# Elijah McClain - medics charged



## FiremanMike (Sep 1, 2021)

So I read an article that the medics were charged in relation to this man's death.  The news story I read is that the cops wrestled him to the ground, medics arrived and administered 500mg of ketamine (which the article states is in their protocol for chemical restraint).  McClain subsequently died and now the medics are in charged.

Our dose here is 3mg/kg, so for most folks 500 would be high, but doesn't seem to be critically high.  Are there other mitigating reasons that you all know of which led to the charges?


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## Aprz (Sep 1, 2021)

I've been reading different things everywhere. My understand of it was that they failed to assess and monitor the patient post Ketamine administration, which lead to them not recognizing respiratory failure. The varying stories from media and their own interpretation, mainly criminalizing Ketamine, makes it too hard to accurate assess what happened.


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## E tank (Sep 1, 2021)

FiremanMike said:


> So I read an article that the medics were charged in relation to this man's death.  The news story I read is that the cops wrestled him to the ground, medics arrived and administered 500mg of ketamine


...what a way to go...


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## DrParasite (Sep 1, 2021)

Grand jury indicts police officers and paramedics in 2019 death of Elijah McClain | CNN
					

A Colorado grand jury indicted three police officers and two paramedics involved in the August 2019 death of Elijah McClain, a 23-year-old Black man who was stopped by police while walking home from a store, placed in a carotid hold and then injected with ketamine, Colorado Attorney General Phil...




					www.cnn.com
				




from the article:


> The indictment is in sharp contrast to prosecutors' initial conclusions in the case. In 2019, Adams County District Attorney Dave Young declined to bring criminal charges because he said prosecutors lacked evidence to prove the officers caused McClain's death or that their force was unjustified.
> But McClain's story gained renewed attention last June after the police killings of George Floyd and Breonna Taylor and the rise of the Black Lives Matter movement. Spurred by protests in Aurora and a viral online petition, Gov. Jared Polis announced a re-examination of the case last year. Weiser was appointed as special prosecutor and opened a grand jury investigation into the case in January.


Translation: the facts/evidence haven't changed, but the Governor is going to put these officers and paramedics through hell to score political points during the next election.  and when they are found not guilty based on the facts, more protests will happen, unfounded claims of racism, and it will further cause divisions between certain groups in this country, which will further aid in fundraising for the governor's PAC.

While his death is a tragedy, the facts didn't support indictments then, and likely don't support them now.  But since a prosecutor can get a grand jury to indict a ham sandwich, it's great for media clicks, so the political pundits can get further cause division, and at the end of the day, 5 public safety professionals will have their careers ruined over this.


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## CCCSD (Sep 1, 2021)

I guess it’s true…ketamine is a racist drug. Ban all drugs.


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## E tank (Sep 2, 2021)

Not to sound cliché, but effective sedation is an 'art', it can't be achieved by rote algorithm and there are times and places for it. A fight with the cops isn't one of them. 

That it was even available for consideration is at the root of this catastrophe. Progressive protocols are popular with a lot of folks in terms of job satisfaction, but they cut both ways. Can't speak for the cops, but the medics were put in an awful position, they were way out of their depth (if the dose was any indication) and the EMS medical director(s) should be ashamed of themselves. And they sure as hell better be subpoenaed for trial.


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## MonkeyArrow (Sep 2, 2021)

I have seen a lot of people speculate on this being an “overdose” of ketamine. 5 mg/kg rounded up to 500 mg is an increasingly common agitated sedation dose given in EDs, and there is some literature and FOAM etc. that supports the dosing.

Now we can argue the semantics of what an overdose means. Was it an overdose in terms of quantity of medication intended vs quantity delivered? Doesn’t look like it. Was it an overdose in terms of the quantity of medication causing untoward adverse effects? Maybe.

I think focusing on the quantity of medication delivered is the wrong avenue to judge the actions of these paramedics. It’s more relevant, IMO: 1. What prompted them to administer the med in the first place? (I.e. Did they push it because the cops told them to or because they independently assessed the patient and felt the patient met the indications for ketamine administration for sedation?) 2. What did post-sedative monitoring look like? Did their monitoring of their now-sedated patient meet standard of care or was it negligent? Even if you cause apnea due to ketamine/benzos/opioids, with prompt recognition, you should be prepared and able to manage the airway: position the airway and bag through it.

The latter point is the critical one to me. Agitated delirium, even though that’s an umbrella diagnosis that has problems with definition, has a reportedly high morbidity and mortality in the literature. It is conceivable that the patient could still arrest due to his primary agitated delirium, and not secondary to respiratory depression/arrest from medication administration. Obviously, I wasn’t there, so who knows if we’ll ever know what happened.


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## SandpitMedic (Sep 2, 2021)

What a load of ****.


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## silver (Sep 2, 2021)

MonkeyArrow said:


> I have seen a lot of people speculate on this being an “overdose” of ketamine. 5 mg/kg rounded up to 500 mg is an increasingly common agitated sedation dose given in EDs, and there is some literature and FOAM etc. that supports the dosing.


Still is an overdose when you realize he weighed <65kg.

I've used substantially smaller IM mg/kg doses as my induction dose for general anesthesia.


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## EpiEMS (Sep 2, 2021)

Seems like some trumped up charges, at least, based on the info publicly available. 

Also PWW has some good commentary: https://www.ems1.com/legal/articles...h-mcclain-case-mean-for-ems-wIPxkOn0Hn4ToKVk/


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## Carlos Danger (Sep 2, 2021)

silver said:


> Still is an overdose when you realize he weighed <65kg.
> 
> I've used substantially smaller IM mg/kg doses as my induction dose for general anesthesia.


But NO! Aren’t you aware that ketamine is the best option for everything and has zero negative effects?!? Even in very large doses??

If you didn’t know that you seriously need to start spending more time listening to FOAMed. Weingart, et al would be disgusted by you.


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## FiremanMike (Sep 3, 2021)

Carlos Danger said:


> But NO! Aren’t you aware that ketamine is the best option for everything and has zero negative effects?!? Even in very large doses??
> 
> If you didn’t know that you seriously need to start spending more time listening to FOAMed. Weingart, et al would be disgusted by you.


For the record I wasn't supporting the dose, and I did not know his weight, I was merely sharing that I've seen 500mg IM given before without resulting in death.


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## Carlos Danger (Sep 3, 2021)

FiremanMike said:


> For the record I wasn't supporting the dose, and I did not know his weight, I was merely sharing that I've seen 500mg IM given before without resulting in death.


