials have released a detailed manual laying out how they plan to conduct the state’s first execution in 11 years.

The 57-page document, dated Nov. 7 and unsealed by a judge last week, has been sought by groups anxious to ensure the state’s rare use of the death penalty happens in a humane manner. Critics include the American Civil Liberties Union of Nevada, which is petitioning the governor to stop the impending execution of 46-year-old Scott Dozier because two possible lethal injection drug combinations under consideration have never before been used in capital punishment.

Clark County District Court Judge Jennifer Togliatti ordered last week that the third drug in the lethal cocktail shouldn’t be used, and the Nevada Department of Corrections is appealing that decision to the Nevada Supreme Court. The execution, originally scheduled to take place on Tuesday, is now on indefinite hold pending a further order of the high court.

Dozier, who was convicted of two murders in the early 2000s, has insisted he wants to be executed and has voluntarily given up further appeals. If he chooses, he could halt the process, although he told a judge last week that that wouldn’t happen.

Here are some key details in the manual:

WHO ATTENDS

The head of the prisons, James Dzurenda, must attend the execution, and he must invite several other people: a physician, the White Pine County Coroner (the execution will take place at Ely State Prison), a psychiatrist and at least six “reputable citizens” over the age of 21.

Others who can attend include the White Pine County sheriff, a mortician, the spiritual adviser to the inmate or prison chaplain, and the district attorney of the county where the inmate was sentenced (in this case, Clark County District Attorney Steve Wolfson).

Officers from the Nevada Department of Public Safety and the White Pine County Sheriff’s Office are also directed to be on the prison grounds for the execution. Attorney General Adam Laxalt or his designee is also supposed to attend.

Dzurenda can set a maximum number of attendees for the execution, but must give preference to family members of the victim (in this case, Jeremiah Miller) who requested to attend.

Dozier’s family members can arrive at 10 a.m. on the day of the execution, while Miller’s family members can arrive at 4:30 p.m. and media are not allowed in until 5 p.m. Witnesses are allowed to view the execution once the inmate has been secured to the execution table and prepared for the procedure.

Details about prison security, traffic control and parking for various types of witnesses have been redacted.

MEDIA COVERAGE

The inmate is allowed to do interviews with the media if he wants to and if his attorney approves. Those can happen within one week of the scheduled execution date and take place in an area designated for visits and interviews, or they can be conducted by phone.

The inmate has the right to cut off an interview at any time, and the inmate may be restrained or kept in a non-contact visitation setting during the interaction. The number of journalists allowed in prison may be limited, and media members must submit to an examination that includes a clothed body search and a metal detector inspection.

The director of the prisons has sole discretion to determine whether a journalist can witness the execution, and courtroom artists are not allowed. Journalists watching the execution cannot bring cameras, recording devices or cellphones into the area where the execution will take place, and they’re not allowed to interview any other witnesses on prison property.

ADMINISTERING THE DRUGS

The manual specifies that the type of drugs used in the execution and the proposed dosages should not be withheld from the public or the inmate. Dzurenda is supposed to consult with the state’s chief medical officer to ensure that the combination is strong enough to kill the inmate.

The warden or a deputy director is responsible for ensuring medical equipment needed at the execution, including a backup cardiac monitor, is on site. That person also needs to make sure the lethal injection drugs arrive at Ely State Prison no later than the day of the execution and are in a secure area that’s temperature controlled and in compliance with manufacturer specifications.

An attending physician or other qualified medical personnel are supposed to oversee the preparation and labeling of the lethal drugs. Syringes for each must be color-coded: Red is for the sedative diazepam (also known as Valium), white is for the opiate fentanyl and blue is for the paralytic cisatracurium.

There must be four syringes of diazepam totaling 100 mg, at least 15 syringes of fentanyl totaling 7,500 micrograms and at least 10 syringes of cisatracurium totaling 200 mg.

Officials must check the medical equipment in the chamber before the execution, although the frequency of those checks has been redacted from the manual provided to the public.

FINAL PREPARATIONS

Two weeks before the execution, a warden is supposed to meet with the inmate to conduct a detailed interview that will inform the death certificate. The warden must also take down the inmate’s request for a final meal (which must come from the standard Nevada men’s prison menu), select a personal spiritual adviser if the inmate chooses and determine how the inmate’s property will be distributed after death.

One week prior, all staff involved must attend a meeting about the operation plan and do a full equipment check and event rehearsal that includes testing restricted phone lines.

After the inmate is moved to a pre-execution holding cell — a process that is recorded with a hand-held camera — he will be positively identified, moved to a unit shower and given an entirely new set of clothes consisting of jeans, a short-sleeved button-down shirt, socks, underwear and tennis shoes, but not a T-shirt.

The inmate’s personal property is loaded on a cart and then thoroughly searched and inventoried in front of him before the inmate signs the list. The property is disposed of according to the arrangements previously made with staff.

Although it is unclear exactly when these events take place due to redactions, the inmate at some point is taken to the yard to spend an hour of supervised recreational time. After that, he’s taken to a shower and given shower shoes, soap, shampoo, a comb, a towel, toothpaste, a toothbrush and toilet paper.

The inmate is given another totally new set of clothing after his shower. At all times, the protocol says, the inmate must be under direct visual observation of at least two officers and is positively identified at several times in the process.

