EMS Ethics & Professional Conduct - Elijah McClain: The Wrong Treatment

Elijah McClain was a young man who died in 2019 after an encounter with law enforcement and subsequent administration of ketamine by paramedics.

The case raised significant concerns and highlighted important considerations for EMS providers. Here are some key points to know:

1. Medical Neutrality: EMS providers should prioritize patient safety and well-being, regardless of the circumstances or involvement of law enforcement. Upholding medical neutrality is crucial to ensure unbiased care.

2. Recognition of Potential Bias: It is essential for EMS providers to be aware of their own biases and prejudices, as these can influence patient assessment, treatment decisions, and overall care. Providing equitable care to all patients is of utmost importance.

3. Communication & De-Escalation: Effective communication skills and de-escalation techniques are vital for EMS providers. Collaborating with law enforcement and other responders to maintain a non-threatening environment can help prevent misunderstandings and minimize the risk of harm to patients.

4. Cultural Competence: Understanding and respecting diverse cultural backgrounds and individual differences is crucial for providing appropriate care. Cultural competence training can help EMS providers deliver care sensitive to each patient's needs and beliefs.

5. Proper Use of Sedation & Restraints: When administering sedatives like ketamine or using restraints, EMS providers must follow established protocols and guidelines. Close monitoring of the patient's vital signs and reassessment throughout the intervention is essential to ensure their safety.

6. Quality Improvement and Transparency: The Elijah McClain case has sparked discussions around the need for transparent investigations, quality improvement initiatives, and accountability within EMS systems. EMS providers should actively participate in these efforts to enhance patient care and safety.

Conclusion

By staying informed about cases like Elijah McClain's and integrating the lessons learned into their practice, EMS providers can contribute to improved patient outcomes, equitable care, and a safer healthcare environment.

Further Reading:

Alfonseca, K. 2022) Amended Elijah Mcclain Autopsy Report Released.  Accessed November 20, 2022

Bruun, H., Milling, L., Mikkelsen, S., & Huniche, L. (2022) Ethical Challenges Experienced by Prehospital Emergency Personnel: A Practice-based Model of Analysis. BMC Medical Ethics 23 (1): 80-94 Accessed December 10, 2023

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911 Accessed December 12, 2023

Mion, G. (2017) History of Anesthesia: The Ketamine Story - Past, Present, and Future. European Journal of Anesthesiology 34 (9): 571–575

National Association of Emergency Medical Technicians (2022) Code of Ethics for EMS Practitioners. NAEMT. Accessed December 4, 2023

Obasogie, O. K. (2021) Excited Delirium and Police Use of Force. Virginia Law Review 107 (8): 1545-1620

Sandman, L. & Nordmark, A. (2006) Ethical Conflicts In Prehospital Emergency Care. Nursing Ethics 13 (6): 592-607

Scheppke, K. A., Braghiroli, J., Shalaby, M., Chait, R. (2014) Prehospital Use of Ketamine for Sedation of Violent and Agitated Patients. Western Journal of Emergency Medicine 15 (7): 736-41

Schoenly, L. (2015) Excited Delirium: Medical Emergency – Not Willful Resistance. EMS1. Accessed November 20, 2022

Young, D. (2019) The Investigation into the Death of Elijah Mcclain. District Attorney's Office, 17th Judicial District, Adams and Broomfield Counties, Colorado. Accessed November 20, 2022