I know. My sarcasm wasn’t directed toward anything anyone posted here. Just the general (false) notion that has taken hold in the past handful of years in the ED/EMS community that ketamine is the solution to every problem.


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## VentMonkey (Sep 3, 2021)

Carlos Danger said:


> I know. My sarcasm wasn’t directed toward anything anyone posted here. Just the general (false) notion that has taken hold in the past handful of years in the ED/EMS community that ketamine is the solution to every problem.


The tide is turning in the prehospital world regarding Ketamine’s favorable profile.

I’ll let everyone get back to the politics regarding this thread now and continue to keep my opinions private. All of it is pretty deplorable and old in general. Society, blah.


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## Kevinf (Sep 5, 2021)

The transcript I read shows poor handling of an anxious but non-violent neurodivergent individual by what should be trained professionals. He appeared to have been stopped for walking while black because there doesn't seem to be any other reason for the stop than, "you were outside and that's suspicious". While he was nervous and anxious, that isn't a reason for slamming a patient with a large dose of ketamine because anyone would likely have been nervous and anxious if placed into the same situation.

The whole thing was handled poorly by the professionals involved, and that resulted in the death of someone in their custody and care. The only failure of justice here was the fact that it was initially swept under the rug. There doesn't appear to have been good cause of this person to have been stopped, restrained, and sedated at all and it appears to have resulted in a needless death. Based on my read of the facts at hand, negligence and involuntary manslaughter sound appropriate here at minimum.


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## Bullets (Sep 6, 2021)

From reading the documents available it seems that the real issue here is that the medics: Failed to perform an initial assessment, administered a medication that wasnt clinically indicated, failed to monitor that patient appropriately, and then missed a decline in patient status due to that lack of ongoing assessment. 

Are these things professionally inappropriate? Id say yes. Are the negligent? id also say yes. Do they amount to a crime? I think theres a case to be tried. If half of what is claimed is accurate, these guys screwed up


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## FiremanMike (Sep 6, 2021)

Kevinf said:


> He appeared to have been stopped for walking while black because there doesn't seem to be any other reason for the stop than, "you were outside and that's suspicious".


This is factually incorrect.  There was a call made to police that there was a black man with a ski mask waving his arms and acting suspicious.  The first officer in the area of the call found a black man wearing a ski mask and made contact based on the call and the description.


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## FiremanMike (Sep 6, 2021)

I just read through the part of the 157 page report that addressed fire/EMS involvement and honestly I think everyone needs to sit down and really ponder the implications of criminal charges filed against the medics.

The determination of giving ketamine is unclear, as the report seems to contradict itself by simultaneously saying McClain wasn’t moving before giving ketamine while also saying he was still actively resisting and required force to sit still for the injection.  What I can say from my own experience is that when we roll up on a dogpile of cops holding someone down who’s still squirming, I’ve never questioned them “are you _sure_ he was resisting?” - and I’d bet that’s the case for you all too, if you’re being honest.

After the ketamine was given, the next few minutes played  out the way ketamine runs usually play out.  Let him calm down, ensure he’s sedated, move him to the truck to start monitoring.  Unfortunately, McClain arrested when they got him to the truck and that was it.


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## Kevinf (Sep 7, 2021)

FiremanMike said:


> This is factually incorrect.  There was a call made to police that there was a black man with a ski mask waving his arms and acting suspicious.  The first officer in the area of the call found a black man wearing a ski mask and made contact based on the call and the description.


This is literally "walking while black" because it's NOT illegal to wear a ski mask OR wave your arms in the air to music OR to be outside doing those things. Also in my opinion it is not particularly suspicious because; does someone with ill intent walk around with a ski mask on and draw attention to themselves, or do they keep the ski mask hidden away and try to draw as little attention as possible until just before they are ready to commit their nefarious deeds?

Let's not forget that a black man had the police called on him by a Karen for walking in the park in broad daylight and it made national news and became a meme. Another black man out for a jog was killed by two vigilantes and the DA is now under arrest and investigation for covering it up. Context matters.


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## ffemt8978 (Sep 7, 2021)

Kevinf said:


> This is literally "walking while black" because it's NOT illegal to wear a ski mask OR wave your arms in the air to music OR to be outside doing those things. Also in my opinion it is not particularly suspicious because; does someone with ill intent walk around with a ski mask on and draw attention to themselves, or do they keep the ski mask hidden away and try to draw as little attention as possible until just before they are ready to commit their nefarious deeds?
> 
> Let's not forget that a black man had the police called on him by a Karen for walking in the park in broad daylight and it made national news and became a meme. Another black man out for a jog was killed by two vigilantes and the DA is now under arrest and investigation for covering it up. Context matters.


Your opinion as to why walking around with a ski mask waving your arms around not being suspicious is just as valid as those who think it is suspicious behavior.  Race may or may not have played a factor into why someone called the police to report it, but once they were called law enforcement has an obligation to at least check on him.

The rest of your post has absolutely nothing to do with this particular case.  If you think race played a part in the medics actions in this case, prove it.  Otherwise save it for Reddit.


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## FiremanMike (Sep 7, 2021)

Kevinf said:


> This is literally "walking while black" because it's NOT illegal to wear a ski mask OR wave your arms in the air to music OR to be outside doing those things. Also in my opinion it is not particularly suspicious because; does someone with ill intent walk around with a ski mask on and draw attention to themselves, or do they keep the ski mask hidden away and try to draw as little attention as possible until just before they are ready to commit their nefarious deeds?
> 
> Let's not forget that a black man had the police called on him by a Karen for walking in the park in broad daylight and it made national news and became a meme. Another black man out for a jog was killed by two vigilantes and the DA is now under arrest and investigation for covering it up. Context matters.


Police were called on someone acting suspicious, they found someone matching the description, so they stopped and tried to talk to him.

The police didn’t invent this call, they were called to investigate a complaint and attempted to do so.


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## DrParasite (Sep 7, 2021)

Kevinf said:


> This is literally "walking while black" because it's NOT illegal to wear a ski mask OR wave your arms in the air to music OR to be outside doing those things.


That is literally not, because the cops didn't start this call; they were responding to a 911 complaint.  Unless you are saying that cops (or dispatchers) should simply ignore certain requests for service based on the color of a person's skin?   because that sounds kind of racist....


Kevinf said:


> Also in my opinion it is not particularly suspicious because; does someone with ill intent walk around with a ski mask on and draw attention to themselves, or do they keep the ski mask hidden away and try to draw as little attention as possible until just before they are ready to commit their nefarious deeds?.