THE DAY OF

The inmate is given a standard breakfast and a sack lunch on the day of the execution, and the selection of the meals is recorded on video. He will get recreation time and a shower, then time in a holding cell where he can write letters, make phone calls and receive visits, including from a spiritual adviser.

An inmate may request a sedative on the day of the execution. Although it is not mandatory, the medication “is intended to provide a calming effect and shall not cause any lack of cognitive ability, incoherency or incompetence.”

The preparation and delivery of the inmate’s final meal must be videotaped and comply with the inmate’s wishes. It’s supposed to be served at 3 p.m.

After that, the inmate can make final calls to his immediate family and attorney, or send out letters to the media with supplies provided by prison officials. Prior to cancellation, Dozier’s execution was scheduled for 8 p.m. on a Tuesday night.

THE EXECUTION

Because of redactions, it is unclear how many staff teams are formed to carry out the execution, although the list of teams includes execution management, guest witnesses, medical aid and debriefing. Others involved include wardens, a timekeeper, a public information officer, nurses and a chaplain.

The protocol gives detailed instructions on how an EMT is supposed to find a vein for IV insertion and then attach the inmate to a cardiac monitor.

Once the medical team leaves the chamber and only the warden is left in the room, lights are dimmed and the blinds of the execution area viewing rooms are opened. The inmate can then say his last words, which are captured on a digital audio recorder.

Throughout the execution, a doctor and other medical personnel are supposed to evaluate the connection between the IV sites and the drip system to ensure they’re not compromised.

Execution staff administer the diazepam first, checking in between doses whether the inmate responds to verbal stimuli (such as moving his fingers, giving a thumbs up or opening his eyes). When the inmate stops responding to verbal cues, the administration of fentanyl begins, but if the inmate is still responding after all the diazepam is given, staff can either wait for it to take effect, start another IV, give more diazepam, begin injecting fentanyl or halt the execution.

Next, 10 syringes of fentanyl, or 5,000 micrograms, are administered within two minutes. Ninety seconds later, medical personnel will try to elicit a response through the “painful stimuli” of a “medical grade pinch.”

If there’s still a response, five more syringes of fentanyl — 2,500 micrograms — are administered, and if there’s still a response after that, the director will consult with the attending physician. Options at that point are waiting for a short period of time, starting another IV, giving more fentanyl, halting the execution or giving the cisatracurium.

Five syringes of the paralytic are supposed to be delivered to the inmate within a minute. After five minutes, another five syringes are administered.

Once all the medication is given to the inmate, a cardiac monitor is turned on, and the medical personnel will watch it until all signs of electrical activity in the heart cease.

At that point, the coroner is brought in to confirm that the inmate is dead and pronounced the time of death, based on clocks in the execution room. Blinds to the viewing room will be lowered, and lights are turned back on.

STOPPING THE EXECUTION

There are a number of ways a planned execution could be stopped, according to state law. There could be a further court appeal, or a determination that the inmate is pregnant, “insane” or “mentally retarded,” according the statute.

The manual provides a process for determining whether an inmate falls in either of those categories, and also a process for issuing a replacement death warrant if an execution isn’t carried out on the date previously planned.

The governor could grant a temporary stay, or the Board of Pardons Commissioners — which the governor chairs — could issue a pardon or a commutation (sentence reduction).

Confidential phone lists of land lines and backup cell phones must be prepared so the governor, attorney general, judge and other court personnel can be reached immediately as the execution nears. Five cell phones must be on hand for use in case there are issues with land lines.

The execution can be stopped midway through, but the protocol notes that doing so could mean the inmate’s respiratory and cardiovascular system may be damaged. If that happens, “all reasonable attempts to save the inmate’s life will be made,” the manual says.

The inmate could also be transported in an ambulance to the nearest emergency room for care.

If there’s a last-minute commutation of the death sentence or an authority orders a stay, the inmate is returned to a holding area and execution personnel are directed to stay on duty until they’re released. In that case, the attorney general is notified as soon as possible.

In the event the inmate doesn’t respond to the drugs as planned, the director can pause the procedure, close the viewing room blinds and consult with the attending physician. If the execution resumes, the blinds must be reopened before proceeding.

AFTER DEATH

After the inmate dies, witnesses viewing the execution are escorted out in a designated order. Official witnesses and victim’s family witnesses are provided with counseling services afterward if they choose.

An associate warden helps the coroner complete the death certificate, ensures that a mortuary vehicle driver signs a body disposition document and checks that a copy of the cardiac monitor’s memory card or a recording of the monitor’s activity is placed in the inmate’s execution file.

The White Pine County coroner is charged with collecting items such as needles and tubes that were connected to the inmate, and must take at least one photo of the executed inmate’s face for identification purposes.

The inmate’s body is then placed in a body bag and into the mortuary vehicle. At some point, it will be transported to the Clark County Coroner’s office.

Staff that is involved in the execution must meet at the chapel for a mandatory debriefing and is offered the services of clergy and psychologists.

All documents and recordings related to the execution are placed in an execution file, forwarded to the warden’s office and then later sent to the office of the prison system’s deputy director of operations for safekeeping.

Nevada Execution Manual by Michelle Rindels on Scribd