The ongoing trial of two Colorado paramedics, charged with negligent criminal homicide in the wake of Elijah McClain’s 2019 death, holds both professional and personal significance for me. Located just a few miles from my home, in the same county where I reside, this trial unfolds in the state where I previously served as the state EMS director.
Although I am not personally acquainted with the individuals involved, my professional path and deep connections to the community provide a unique lens through which I view this case. Having the opportunity to be present in the courtroom and connected through online streams, I perceive this trial as more than a legal confrontation; it represents a pivotal moment for reflection and growth within the EMS profession.
As an experienced paramedic, a leader on the national EMS stage, and a former state EMS official, I have been diligently monitoring each turn of the trial, keenly aware of the crucial lessons it imparts for the future of our profession, independent of the final verdict.
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As the prosecution continues to build its case against the two Colorado paramedics, the courtroom atmosphere intensifies with each passing minute. With the trial still underway and the situation evolving dynamically, several key observations have already emerged.
These insights are shaping not only the trajectory of the trial but also the broader conversation within the EMS community. Here are some of the pivotal aspects being highlighted as the prosecution methodically lays out its arguments:
Understanding Public Perception and Meeting Expectations
Throughout the trial, it has become clear that the prosecution is emphasizing a disconnection between public expectations of EMS personnel and the often-gritty reality of providing EMS care. They have pointedly highlighted instances where the EMS team didn’t conform to “typical paramedic behaviors” as perceived by the public.
This includes not immediately bringing medical equipment to the patient, foregoing an immediate hands-on assessment, and not visibly advocating for the patient. This depiction crafts a stark contrast between public expectations and the initial actions observed in this case.
While public education and community outreach are crucial for EMS, it’s equally important for us, as EMS professionals, to ensure that we consistently meet these expectations in practice. Every patient deserves a thorough assessment; we must be relentless in advocating for them. There’s no room for complacency in our field.
We must actively work to align the realities of our service with public perception, ensuring that the standard of care we provide reflects both our professional obligations and the expectations of the communities we serve.
The Imperative of Professionalism in a Digital Era
The trial, with its multitude of high-definition camera angles, serves as a stark reminder that in EMS, nearly everything we do is recorded by someone. As EMS providers, educators, and leaders, it’s essential to make our teams aware that they’re likely being recorded on nearly every call. The ubiquity of police body cameras, doorbell cameras, traffic cams, and security cams means every moment and sound could undergo frame-by-frame scrutiny.
Importantly, while recordings made by EMS personnel might be subject to HIPAA regulations, the same is not true for most other forms of footage. It’s crucial to remember that video from police body cameras, civilian devices, and other non-EMS sources is not bound by HIPAA constraints and can be freely used and distributed. This adds another layer of complexity to our operations, as such footage could become public and be utilized in legal proceedings.
This trial underscores the need for steadfast professionalism. It’s not just about being aware of being recorded; it’s about ingraining a culture of professionalism that aligns with always doing the right thing. Our commitment to professionalism must be resolute, anchored in our dedication to the highest standards of patient care and ethical conduct.
A significant opportunity lies in adapting to this reality. I’m quite convinced that if the EMS personnel at this scene had verbalized their assessments and actions more explicitly, such as stating, “I’m visually assessing the patient for breathing,” or “We are waiting for police to safely transfer the patient from their custody,” it might have significantly impacted the case.
In a world where every action might be recorded, a verbal record of decision-making and actions becomes invaluable. Defending ‘what you were thinking’ is challenging in court; however, ‘what you said’ becomes a tangible, defensible record. Thus, incorporating more verbalized communication with your team, especially during high risk patient encounters, becomes an essential practice in today’s era of ubiquitous digital recording.
Patient Advocacy in Complex Environments
The trial has brought into focus the crucial role of patient advocacy, particularly when EMS personnel work alongside other agencies such as law enforcement. This case sheds light on areas for potential improvement in EMS communication and advocacy. As leaders, it’s our responsibility to ensure that our training programs equip our teams with the necessary skills to effectively handle these complex situations.
A recurring theme in the prosecution’s narrative is the perceived lack of patient advocacy by the EMS providers involved in this case. They have depicted these providers as failing to fulfill their primary duty of medical care and advocacy for the patient, suggesting a lapse in the EMS’s role as medical experts on the scene.
Another critical aspect highlighted by the prosecution is the issue of medical consent. They’ve pointed out, “The paramedics did not even attempt to ask the patient for consent” or make efforts to obtain permission. While the defense has countered with the role of implied consent (which is difficult for jury to understand), this aspect of the trial underscores the importance of making verbal attempts to obtain consent in future similar situations.
It’s essential for EMS providers to understand and apply the principles of consent, ensuring that their approach to patient care is both medically sound and legally compliant. This aspect of the trial reinforces the need for continuous education and training in the nuances of consent and patient rights, especially in challenging and dynamic emergency environments.
Re-Evaluating and Adapting to Rapid Changes
The prosecution is using video to demonstrate the patient’s condition changed in the brief period between the EMS team’s arrival, their decision to administer medical sedation, and the actual administration of the sedation. They have used video evidence, police testimony, and expert witness accounts to demonstrate this change, that was allegedly not appreciated by the EMS responders.
This element of the trial is a crucial reminder for all EMS providers about the inherently dynamic nature of our work. Patient conditions can change dramatically, often in a matter of seconds or minutes. It’s essential for EMS personnel to maintain a high level of vigilance and continuously reassess their patients. This trial underscores the need for heightened awareness and the ability to adapt quickly. It stresses the importance of regularly re-evaluating treatment plans in response to evolving patient conditions, highlighting the critical role of ongoing assessment and the necessity to be flexible in our approach as circumstances change.
