Why every firefighter-paramedic must know the story of Elijah McClain
4 reasons the ketamine-focused case should serve as a wakeup call to first responders
I’ll be honest, I was not familiar with the tragic death of Elijah McClain until I read about Colorado’s House Bill 21-151 banning the use of ketamine by paramedics unless the patient could be weighed.
After speaking to a few firefighters, I realized that I was not alone. Few of us had heard of McClain. After reading the reports, the articles and becoming aware of the public outrage, it is clear that every firefighter-paramedic needs to know McClain’s story.
So much attention has focused on the deaths of Breonna Taylor and George Floyd at the hands of police. But community members and the media are pointing fingers at other first responders, too, as is the case in McClain’s death.
- Report: FD medic gave high dose of ketamine to patient who later died
- Ketamine administration comes under the spotlight
What went wrong
Responding to a call about a suspicious person, Aurora (Colorado) police stopped 23-year-old McClain while he was walking home. A struggle ensued during which an officer applied a carotid hold to restrain McClain.
Assuming that McClain was under the influence, police requested Aurora Fire and Rescue. Upon arrival, police officers continued to restrain McClain while the fire department paramedics administered ketamine.
McClain went into cardiac arrest while still on the scene and ultimately died three days later.
- Colo. governor appoints AG to investigate death of restrained man given ketamine
- City-commissioned investigation faults police, paramedics in Elijah McClain case
A personal wakeup call
I’ve watched the body camera footage and it is chilling, not only because I know how it ends but also because of how similar it is to calls I respond to every day. Given what the Aurora Fire and Rescue paramedics saw upon arrival, I have to wonder, would I have done anything different?
It’s a question for which I will never know the answer. I wasn’t there, and I can’t go back in time.
But knowing what I do now, there are few points I plan to keep in mind going forward:
- Never assume, always assess
- Know the methods for determining the dose and what to do when we can’t
- Everyone is a public information officer (PIO)
- Stay informed of national issues
Let’s consider how each point relates to our job as firefighter-paramedics.
1. Never assume, always assess
It is easy to assume that anyone who becomes agitated is “on something,” but we can’t base our treatment on assumptions. When possible, we must gather a full assessment – heart rate, blood sugar, etc. – before jumping into a course of treatment.
Sometimes, taking an agitated patient’s vital signs can actually deescalate a tense scene. But even when they will not cooperate, our attempt affords a moment to run through all available options before reaching for the drug box.
2. Know the methods for determining the dose and what to do when we can’t
The Aurora Fire and Rescue paramedics stated that due to McClain’s clothing and the presence of police officers, he looked bigger than he actually was. Considering how difficult it is to guess a person’s weight standing in plain view, I completely understand.
So, what can we do? Well, if the police have the agitated person restrained, we can check for a driver’s license. That should have their height and weight on it. If they do not have a driver’s license on them, then conducting a visual and physical assessment as if they were a trauma patient would provide a better idea of a person’s actual size.
If the patient is overly combative and none of these options are available, contact online medical direction and ask for advice. Administering an alternative medication whose dose is not dependent on the patient’s weight may be a safer option. Ketamine is a useful medication, but it's important to remember that it is only one tool in the toolbox.
3. Every one of us is a PIO
We have been trained to keep our mouths shut when questioned by the public. Firefighters, police, we are there to do a job. They can direct all their questions to the person in charge.
This culture worked well when all we had to worry about was a few news reporters showing up on the scene of a large-scale incident, but not anymore. Thanks to social media, the potential exists for every incident to suddenly become a “big one.” Everyone with a social media account and a cell phone is suddenly a citizen reporter, and they do not understand why we choose not to comment. Silence breeds suspicion.
I get just as annoyed as anyone else when I see a cell phone aimed in our direction. It seems like all they want is to see us make a mistake. The good news is that 99.9% of the time, we get it right. We need to see this for what it is – an opportunity.
The truth is, many who stop on the street to record our actions are concerned. Instead of feeling protected when they see firefighters and police, they feel fear. The camera phone has become their protection against any abuse of power. However, if we take a moment to acknowledge this concern and explain our actions after a scene has been safely mitigated, we may hopefully begin to earn back some of that trust.
The most common example of when this type of on-scene dialogue can help is when the fire department must stage away from the incident until the police have deemed it secure. To the untrained public, this delay can be seen as a slow response time, or worse, inaction on our part. We are the people who run into fires, shouldn’t we run into every dangerous situation?
Having an informal conversation with bystanders to explain department policies when responding to potentially dangerous scenes can go a long way. When they know our limitations, they will begin to have more reasonable expectations.
I believe it is possible to be informative to bystanders and also keep patient information confidential. I think it is natural for people to want to know more about what they witnesses and it is possible to share a limited amount of information that satisfies curiosity.
4. Stay informed on national issues
Elijah McClain died in 2019, and I didn’t hear about him until 2021. Whether or not preventable mistakes were made by the fire department, members of the public have demanded reform. Colorado lawmakers have responded by drafting HB 21-151 bill, which takes away our ability to safely treat combative patients.
Although I do not agree with this bill, I do believe we must acknowledge that a life was lost while under our care. Just as we would treat a line-of-duty death in a house fire, we need to remember Elijah McClain and do whatever it takes to ensure that we do not repeat the same mistakes. Otherwise, we leave decisions regarding the future of our industry to people on the outside, who may not fully understand what we do.