Let be honest... in the last 10 years, how many times have you seen a person walking around with a ski mask on, in an urban area?  assuming the answer is less than 10 times a year, it's a once-a-year event... doesn't that make it unusual and worthy of investigating why?


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## GMCmedic (Sep 7, 2021)

Kevinf said:


> This is literally "walking while black" because it's NOT illegal to wear a ski mask OR wave your arms in the air to music OR to be outside doing those things. Also in my opinion it is not particularly suspicious because; does someone with ill intent walk around with a ski mask on and draw attention to themselves, or do they keep the ski mask hidden away and try to draw as little attention as possible until just before they are ready to commit their nefarious deeds?



Wearing a ski mask in August is suspicious behavior in any context unless you live in Antartica.


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## DesertMedic66 (Sep 7, 2021)

Kevinf said:


> This is literally "walking while black" because it's NOT illegal to wear a ski mask OR wave your arms in the air to music OR to be outside doing those things. Also in my opinion it is not particularly suspicious because; does someone with ill intent walk around with a ski mask on and draw attention to themselves, or do they keep the ski mask hidden away and try to draw as little attention as possible until just before they are ready to commit their nefarious deeds?
> 
> Let's not forget that a black man had the police called on him by a Karen for walking in the park in broad daylight and it made national news and became a meme. Another black man out for a jog was killed by two vigilantes and the DA is now under arrest and investigation for covering it up. Context matters.


Sure it’s not illegal to be wearing a ski mask around town nor waving your hands around. But if I drive by and see someone doing that, I am going to think it is very odd. Someone decided to call 911 to have the police investigate.

It doesn’t mean he has to have ill intent to be walking around with a mask. It just means it was odd and a citizen felt it was best to have the police department investigate the incident. Think of how often this actually happens. People call because they see an odd vehicle in their neighborhood. There has been a huge push for “if you see something, say something”. I think it is a huge stretch to say in this specific instance it was a “walking while black” that lead up to it. 

What if the subject was a known psych patient who went off their meds? You won’t know until the police do their investigation.

You also do not need to be a licensed bank robber to by a ski mask.


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## Jim37F (Sep 7, 2021)

Just gonna point out, in some places it IS actually illegal to be going around wearing a ski-mask....









						Are Ski Masks Illegal? (Anti-Mask Laws) | New To Ski
					

this article has not yet been updated since the pandemic. It’s not uncommon to see skiers and snowboarders donning full-face ski masks both on the...




					newtoski.com


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## ffemt8978 (Sep 7, 2021)

Now that we've gone down that rabbit hole, let's get back on topic please.


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## Kevinf (Sep 7, 2021)

He did nothing wrong of note, and was probably highly confused by the fact that he had headphones in that he couldn't remove easily due to his headwear and likely couldn't hear instructions well or at all. "Wellness checks" should not end with a living person becoming a dead person, so I'm sure his family is glad that someone called to have the police make sure he was alright. I think this situation to be less likely to play out in a country that has a properly trained police and medical force, so maybe we should up our own standards instead of saying "well what can you do, these things happen." And I say that based on the PER CAPITA police involvement deaths and higher levels of training and education involved to be a medical first responder in most other developed countries.

If this had happened to YOUR child or SIBLING you would be furious. This death and others need to be looked at long and hard, and believing it doesn't is saying that you're happy with the lack of education required of our police and EMS services.


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## ffemt8978 (Sep 7, 2021)

Kevinf said:


> He did nothing wrong of note, and was probably highly confused by the fact that he had headphones in that he couldn't remove easily due to his headwear and likely couldn't hear instructions well or at all. "Wellness checks" should not end with a living person becoming a dead person, so I'm sure his family is glad that someone called to have the police make sure he was alright. I think this situation to be less likely to play out in a country that has a properly trained police and medical force, so maybe we should up our own standards instead of saying "well what can you do, these things happen." And I say that based on the PER CAPITA police involvement deaths and higher levels of training and education involved to be a medical first responder in most other developed countries.
> 
> If this had happened to YOUR child or SIBLING you would be furious. This death and others need to be looked at long and hard, and believing it doesn't is saying that you're happy with the lack of education required of our police and EMS services.


Nobody is disagreeing with this, especially the training aspects of it.  But should a lack of training, as you put it, form the basis for criminal charges?


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## Kevinf (Sep 7, 2021)

What happened to personal responsibility? Police and EMS personnel in this country accept that we are put on the streets given relatively minimal training and if you want to work that job, you have to accept the mistakes you make that could have been avoided with better training. The only way out of that is to demand higher standards, and that won't happen until accountability for needless negative outcomes are routine. Hold some feet to the fire and perhaps fewer will be willing to work the job for the minimal compensation (pay, mental health care, long/poor hours, etc) with minimal education and our vocation can actually see systemic improvements.

As to there being a basis of criminal charges, we have a judicial system that will decide that. When there are criminal charges involved, the officers and medics can be judged by a jury of their peers. I'm sure Elijah would have preferred to be judged by 12 versus carried by 6 but he won't get that chance... the officers and medics will though.


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## FiremanMike (Sep 7, 2021)

Also, it is NOT normal to be wearing a ski mask in August..


Kevinf said:


> What happened to personal responsibility? Police and EMS personnel in this country accept that we are put on the streets given relatively minimal training and if you want to work that job, you have to accept the mistakes you make that could have been avoided with better training. The only way out of that is to demand higher standards, and that won't happen until accountability for needless negative outcomes are routine. Hold some feet to the fire and perhaps fewer will be willing to work the job for the minimal compensation (pay, mental health care, long/poor hours, etc) with minimal education and our vocation can actually see systemic improvements.


Two questions for tou

1. What do you think should have happened when someone called the police to report a suspicious person and the police find a person matching that description.

2.  Do you feel medical errors should be treated as criminal charges?


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## Kevinf (Sep 7, 2021)

FiremanMike said:


> Also, it is NOT normal to be wearing a ski mask in August..
> 
> Two questions for tou
> 
> ...


All of that is up to the oversight for the personnel involved whether that be managerial or judicial. I think that I shouldn't die because I'm neurodivergent and the police can't handle that. Our country's police uses force far too easily, in the video you can see he went hands on immediately when Elijah didn't respond... likely due to approaching him from the flank and Elijah having headphones in. So now our initial encounter is someone grabbing you and yelling at you while you have no idea what's happening. If you have panic attacks or anxiety issues, do you DEMAND that that person handle the situation calmly? Should clinically depressed people, "JUST BE HAPPY"? We know better as trained medical providers don't we? I do DEMAND that the public servants in this scenario be able to manage the situation and make good decisions in a way this individual was not capable of doing. Because it's not HIS responsibility to do so, it's OURS.


