Paramedic Suspected of Murdering Six Patients

A former ambulance driver accused of killing six patients in northern Italy by injecting air into them is described as a serial predator in a report by the investigative psychology section of Italy's Carabinieri police.

Luca Spada, 28, drove ambulances in the Forlì area. The report, written by RACIS specialists in Rome at the request of the Forlì prosecutor's office, says he was driven by an "obsessive, uncontrollable internal motivation" and that he selected his elderly, sick victims in a way it called compatible with a predatory, serial pattern.

Those conclusions were cited in the prosecutor's opinion and in a ruling by the judge for preliminary investigations, who over the summer turned down Spada's request to be released from prison. He has been behind bars since April 11.

Spada has rejected the accusations from the start and has said repeatedly that he is innocent.

Only one of the six deaths goes to trial on October 15

A fast-track proceeding known in Italy as an immediate trial has been ordered, with a hearing set at the Assize Court in Forlì for October 15. That case covers a single death: Deanna Mambelli, 85, who died in an ambulance on November 25, 2025.

Investigations into the other five deaths are still open. So while the number attached to this case is six, the courtroom in October will be dealing with one name, one date, and one autopsy.

Mambelli's death was the last in the run of cases investigators are examining. The autopsy on her body found she died of an embolism, and investigators consider that report the strongest piece of evidence they have.

Air, a catheter, and a stopped heart

The accusation is narrow and specific. Prosecutors allege Spada pushed air into a vein through a catheter while elderly patients were being transported in rescue vehicles, setting off a gas embolism that stops the heart.

In Mambelli's case, the allegation is that the air was injected into the catheter. She was 85 and died during the ride.

Spada was a driver and rescuer for the Red Cross at Forlimpopoli before his arrest in April. He is from Meldola, a town in the same province as Forlì. Drivers in that role are not clinicians and were not permitted to administer drugs.

The report's central finding: a pattern, not isolated episodes

What the RACIS specialists focused on was repetition. The defining feature of the case, the report says, is "a criminal behavior with a serial character," and the documents show conduct repeated over time with common, recurring elements.

The report describes an "identifiable operational scheme" that it says cannot be traced back to "single isolated or merely occasional episodes," but instead to a "behavioral scheme which is repeated over time through similar and functionally coherent methods." The specialists tie the incidents together under what they call a "compulsion to repeat."

The report sets out the traits it says are typical of people who commit offences of this kind: they tend to show "the maintenance over time of the motivations and objectives of elimination without repentance or second thoughts," along with "well-linked actions and articulated ideas" built on careful choices of victims and conscious decision-making.

The assessment is the conclusion of police psychologists. It is not a finding of guilt by a court.

Hospital visits the report flags as rehearsal

Spada's own hospital admissions drew the specialists' attention. In one case, according to the report, he is believed to have induced an embolism in himself.

Those admissions, the report says, appear to belong to a preparatory phase marked by persistent elaboration of the action, and are consistent with a kind of experimentation, verification or refinement of methods.

The document also addresses the quiet stretches. In the specialists' reading, the so-called cooling-off period, the interval in which a serial offender does not act, would not be a pause in the plan but its continuation in less visible forms that still serve the same end.

Selfies with coffins in the group chats

Between the end of 2024 and the beginning of 2025, Spada shared photos in group chats he took part in: selfies with coffins in the background, pictures of hearses, exhumations of corpses, crematoriums, all with joking captions. Those images are now in the investigation file. Work colleagues told the Forlì Carabinieri about them.

A colleague questioned as a witness described his habit of posting the macabre content from his second line of work, in a particular tone. In September 2024, one photo shows Spada in the foreground with four coffins behind him and the line "I'll accompany you to Edmondo."

In February 2025, more coffins, with the comment: "Guys, special offer! They have arrived and I don't know where to put them, if you find one to sell, give a shout." Around the same time, an image of a hearse parked in front of a mortuary carried the caption "if you want to take a ride with me, just call me." Another post showed an open coffin with the words "Today is exhumation day."

The funeral home in Meldola, and a motive that fell apart

Spada worked with a funeral home in Meldola, though there was no formal employment relationship, something that emerged at the time of his arrest in April.

Investigators dug into that side job looking for a possible motive, the theory being that deaths in the back of an ambulance might have fed business to the funeral company. They set it aside. None of the deaths listed in the files were handled by the firm Spada dealt with, though financial checks continued.

The failed bid for house arrest

His lawyers asked for house arrest, arguing that he could not repeat anything like the conduct he is accused of because the Red Cross had dismissed him in May.

Prosecutor Andrea Marchini argued the opposite, pointing to the RACIS report as evidence that the risk remains high. The judge for preliminary investigations sided with the prosecution and rejected the request, leaving Spada in prison.

He had already been in custody for months at that point. April 11 is the date he entered prison.

What the October hearing will and will not settle

An immediate trial in Italy skips the usual preliminary hearing when prosecutors believe the evidence is clear enough to go straight to court. That is the route chosen here, and the venue is the Assize Court in Forlì, the panel that handles the most serious crimes.

The October 15 hearing concerns Mambelli's death alone. A verdict there, whichever way it goes, will not resolve the five other deaths, which remain under investigation.

The status of each piece matters. Spada is charged in one death and suspected in five others. The RACIS report is an expert opinion commissioned by prosecutors, used so far to argue about whether he should stay in a cell, not to prove a killing.

Spada is 28. He has denied everything since April, including in front of the judge who kept him locked up. In October, a court will hear the case for the first time.