Nothing brings out the armchair quarterbacks quite like a tragic situation where errors were made, and the guilty verdicts in the trials of two Aurora (CO) Fire Department paramedics criminally charged in the Elijah McClain death in Colorado have certainly revealed these individuals. The EMS public has been flooded with commentary from authors and speakers who are calling balls and strikes on Jeremy Cooper and Peter Cichuniec, discussing what should and should not have been done.
Sir Arthur Conan Doyle, the creator of Sherlock Holmes and the resulting body of literature from that character, said “It is easy to be wise after the event.”1 Therefore, a word of admonition to the post hoc judges looking at the McClain matter: you do not know what you would have done in that scenario unless you were in the very same situation under the very same circumstances.
Related: ‘Problem or Patient?’ What the Paramedic Verdicts in the Elijah McClain Case Can Teach Us All
A review of the video from that evening in August 20192 showed a chaotic mess of multiple police officers, flashing lights everywhere, and uncoordinated command about who was in charge. Any person claiming that he or she would have done all the right things at all the right times will also probably try to sell you beachfront property in Wyoming, too.
This is not going to be another rebuke of Cooper and Cichuniec – that has been done ad nauseum. Instead, it will propose a more radical solution if and when EMS workers are faced with another situation similar to that of the Elijah McClain case: EMTs and medics walk away. No more will EMS be the cleanup crew for law enforcement.
Just Walk Away
What readers must think upon comprehending those words: just walk away. The arrogance! The lack of care and compassion! The audacity! Or stupidity!
Really?
Consider the following: the two best pieces of information about the McClain events are the incident video itself3 and the summary report titled “Investigation Report and Recommendations: City of Aurora, Colorado”4 prepared by the Washington Lawyers’ Committee for Civil Rights and Urban Affairs at the request of the Aurora city government. Both the video and the report agree that the decision to stop, investigate, detain and arrest Mr. McClain was incredibly fast – less than one minute of interaction. Mr. McClain’s agitated response to this was equally rapid. His agitation was perceived by officers as resisting, and the cycle of force-resistance escalated. The Aurora Police made this mess. EMS was dragged into it after it became a disaster.
How about this? It is unknown whether Elijah McClain was a patient in the EMS sense of the definition. Both the Aurora Fire and Denver Metro EMS protocols state that, to categorize a patient, a “3rd party caller indicates [an] individual is ill, injured or gravely disabled.”5 Aurora Police informed the paramedics that Mr. McClain exhibited all the bells and whistles of “excited delirium.” Elijah McClain said nothing about his health condition(s).
However, he made coherent statements at the scene (a number in the presence of paramedics), responded to most questions appropriately and, while obviously tense and trying to move, was readily subdued by one officer applying restraint techniques. True, Mr. McClain vomited; however, this fact, standing in isolation alone, does not automatically constitute a life threat making someone a patient, and should only prompt further investigation by reasonable medical personnel.
Consider this also: an amended medical examiner’s report, the trial jury and the greater public have concluded that Elijah McClain died from the toxic effects of a ketamine overdose.6 Not an underlying respiratory condition, a cardiac problem or anything else – ketamine. It stands to reason that if Elijah McClain had not received the 500 mg intramuscular ketamine injection on that August 2019 night, he’d be alive.
One more fact to ponder: the time elapsed between when Aurora Fire personnel first encountered Elijah McClain and he went into cardiac arrest was approximately 14 minutes.7 The distance between where he was stopped in Aurora and the University of Colorado Medical Center – Anschutz Campus (a Level One trauma center) is 1.7 miles. It is less than an eight minute drive under normal traffic conditions for an average person driving a car between those points.
How about this? The person with the highest and best training to manage Mr. McClain’s psychological situation was not any EMS personnel – it was Aurora Police Officer Jason Roedema. After all, he was the one officer convicted of criminally negligent homicide and third-degree assault in the McClain matter.
More from the Author: Twenty Minutes? Thirty? Forty? EMS Liability for Delayed Response Times
He completed Crisis Intervention Team (CIT) training prior to the McClain encounter.8 This certification requires completion of a five day, 40 hour course focusing on law enforcement responding to scenes involving mental health crises.9EMS training for mental health problems? The standards set by the Commission on Accreditation of Allied Health Programs for paramedics sets no minimum training time for behavioral emergencies.10 Colorado only required six hours’ training in medical/behavioral emergency patient assessment and management every three years.11
And the final consideration? The Elijah McClain incident happened at the worst possible time for the accused. It occurred on August 24, 2019 – in the wake of a string of high profile deaths in police custody where race was a public consideration (these include Freddie Gray, Philando Castile and Eric Garner). The area district attorney had already reviewed the McClain matter and concluded that he could not prove any violation of criminal laws beyond a reasonable doubt against the involved police – EMS personnel were not even a consideration.12 An online petition with six million signatures prompted the Colorado governor to issue an executive order to have the case re-examined, which the state attorney general did via a grand jury – a move that was described as “unprecedented.”13 The resulting prosecution was looking for someone to hold responsible, and did not differentiate between those who had guns and handcuffs and those who did not.