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## ffemt8978 (Sep 7, 2021)

Did we watch the same video?  The one I saw showed PD speaking calmly at first trying to explain what was going on.  Elijah clearly knew they were there, so I don't see how your comment about his earphones being in and the officers approaching from the flank holds water.


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## FiremanMike (Sep 7, 2021)

Kevinf said:


> All of that is up to the oversight for the personnel involved whether that be managerial or judicial. I think that I shouldn't die because I'm neurodivergent and the police can't handle that. Our country's police uses force far too easily, in the video you can see he went hands on immediately when Elijah didn't respond... likely due to approaching him from the flank and Elijah having headphones in. So now our initial encounter is someone grabbing you and yelling at you while you have no idea what's happening. If you have panic attacks or anxiety issues, do you DEMAND that that person handle the situation calmly? Should clinically depressed people, "JUST BE HAPPY"? We know better as trained medical providers don't we? I do DEMAND that the public servants in this scenario be able to manage the situation and make good decisions in a way this individual was not capable of doing. Because it's not HIS responsibility to do so, it's OURS.


You’re not answering my question.  You asserted early on that this was “walking while black”.  In your opinion, what do you think should happen when someone calls 911 to report a suspicious person and then a person matching that description is located.

You also haven’t answered my question regarding medical errors.  From the report, this was a protocol deviation and an overdose of ketamine.  The cardiac arrest was quickly identified and resuscitation was initiated.  So I ask again, do you feel protocol deviations and med dosing errors (lumped into the term “medical errors”) should be criminally prosecuted?


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## Kevinf (Sep 7, 2021)

FiremanMike said:


> ou’re not answering my question. You asserted early on that this was “walking while black”. In your opinion, what do you think should happen when someone calls 911 to report a suspicious person and then a person matching that description is located.
> 
> You also haven’t answered my question regarding medical errors. From the report, this was a protocol deviation and an overdose of ketamine. The cardiac arrest was quickly identified and resuscitation was initiated. So I ask again, do you feel protocol deviations and med dosing errors (lumped into the term “medical errors”) should be criminally prosecuted?


Point 1: Perhaps the officer could have simply observed Elijah instead of making direct contact. Perhaps they could have sent a social worker along or instead of an officer. Perhaps nobody should have been dispatched, as case law has set the precedent that police have no duty to respond. Perhaps many things should or should not have happened. I think that perhaps Elijah should not be dead.

Point 2: Depends on the circumstance. We are not privy to everything the investigators will be so anything said here is largely speculation based off incomplete information. I do feel that this person did not need to die for walking down the street listening to music and not harming anyone.

This entire situation is a stain on our country's police and EMS forces, and we should be doing everything we can to earn the public trust back, or things are only going to get worse for us, not better. Anything that happens to the medics or officers involved are the result of the system we've implemented. It's on us to create improvements to the system if that is resulting in no-win situations for first responders.


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## ffemt8978 (Sep 7, 2021)

Kevinf said:


> Point 1: Perhaps the officer could have simply observed Elijah instead of making direct contact. Perhaps they could have sent a social worker along or instead of an officer. Perhaps nobody should have been dispatched, as case law has set the precedent that police have no duty to respond. Perhaps many things should or should not have happened. I think that perhaps Elijah should not be dead.
> 
> Point 2: Depends on the circumstance. We are not privy to everything the investigators will be so anything said here is largely speculation based off incomplete information. I do feel that this person did not need to die for walking down the street listening to music and not harming anyone.
> 
> This entire situation is a stain on our country's police and EMS forces, and we should be doing everything we can to earn the public trust back, or things are only going to get worse for us, not better. Anything that happens to the medics or officers involved are the result of the system we've implemented. It's on us to create improvements to the system if that is resulting in no-win situations for first responders.


Hindsight is great, but how would it be known to anyone involved in taking the call or responding to it that a social worker should have been sent?  Keep in mind what you know now about this was *not* known to those involved in it until it was over.

I've never seen a social worker respond to a scene with a response time that wasn't measured in hours, even during business hours.  There isn't a bunch of social workers driving around town at all hours of the day and night on the off chance they will be needed on a call.

You're willing to use "speculation and incomplete information" as a basis to push for everyone involved to be criminally charged so that some in our profession will have their feer put to the fire in an effort to improve education and training?

Did he Elijah deserve to die?  No way.  

Can his case help others and help EMS and law enforcement improve? Absolutely, provided it is done correctly and does not turn into a witch hunt.  

Are criminal charges warranted in this case?  Unknown, since even you admit we don't have all the information.  The fact the district attorney charged them could be because the case warranted it, or it could be due to  other factors such as public pressure.


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## FiremanMike (Sep 7, 2021)

Kevinf said:


> Point 1: Perhaps the officer could have simply observed Elijah instead of making direct contact. Perhaps they could have sent a social worker along or instead of an officer. Perhaps nobody should have been dispatched, as case law has set the precedent that police have no duty to respond. Perhaps many things should or should not have happened. I think that perhaps Elijah should not be dead.
> 
> Point 2: Depends on the circumstance. We are not privy to everything the investigators will be so anything said here is largely speculation based off incomplete information. I do feel that this person did not need to die for walking down the street listening to music and not harming anyone.
> 
> This entire situation is a stain on our country's police and EMS forces, and we should be doing everything we can to earn the public trust back, or things are only going to get worse for us, not better. Anything that happens to the medics or officers involved are the result of the system we've implemented. It's on us to create improvements to the system if that is resulting in no-win situations for first responders.


Point 1, but incorporating your logic of point 2 - I will agree, in a vacuum, that observation prior to contact is a valid tactic.  But what we aren’t privy to everything the investigators know, such as standard operating procedures, crime statistics in the area of the contact, and how officers are trained.  What may seem reasonable as an approach *can* become an unreasonable approach once all factors are considered.  In this case, officers chose to make contact to investigate the complaint that someone else made.  They identified themselves and attempted to speak with Elijah prior to force being applied (contradictory to your earlier statements).

Point 2, It’s interesting to me that you apply the “well hey I wasn’t there” approach to the medics but not the cops.  The report is available, the body cam is on YouTube.  Read the report and watch the video and educate yourself before you return to this conversation.  When you do, answer the very clear question that you continue to evade - should medical professionals be held criminally liable for medical mistakes?

The implications of this case should be terrifying to everyone working in healthcare.


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## Tigger (Sep 7, 2021)

Here is all of the bodycam footage.

