Have you ever been sitting in the back of an ambulance and suddenly realized you were an active participant in the main event of a WWE wrestling match? It is not a whole lot of fun. Those who work in EMS however, often find themselves in very precarious positions with no one to assist them.
Enter the role of sedative medications.
In light of the recent convictions of the EMS employees in the Elijah McClain case along with my own 16 years of experience as an EMT/Paramedic, I felt compelled to review the evidence of the case that has been available in the public domain.
I’ve been an EMS Program Director and I currently teach Managing Emergency Response Operations at the collegiate level.
There are a litany of medical reasons, protocols, and procedures which could be cited to support my opinion of this case and in the space provided I can’t go into all of them in the detail needed, but at the end of the day, this is just my opinion. That will likely upset a few (loud) folks but oddly, anger only gets distributed one way…if the opinion goes against the media narrative.
The case is seemingly over. Then jury has convicted two paramedics on criminally negligent homicide and rejected the manslaughter charges.
In my opinion: The jury got this one wrong and the outcome from this case could have serious consequences in my profession for decades to come.
The Body Camera Footage
Upon reviewing the body camera footage, I noticed several things. First, when Mr. McClain was first confronted, he was not cooperative with law enforcement. Mr. McClain became combative and, allegedly, was reaching for one of the officer’s weapons. Mr. McClain failed to comply with directives on several occasions. He then began talking about being a vegetarian and an introvert in the midst of the melee.
Mr. McClain’s behavior was bizarre.
Given Mr. McClain’s behavior, I believe EMS personnel and law enforcement were correct in assuming the individual was under the influence of drugs or possibly experiencing some sort of psychotic episode such as excited delirium. The National Institute of Health (2020) explains that “a person experiencing a psychotic episode may behave in confusing and unpredictable ways and may harm themselves or become threatening or violent toward others”[i]
The Role of Sedatives
It is in these situations where administering a sedative, such as ketamine, is appropriate. According to the body camera footage, EMS personnel administered the ketamine one hour and 47 minutes after the initial 911 call was made. This further indicates that Mr. McClain was in a persistent uncooperative state and would have been a danger to himself or to the EMS personnel had he not been sedated for transport. EMS personnel do not carry mace, tasers, handcuffs or firearms. The only tools EMS personnel have at their disposal to restrain patients are medications and some physical restraint options. The medications, arguably, are safer than any physical restraint mechanisms EMS personnel may have.
The Autopsy
Upon reviewing the autopsy report, the details are beyond the cover page. The autopsy report shares that therapeutic ketamine serum and plasma levels range from 1.0-6.3 mg/L. Mr. McClain’s ketamine level was measured at 1.4 mg/L; well within the therapeutic range. Furthermore, the medical examiner states he cannot rule out other metabolic causes of death as a result of the physiological and emotional stress of Mr. McClain’s situation. The medical examiner further states Mr. McClain’s death was tragic, would generally be considered as accidental and “I still contend the appropriate manner of death in this case is undetermined (Cina, 2021).”[ii]
Conclusion
I admit I was not in the courtroom. I do not know what evidence was presented. My heart goes out to Mr. McClain’s family. However, I simply do not understand how, given the video evidence and the amended autopsy report, the paramedics involved were convicted on homicide charges.
The autopsy revealed that Mr. McClain had a heart condition. He had a history of asthma. He had marijuana in his system and a few years earlier he was hospitalized with LSD intoxication with hyperactive behavior.
Are paramedics now subject to being arrested for murder when they follow their policy and training?
Testimony in court by one of the paramedics revealed that they did exactly what was expected of them in this situation.
“During our training, we were told numerous times that this is a safe, effective drug…That is the only drug we can carry that can stop what is going on and calm him down so we can control his airway, we can control him and the safety of him, get him to the hospital as quick as we can.”
Aurora Fire Rescue Chief Alec Oughton may have said it best, “While I appreciate the jury’s diligence, integrity and public service to ensure a fair trial, I am discouraged that these paramedics have received felony punishment for following their training and protocols in place at the time and for making discretionary decisions while taking split-second action in a dynamic environment,”
The implications of such a conviction are massive.
Paramedics, and doctors for that matter, do not know if a patient will respond to a medication adversely. The medication must be administered first and if there are any adverse events, those events must be treated. Conversely, failure to treat a patient is not without its risks and drives medicine into dangerously unethical territory.
Given the results of this case, paramedics nationwide will be questioning themselves and potentially putting their own lives endanger simply because the vast majority of this country does not understand medicine nor the danger public safety officials face when going to work every day.
Punishing paramedics for trying to help a man in crisis was simply the wrong outcome.
Graham Judd is an EMS professional with 16 years of experience as an EMT/paramedic and EMS Leader. Graham has a Master of Business Administration with a Healthcare Administration concentration and is a doctoral candidate at Liberty University. Graham has been an EMS program director and currently teaches Managing Emergency Response Operations at the collegiate level.
[i] National Institute of Mental Health. (2020). Understanding psychosis. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis
[ii] Cina, S. (2021, July 1). Office of the Coroner – Adams & Broomfield Counties, Colorado. The Office of the Coroner of Adams & Broomfield Counties, Colorado. https://officeofthecoroner.com/wp-content/uploads/2022/09/MCCLAIN-amended-autopsy-report.pdf