What If EMS Had Just Walked Away?
So, let’s play hypothetical: what if paramedics Cooper and Cichuniec had approached the scene, asked police for a detailed explanation of how Elijah McClain ended up in that place and got an explanation indicating that police made him agitated? What if they spoke with Mr. McClain, discovered he was alert and oriented and had no complaints, but only wanted cops to get off him so he could sit more comfortably and breathe better?
At this point paramedics could have justifiably said: “He is your problem. You made him this way – you solve it.” Police could have loaded Mr. McClain into a patrol car in an upright position, driven him the 1.7 mile / eight minute trip to CU Anschutz and there would have likely been a very different outcome to this whole affair.
Instead, we now have the hand-wringing of the entire EMS industry about what the paramedics did or did not do, and no one is asking the question of whether or not this should have been an EMS problem in the first place. And we should for the simple reason that no one knows what future scene under similar circumstances is going to be the political or societal controversy that could end in criminal charges for a bad outcome. With 61.5 million citizen-police encounters annually, the odds favor this scenario will happen again.
The Cooper/Cichuniec verdict is a game changer. One media source said it was “exceedingly rare” for emergency medical technicians to be criminally charged in relation to field medical care, and a guilty verdict in the trial would have a “chilling effect” on EMS.14
Well, the EMS environment’s climate is now very chilly. One avenue for solutions is what is currently happening – discussions about what providers should or should not have done at the scene. The industry needs to discuss whether or not EMS should even been dealing with these specific types of calls in the first place.
References
1. https://www.goodreads.com/quotes/tag/hindsight, p. 2
2. https://youtu.be/q5NcyePEOJ8?si=F2JB3KbGxAeZudV8
3. Id.
4. Smith, J. et al. (2021). Investigation Report and Recommendations: City of Aurora, Colorado. Washington Lawyers’ Committee. https://www.washlaw.org/independent-investigation-report-and-recommendations-to-aurora-city-council-regarding-elijah-mcclain-case/
5. Aurora EMS Protocols, Jan. 24, 2022. https://www.auroragov.org/residents/public_safety/fire_rescue/emergency_medical_services; General Guidelines 0070. Denver Metropolitan Prehospital Protocols, Jul. 17, 2023. https://www.dmemsmd.org/protocols. General Guidelines 0070.
6. This conclusion is disputed. The original 2019 autopsy concluded the cause of death was undetermined; however, that was later amended in September 2022 to indicate “ketamine toxicity” as the cause of death. Hampton, D. and Ortiz, E. (Sept. 22, 2022). Elijah McClain’s death caused by ketamine injection, amended autopsy report says. https://www.nbcnews.com/news/us-news/elijah-mcclains-death-ketamine-injection-amended-autopsy-report-rcna49024.
7. Smith, J. et al. (2021). Investigation Report and Recommendations: City of Aurora, Colorado. Pp. 47, 61.
8. Id. at p. 143.
9. Bureau of Justice Assistance. Training for Police-Mental Health Collaboration Programs. https://bja.ojp.gov/program/pmhc/training
10. CAAHEP, Standards and Guidelines for the Accreditation of Educational Programs in the Emergency Medical Services Professions (effective through Dec. 31, 2023).
11. 6 CCR 1015-3, Sec. 5.3.3(A)(1)(b)(vii) (2021).
12. CBS News (Jun. 25, 2020). Elijah McClain Death: District Attorney Says Evidence Does Not Support Homicide Ruling. https://www.cbsnews.com/colorado/news/elijah-mcclain-death-district-attorney-dave-young-evidence-does-not-support-homicide-ruling/
13. Paul, J. (Jan. 8, 2021). Colorado attorney general opens grand jury investigation into Elijah McClain’s death. Colorado Sun. https://coloradosun.com/2021/01/08/elijah-mcclain-grand-jury-colorado-attorney-general/
14. Tucker, E. (Dec. 17, 2023). Paramedics are rarely charged if someone they’re treating dies. The Elijah McClain trial is testing that. CNN.com. https://www.cnn.com/2023/12/17/us/elijah-mcclain-aurora-colorado-paramedics-criminal-trial/index.html
This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS.