I really don't know what to make of this. I've watched it a lot, and am not sure how I would approach this if I was called to this. My initial impression was that this was not a patient I'd have wanted to sedate. There wasn't a clear medical reason for how the patient presents and the police stated they had applied a carotid control hold, which would have made me a bit nervous especially considering how long the patient has been restrained in a medically less than desirable position for. It seems that EMS made no attempt to de-escalate the situation at all. Who knows if they would have had any effect, I know personally with similar patients I've had some luck just being a different person and not a cop when talking to them and they chill out a little bit. It also appears that no assessment was attempted prior to medication, which is not cool. If the patient won't cooperate that's one thing, but you have to try to get some sort of baseline. In general I struggle with what the right course is when law enforcement calls us when someone continues to resist arrest. It is inevitable that people will not want to be arrested, does that mean this must be solved pharmacologically? I think the answer to that is probably not.  

While by their guideline a med error was made (5mg/kg), at the time my system a few miles away was flat dosing everyone with 500mg (also not good). While the dose is unnecessary, I think if 300mg had been given the same thing would have happened. 

We don't really know what happened in the ambulance in terms of how fast the arrest was noted. Really we don't know if he was even awake when he was medicated. Any sedation requires close monitoring, did that happen? If monitoring willfully did not occur in a proper timeline, that would meet the requisites of negligence.  

If I was going to sedate this patient, I would have made much more of an effort to control the scene, which this crew didn't do. Minimal direction to the officers, no verbalized plan, no apparent plan ready to care for the patient. That's not criminal, but it's not setting anything up for success.

Of note, in Colorado we can no longer administer Ketamine for agitation.


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## Tigger (Sep 7, 2021)

ffemt8978 said:


> Hindsight is great, but how would it be known to anyone involved in taking the call or responding to it that a social worker should have been sent?  Keep in mind what you know now about this was *not* known to those involved in it until it was over.
> 
> I've never seen a social worker respond to a scene with a response time that wasn't measured in hours, even during business hours.  There isn't a bunch of social workers driving around town at all hours of the day and night on the off chance they will be needed on a call.


Well, we do send caseworkers with police to calls all over Colorado. Sometimes there's even a dedicated paramedic with them. Just because you haven't seen it doesn't mean it is not viable strategy that had potential to change the dynamic of how this all transpired. Aurora doesn't do that, but I bet they're thinking about it now. There's a lot to be said for bringing the right resources at the right time. This call would have gotten a behavioral health response in all the jurisdictions I work for. Maybe they wouldn't have been available but the point is that police are seeing benefit and patrol officers here would want their help.


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## FiremanMike (Sep 8, 2021)

Tigger said:


> Here is all of the bodycam footage.
> 
> I really don't know what to make of this. I've watched it a lot, and am not sure how I would approach this if I was called to this. My initial impression was that this was not a patient I'd have wanted to sedate. There wasn't a clear medical reason for how the patient presents and the police stated they had applied a carotid control hold, which would have made me a bit nervous especially considering how long the patient has been restrained in a medically less than desirable position for. It seems that EMS made no attempt to de-escalate the situation at all. Who knows if they would have had any effect, I know personally with similar patients I've had some luck just being a different person and not a cop when talking to them and they chill out a little bit. It also appears that no assessment was attempted prior to medication, which is not cool. If the patient won't cooperate that's one thing, but you have to try to get some sort of baseline. In general I struggle with what the right course is when law enforcement calls us when someone continues to resist arrest. It is inevitable that people will not want to be arrested, does that mean this must be solved pharmacologically? I think the answer to that is probably not.
> 
> ...


I agree that I would have attempted to play the “good medic, bad cop” game to see if we could get him to comply.  With that said, I can see how it played out - they show up, cops still pinning him down and said they’ve been fighting him for several minutes, corroborated by the on scene firefighters.  He probably should have questioned this, but everything we know about group dynamics and social psychology explain why he didn’t.

Sucks that you lost ketamine for sedation, it’s still a useful tool..


Tigger said:


> Well, we do send caseworkers with police to calls all over Colorado. Sometimes there's even a dedicated paramedic with them. Just because you haven't seen it doesn't mean it is not viable strategy that had potential to change the dynamic of how this all transpired. Aurora doesn't do that, but I bet they're thinking about it now. There's a lot to be said for bringing the right resources at the right time. This call would have gotten a behavioral health response in all the jurisdictions I work for. Maybe they wouldn't have been available but the point is that police are seeing benefit and patrol officers here would want their help.



What types of runs are they dispatched on?  It doesn’t seem to me that they’d be sent on a suspicious person call..


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## DrParasite (Sep 8, 2021)

Tigger said:


> It seems that EMS made no attempt to de-escalate the situation at all. Who knows if they would have had any effect, I know personally with similar patients I've had some luck just being a different person and not a cop when talking to them and they chill out a little bit. It also appears that no assessment was attempted prior to medication, which is not cool. If the patient won't cooperate that's one thing, but you have to try to get some sort of baseline. In general I struggle with what the right course is when law enforcement calls us when someone continues to resist arrest. It is inevitable that people will not want to be arrested, does that mean this must be solved pharmacologically? I think the answer to that is probably not.


Back in the day, PD used to dogpile on a violent/combative person, and once the cuffs went on, they would throw them in the back of a BLS ambulance for a ride to the ER for a mental health eval.  Not saying it was the right way to do things, but it is what happened.

if there is a criminal who is resisting arrest, cops will use escalating levels of force to gain compliance and control of a situation.

I am not saying that either of these two situations apply, and I think that an IM chemical sedative is probably safer for all involved.

Currently, we (EMS) lets PD secure a scene before we get involved.  if they are fighting with an EDP, it's by definition not a safe scene.  similarly, if they are arresting a combative criminal, it's not a safe scene.  There is a huge difference between antagonizing someone who the PD are dealing with, taking action to diffuse a situation (using various psychological/chemical tools), and doing nothing.  There is also the question of should EMS be telling PD how to deal with a violent subject, when PD are the "experts" in dealing with violent individuals (hence why we send PD in first).

At what point do you draw the line between a violent person and a combative patient, enough where EMS should start telling the cops how to manage the scene?


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## DrParasite (Sep 8, 2021)

Kevinf said:


> Point 1: Perhaps the officer could have simply observed Elijah instead of making direct contact. Perhaps they could have sent a social worker along or instead of an officer. Perhaps nobody should have been dispatched, as case law has set the precedent that police have no duty to respond. Perhaps many things should or should not have happened. I think that perhaps Elijah should not be dead.