Incorporating Legal Education in EMS Training
The ongoing trial also underscores the reality that EMS actions can come under intense legal scrutiny. This situation highlights the necessity of integrating legal education into EMS training programs. Such inclusion is essential to adequately prepare our personnel for the potential legal ramifications of their decisions and actions.
While EMS curricula are already extensive, the growing need for legal awareness and education in jurisprudence for EMS personnel cannot be overlooked. Police officers, for example, often receive education related to court proceedings, trials, and testimony – an area where EMS training currently falls short.
As legal cases involving EMS providers become more frequent, it’s our industry’s responsibility to equip our providers with the knowledge and tools needed to navigate this increasingly vital aspect of their roles. By enhancing legal education within EMS training, we can better prepare our teams not only to provide top-notch medical care but also to understand and handle the legal complexities that may arise in the line of duty.
The Critical Role of Documentation and Record Keeping in EMS
The ongoing trial has already thrown a spotlight on the meticulous nature of documentation and record-keeping in EMS. The prosecution’s approach in this case, dissecting every line, field, and word of the patient care report, has been exhaustive.
They have scrutinized times down to the millisecond, questioning the source of these timestamps – whether they were auto-imported from Computer Aided Dispatch (CAD), derived from a monitor or device, or manually entered. Questions have been raised about whether the paramedics confirmed the report’s accuracy at the time and why certain details were omitted. Were these omissions due to the actions not being performed, deemed unimportant, or unprofessional? Could they be indicative of incompetence?
This level of scrutiny underscores the importance of the narrative section of EMS reports. The narrative should effectively paint a verbal picture of the scene, reflecting the challenges faced and the actions taken from the perspective of the treating EMS personnel.
The patient care narrative, when crafted accurately and comprehensively, becomes an invaluable tool. It’s more than just a formality; it’s a record that conveys the context and decision-making process of the EMS team at the time of the incident.
In light of this trial, it’s clear that EMS providers must be trained not only in the medical aspects of their roles but also in detailed, clear, and accurate documentation. The words documented at the time of an incident are invaluable, providing a real-time account that is far more reliable than retrospective analyses formed after an investigation begins or years later. This real-time documentation carries significant weight and can be pivotal in legal settings, as well as in ensuring quality patient care.
As EMS leaders and educators, we must emphasize the critical role of documentation and encourage our personnel to use the narrative portion of reports to comprehensively describe each incident. This includes detailing the environmental, situational, and patient-specific challenges they encounter. Proper documentation is not just a legal safeguard; it’s a professional responsibility that enhances the credibility and accountability of our profession.
Adapting to Changing Public Perceptions
The public perception of EMS personnel has transformed significantly since the post-September 11, 2001 era, demanding a proactive approach to rebuild and maintain public trust. The fleeting heroism associated with EMS post-9/11 and the COVID-19 pandemic highlights the need for us as a profession focusing efforts on creating a strong foundation in professionalism and education.
Historically viewed as “Good Samaritan” neighbors helping neighbors, EMS personnel are now viewed as professional medical experts in prehospital emergency care. Enhancing communication and public education is crucial.
EMS professionals must maintain high medical standards and improve interaction with the communities they serve. Professional development should extend beyond medical training to include ethics, patient advocacy, and legal considerations.
Active participation in public discourse is vital to reshape public views and values regarding EMS work. Reinforcing the image of EMS professionals as integral, well-trained, and compassionate healthcare providers is key to regaining the respect and trust the EMS profession deserves in this era of heightened expectations and legal scrutiny.
Conclusion
This ongoing criminal jury trial, involving two paramedics, reaches well beyond their individual case and casts a wide-ranging and critical eye on various elements of the EMS profession. It underscores an urgent necessity for growth and adaptability in key areas of EMS practice. These include enhancing public education and communication, bolstering professionalism, nurturing patient advocacy, augmenting legal awareness, and guaranteeing meticulous documentation.
The trial offers an invaluable opportunity for collective advancement in our field. As EMS professionals, we are tasked with embracing this moment to refine our skills, adapt to evolving public perceptions, and strengthen our commitment to the highest standard of care. By doing so, we not only uphold the integrity of our profession but also serve our communities with unmatched dedication, affirming the essential and esteemed role of EMS in healthcare and public service.
In writing this article, I’ve chosen to focus on the claims currently being presented by the prosecution. While I do not personally believe all these claims accurately represent the events, nor do I think the actions of the accused paramedics led to homicide, the lessons being highlighted are relevant to the entire EMS profession.
Reflecting on my own career, I recall instances where I did not bring equipment to the patient’s side, relied on ‘obvious’ implied consent without verbal confirmation, and recognize that my patient care reports could also be scrutinized.
Despite these realities, the accused paramedics face serious charges and are now in a battle for their freedom. This scenario profoundly illustrates the significant responsibilities and potential consequences faced by EMS professionals in their decisions and actions in the field.
I hope we as a profession are paying close attention to this case, the approach and tactics of the prosecution, so that we can better educate and prepare our colleagues. This is a pivotal moment for us to continue improving and maturing as a medical profession. By learning from this trial, we can enhance the way we train, operate, and interact with the communities we serve.
Author Disclaimer
The views and opinions expressed in this article are solely those of the author and do not reflect the positions or viewpoints of any current or former employers. This article is intended to provide personal insights and is not an official statement from any organization associated with the author.