Hindsight is awesome.  and we can play the "whatif" game all day.  what if the officer didn't investigate the suspicious person, and just let him go; and 20 minutes later he pushed a grandmother into the path of a moving bus?  what if they sent a social worker, and when the social worker made contact, he pulled out a handgun and put 3 bullets into their chest?  what if no one was dispatched, and then Elijah broke into the caller's house, assaulted her and her family, and kidnapped her 3 year old daughter? of course, none of these things happened (and hindsight tells me none of them would have happened), but the officers didn't have the benefit of hindsight when the situation started.  


Kevinf said:


> Point 2: Depends on the circumstance. We are not privy to everything the investigators will be so anything said here is largely speculation based off incomplete information. I do feel that this person did not need to die for walking down the street listening to music and not harming anyone.


Here is a whatif for you... what if Elijah and calmly spoke to the officers, answered their questions, and complied with their investigation?  Perhaps he would not have died that night?  No one was trying to kill Elijah... that was not their intent.  And this is a tragedy, likely brought on by a medicinal error, with a contributing factor of the victim's own actions during the interaction with police.


Kevinf said:


> This entire situation is a stain on our country's police and EMS forces, and we should be doing everything we can to earn the public trust back, or things are only going to get worse for us, not better. Anything that happens to the medics or officers involved are the result of the system we've implemented. It's on us to create improvements to the system if that is resulting in no-win situations for first responders.


So what are you saying?  cops should stop responding to suspicious person calls?  if the person is violent, cops should just let them do their thing?  EMS should interfere with law enforcement actions?  social workers should take the place of LEO in investigations?  EMS should have been sent to investigate instead of LEO?  

It's very easy to say the cops suck, are racist, are bad at their job when you haven't been in their shoes.  I've never been a cop, so in 99% of the situation, I give them the benefit of the doubt, because I am not willing to do their job.  Ketamine is a drug that is used all over the country; was it used inappropriately here?  maybe, but should an isolated misuse of a medication result in everyone not being able to use this (normally) safe medication?

This is a BAD situation, one where the facts don't support criminal charges (which is why the AG didn't charge them when it first happened), but due to political motivations, the local DA decided to charged these professionals.  And when they are found not guilty, there will be riots and protests in the streets of racism, when the truth is, a criminal court is not the right place for this to be adjudicated, because the facts don't support the charge.  Hopefully the public will learn from this, and realize they often play a greater role in these poor LEO interactions than PD training levels.


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## gclol (Sep 8, 2021)

You forget that the kid was autistic and doesn't function or interact with law enforcement like a atypical person? The cops messed up and don't know how to interact with special needs clients and the medics messed up up for not doing a proper assessment. Everyone screwed up in this call


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## FiremanMike (Sep 8, 2021)

So I think we all (myself included) have become bogged down on a tangent of this case.

Back to the original point, we have scenario where the medics showed poor crew resource management, an incomplete assessment, a possibly incorrect application of an existing sedation protocol, and a patient death.  It is extremely important to note that the autopsy was inconclusive and showed no correlation between the ketamine and the patients death.

Based on the body cam and report, there is no indication that the medics were acting with malice or intent, but we still have felony indictments against EMS.

The implications of this case for everyone’s future practice are huge.

So the original question stands.  When should medical mistakes transition to criminal liability?


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## mgr22 (Sep 8, 2021)

FiremanMike said:


> So I think we all (myself included) have become bogged down on a tangent of this case.
> 
> Back to the original point, we have scenario where the medics showed poor crew resource management, an incomplete assessment, a possibly incorrect application of an existing sedation protocol, and a patient death.  It is extremely important to note that the autopsy was inconclusive and showed no correlation between the ketamine and the patients death.
> 
> ...


That's a good summary. I think most of us can relate to pressure involving the different missions of law enforcement and EMS. Perhaps there should be more joint training -- something that acknowledges the issue and suggests how to handle it. I'm thinking of Crew Resource Management in aviation as an example of radical changes to critical communication between coworkers.

I think the answer to your question is "Only if there's intent," but I'm not a lawyer.


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## Tigger (Sep 8, 2021)

FiremanMike said:


> I agree that I would have attempted to play the “good medic, bad cop” game to see if we could get him to comply.  With that said, I can see how it played out - they show up, cops still pinning him down and said they’ve been fighting him for several minutes, corroborated by the on scene firefighters.  He probably should have questioned this, but everything we know about group dynamics and social psychology explain why he didn’t.
> 
> Sucks that you lost ketamine for sedation, it’s still a useful tool..
> 
> ...


Also of note, fire is ALS and has control of the scene always. The ALS ambulance is just a ride to the hospital, AFD will maintain care enroute should anything “ALS” be done. From a system perspective, the Falck crew has no obligation to provide an assessment. The Ketamine was given by an AFD paramedic, they just used the ambulance’s controls.

Here the “people not acting right” calls will get a behavioral unit if available. It would really depend how the dispatch put it in, but the guy walking down the street acting oddly will often get a cop and social worker response and patrol will often request it if they aren’t enroute anyway.


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## FiremanMike (Sep 8, 2021)

Tigger said:


> Also of note, fire is ALS and has control of the scene always. The ALS ambulance is just a ride to the hospital, AFD will maintain care enroute should anything “ALS” be done. From a system perspective, the Falck crew has no obligation to provide an assessment. The Ketamine was given by an AFD paramedic, they just used the ambulance’s controls.
> 
> Here the “people not acting right” calls will get a behavioral unit if available. It would really depend how the dispatch put it in, but the guy walking down the street acting oddly will often get a cop and social worker response and patrol will often request it if they aren’t enroute anyway.


That’s interesting, thanks for the insight on their system.

Who were the providers that were charged, were they off the fire truck or ambulance?


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## Tigger (Sep 8, 2021)

That’s interesting, thanks for the insight on their system.


FiremanMike said:


> Who were the providers that were charged, were they off the fire truck or ambulance?


Fire engine. Not sure what if anything happened to the Falck crew.


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## FiremanMike (Sep 8, 2021)

Tigger said:


> That’s interesting, thanks for the insight on their system.
> 
> Fire engine. Not sure what if anything happened to the Falck crew.


So, for the sake of debate.. 

In my world, visual observations of combative behavior would be considered a key initial assessment point for moving towards chemical restraint.  So I don't think it's fair to say that NO assessment was done.


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## Tigger (Sep 8, 2021)

FiremanMike said:


> So, for the sake of debate..
> 
> In my world, visual observations of combative behavior would be considered a key initial assessment point for moving towards chemical restraint.  So I don't think it's fair to say that NO assessment was done.


I suppose. But no effort was made to engage with the patient. I want to establish some sort of baseline if I can. This isn’t possible with every situation but in this case I feel that with a patient that isn’t just screaming insistently like some “excited delirium” (wait can’t use that term in CO anymore) that attempting to determine mental status before sedation is appropriate.


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## FiremanMike (Sep 8, 2021)

Tigger said:


> I suppose. But no effort was made to engage with the patient. I want to establish some sort of baseline if I can. This isn’t possible with every situation but in this case I feel that with a patient that isn’t just screaming insistently like some “excited delirium” (wait can’t use that term in CO anymore) that attempting to determine mental status before sedation is appropriate.


100% agree and that would be my approach as well..


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## CCCSD (Sep 8, 2021)

gclol said:


> You forget that the kid was autistic and doesn't function or interact with law enforcement like a atypical person? The cops messed up and don't know how to interact with special needs clients and the medics messed up up for not doing a proper assessment. Everyone screwed up in this call


utter BS.
How long have YOU been a Police…?
Thought so.


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## Rano Pano (Sep 8, 2021)

I understand there’s a few points of the call that have been discussed back and forth in this thread, but does ANYONE actually disagree that ketamine was administered inappropriately due to Elijahs presentation during administration?


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## ffemt8978 (Sep 9, 2021)

Rano Pano said:


> I understand there’s a few points of the call that have been discussed back and forth in this thread, but does ANYONE actually disagree that ketamine was administered inappropriately due to Elijahs presentation during administration?


The question in this thread is do inappropriate actions rise to the level of criminal liability, especially when there are other avenues (regulatory, licensing, civil, etc) available?


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## Ensihoitaja (Sep 9, 2021)

Tigger said:


> That’s interesting, thanks for the insight on their system.
> 
> Fire engine. Not sure what if anything happened to the Falck crew.


This came out over 6 months ago, but it seems the Falck medic pretty effectively washed his hands of the situation.



> The Aurora Fire Rescue medic “administered 500 mg Ketamine IM to (patient’s) R deltoid prior to discussing (patient’s) weight and proper dosage with Falck medic,” the report said. “(Patient) had not been seen by Falck medic prior to administration of Ketamine due to darkness as well as multiple APD officers being on top of (patient).”



Having worked in that system once upon a time, I remember documenting things like that. Nothing this high profile, though.


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## Tigger (Sep 9, 2021)

Rano Pano said:


> I understand there’s a few points of the call that have been discussed back and forth in this thread, but does ANYONE actually disagree that ketamine was administered inappropriately due to Elijahs presentation during administration?


Are you saying it was not appropriate to sedate this patient? I think it might have been, just not not the way they went about it here. If you feel that someone in law enforcement custody is in grave danger of harming themselves, sedation is probably warranted. The cops arent just going to let him go.


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## Rano Pano (Sep 9, 2021)

Tigger said:


> Are you saying it was not appropriate to sedate this patient? I think it might have been, just not not the way they went about it here. If you feel that someone in law enforcement custody is in grave danger of harming themselves, sedation is probably warranted. The cops arent just going to let him go.


That’s exactly what I’m saying. When you say “just not the way they went about it here” are you not saying the same thing?

I’m not quarterbacking the call for Aurora, Falck or any other provider for that matter but the initial use of Ketamine was clearly inappropriate.


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## Rano Pano (Sep 9, 2021)

ffemt8978 said:


> The question in this thread is do inappropriate actions rise to the level of criminal liability, especially when there are other avenues (regulatory, licensing, civil, etc) available?


I think we’re seeing in the last several years they do. I don’t agree with it. I don’t think it’s very hard presently to be thrown in a situation with little information and make a incorrect tx or oversight accordingly.


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## Tigger (Sep 9, 2021)

Rano Pano said:


> That’s exactly what I’m saying. When you say “just not the way they went about it here” are you not saying the same thing?
> 
> I’m not quarterbacking the call for Aurora, Falck or any other provider for that matter but the initial use of Ketamine was clearly inappropriate.


It is inappropriate to sedate a patient without attempting an assessment, yes.


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## Tigger (Sep 9, 2021)

ffemt8978 said:


> The question in this thread is do inappropriate actions rise to the level of criminal liability, especially when there are other avenues (regulatory, licensing, civil, etc) available?


If a provider willfully causes harm to patient, then yes. One of the ways a provider could do this is willfully choosing to not monitor a patient that you just administered ketamine to (which I have no idea if that happened in this instance). That is what I hope this trial will establish. If they just sedated him, through him on the cot, and then at some point much later recognized that he was doing poorly/in arrest because they made no attempt at assessment or monitoring, I suspect these charges will hold.


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## FiremanMike (Sep 9, 2021)

Tigger said:


> If a provider willfully causes harm to patient, then yes. One of the ways a provider could do this is willfully choosing to not monitor a patient that you just administered ketamine to (which I have no idea if that happened in this instance). That is what I hope this trial will establish. If they just sedated him, through him on the cot, and then at some point much later recognized that he was doing poorly/in arrest because they made no attempt at assessment or monitoring, I suspect these charges will hold.


The way I read the report is that they gave the ketamine, waited for it to start to take effect, moved him to the cot, then noticed the cardiac arrest..


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## DrParasite (Sep 9, 2021)

FiremanMike said:


> The way I read the report is that they gave the ketamine, waited for it to start to take effect, moved him to the cot, then noticed the cardiac arrest..


So they gave ketamine, saw him calm down, moved him to the cot and then into the truck where there was much better light, better privacy, and more controlled situation, in order to perform a proper assessment... I'm assuming he arrested before they left the scene right?  sounds like a logical flow of events to me...  Does the report imply something differently?


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## FiremanMike (Sep 9, 2021)

DrParasite said:


> So they gave ketamine, saw him calm down, moved him to the cot and then into the truck where there was much better light, better privacy, and more controlled situation, in order to perform a proper assessment... I'm assuming he arrested before they left the scene right?  sounds like a logical flow of events to me...  Does the report imply something differently?


Nope, you pretty much nailed it


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## DrParasite (May 7, 2022)

Grand jury testimony: Ketamine, not police hold, caused Elijah McClain's death
					

Medical experts testified that the 500-milligram dose of ketamine administered by an Aurora Fire Rescue paramedic caused McClain's death




					www.ems1.com


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## FiremanMike (May 7, 2022)

Wow.. no bueno


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## Carlos Danger (May 7, 2022)

As someone who views this type of incident from a different perspective than many folks in the public safety realm, I find it disappointing that so many folks fail to take a high level view of these events in order to try to learn as much from it as possible.

Instead of "An innocent kid ended up dead for no apparent reason; what could have / should have been done differently?", so many people get defensive of their tribe and seek ways to justify and excuse everything. "The police were just doing as they were trained by choking a person of small stature who didn't appear to posses a weapon or intend on causing any harm". "He just should have complied". "The medics were just following their protocols by giving a MASSIVE dose of a potent anesthetic to a small person who was already physically controlled ".

OK.....alright....even putting aside the personal responsibility of the police or medics for the outcome of their actions, immediately going to "HEY...HEY....everything they did was LEGAL!!! Don't JUDGE!! You WEREN"T THERE!!" totally misses the entire point of reviewing the scenario.

It is entirely possible to acknowledge that actions didn't violate training or SOP or protocol or law, but still admit that clearly whatever was done didn't result in a desired outcome, so perhaps we could talk about doing it differently in the future.


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## DrParasite (May 8, 2022)

Carlos Danger said:


> Instead of "An innocent kid ended up dead for no apparent reason; what could have / should have been done differently?", so many people get defensive of their tribe and seek ways to justify and excuse everything. "The police were just doing as they were trained by choking a person of small stature who didn't appear to posses a weapon or intend on causing any harm". "He just should have complied". "The medics were just following their protocols by giving a MASSIVE dose of a potent anesthetic to a small person who was already physically controlled ".


and


Carlos Danger said:


> It is entirely possible to acknowledge that actions didn't violate training or SOP or protocol or law, but still admit that clearly whatever was done didn't result in a desired outcome, so perhaps we could talk about doing it differently in the future.


My issue isn't that the kid is dead; my issue is that the paramedics are being criminally charged for a systemic issue.  They followed the rules that their medical director laid out, in the circumstances they were in.  Even the cops, if the choke hold was in accordance to their training (I don't know, and I don't care), and their followed their training as their employer directed them to, then it's a leadership systemic issue, and it's wrong to criminally charge the staff for follow the lawful rules of their employer.

This is the complete opposite of the Vanderbilt nurse, who bypassed many of the controls that were in place during a non-emergency situation; this was an uncontrolled scene, at night in the dark, with a combative patient.  and once the paramedics noted a problem, they took action immediately. 

Do I think things could have been done differently?  absolutely, and hindsight is 20/20.  We can what if this until the end of time.   and it's really easy to review this situation online, at home, or in an office afterwards.  It's even easier for a lawyer to stand up in court and say how these paramedics killed the person, and should never have been paramedics, and should be tarred and feathered every day during their life sentence.

But I can also say that if I was in the same position as the two paramedics, with limited information, with the cops fighting with a combative and violent EDP, in the dark, I would follow my MD's orders and give the same dose (assuming the dose was correct, based on the information they have).


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## Carlos Danger (May 8, 2022)

DrParasite said:


> if I was in the same position as the two paramedics, with limited information, with the cops fighting with a combative and violent EDP, in the dark, I would follow my MD's orders and give the same dose (assuming the dose was correct, based on the information they have).


I don't doubt that you would, and that just proves my point.


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## Carlos Danger (May 9, 2022)

DrParasite said:


> and
> 
> My issue isn't that the kid is dead; my issue is that the paramedics are being criminally charged for a systemic issue.  They followed the rules that their medical director laid out, in the circumstances they were in.  Even the cops, if the choke hold was in accordance to their training (I don't know, and I don't care), and their followed their training as their employer directed them to, then it's a leadership systemic issue, and it's wrong to criminally charge the staff for follow the lawful rules of their employer.
> 
> ...


To expand on my point:

What I take away from this and similar situations is just that it was entirely unnecessary and avoidable and that hiding behind that fact that no one appears to have violated any laws or protocols doesn't change the fact that the entire response was flawed and a young man is dead because of it.

Let's start with the 911 caller. They reported that Elijah did not appear to have a weapon, nor did he appear to be threatening anyone. OK....not threatening, not breaking any laws, so why again are you calling the police? Because he is dressed unusually and is dancing as he walks? Sure, that *could* be a sign of a problem, but if I called the police every time I saw someone fitting that description in Asheville or Charlotte and they responded to every one, my calls alone would constitute a significant portion of the police department's work load. It hardly seems necessary to get law enforcement involved in such a scenario. There are a dozen ways that an interaction between the police and a citizen can go sideways, and when they do it's bad for everyone, but almost always much worse for the citizen. "If you see something, say something" is total BS when the only thing you see is someone acting in a way that you deem unusual. I'm not sure how Karen Culture got to be what it is, but it is just plain wrong and it always has the potential to lead to something like this.

Now on to the police response. The police essentially have one tool: violence, or at least the threat of it, and when the only tool you have is a hammer, everything looks like a nail to you. Because of the way police are trained and to some degree because of human nature, they interpret everything other than immediate and total compliance as an immediate threat to not only their authority but also their physical safety, and react accordingly. The problem is that citizens are subject to the effects of human nature as well, and fear, confusion, misunderstanding, not being able to hear instructions because you have headphones in or have poor hearing, being intoxicated even if not otherwise violent or disruptive at all, or being autistic or having other neuro-divergent characteristics will all often be interpreted as willful noncompliance and trigger a violent response from the police. Even showing any level of indignance or "having an attitude" at what you perceive as unfair targeting can do so. Once that train is rolling, it is hard to stop because at that point it has already been decided that you are a serious threat, and then even actions that in any other setting would be considered perfectly natural and reasonable - such a reaching out to break your fall as you are being tackled or trying to pry the attacker's arms away from your airway - is later described as "continuing noncompliance" or "reaching for the officers weapon" and that appears to be exactly what happened in this case. I'm not sure why they continued to remain dog-piled on this slightly-built 130 pound guy even after he started vomiting and apologizing and telling them he was having trouble breathing, but apparently that's what they are supposed to do. I'm not saying these were bad cops, nor am I even suggesting that anything they did violated the law or their training or SOP. In fact it all seems like a pretty standard police response, to me. That's the whole problem - the way these scenarios are approached by the police is fundamentally, seriously flawed. 

Now on to the medics. Again, I'm not suggesting that they violated their training or protocols. I'm just saying.....500mg of ketamine? Especially in a patient who was already thoroughly restrained? WTAF? Oh yeah, that's right....."agitated delirium". The catch-all term that clinicians casually throw about but can't even define and can be used to describe pretty much anyone who is uncooperative. It's the medical equivalent of "he appeared to be reaching into his waistband". Again, just a horrible protocol and a horrible approach to "care".


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