Learning from Boulder: When Restraint and Sedation Become Deadly

A recent case out of Boulder, Colorado has sent shockwaves through the EMS community. A paramedic, Edward McClure, was charged with manslaughter and forgery after sedating and restraining a patient who later died. The case serves as a sobering reminder of the immense responsibility placed on first responders to balance scene safety, patient dignity, and medical best practices.

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What Happened in Boulder

On December 27, 2024, police responded to reports of a man, later identified as Jesus Lopez Barcenas, acting erratically at the University of Colorado’s Center for Innovation and Creativity. Barcenas was shouting about fires and deaths, hitting a fire alarm, and resisting arrest. After a struggle, he was handcuffed and restrained.

When paramedics arrived, McClure chose to inject Barcenas with Droperidol, a sedative. Importantly, Barcenas was already handcuffed, prone, and under police restraint. McClure then directed his team to strap the patient tightly to a gurney in a face-down position—a practice long known to be dangerous and forbidden by agency policy. A spit hood was placed on Barcenas’ head despite no evidence of spitting.

Minutes later, Barcenas suffered a cardiac arrest in the ambulance. He died two days later. The coroner’s report cited sudden cardiac arrest linked to prone restraint, sedation, and struggle, compounded by methamphetamine in his system.

The district attorney cleared the police officers but concluded McClure’s “reckless acts” led to the death. McClure now faces criminal charges and the end of his EMS career.

The Big Questions for EMS

This tragedy forces us to ask uncomfortable—but essential—questions:

What was the threat?
Once Barcenas was handcuffed, legs bound, and covered with a spit hood, was he truly a danger to responders?
Why prone?
We know prone restraint carries high risk of positional asphyxia. Policies forbid it, yet it was used here. What added safety did it actually provide?
Where was the assessment?
According to the affidavit, McClure never physically examined Barcenas or gathered a full history before giving a sedative. In crisis, skipping assessment can be as dangerous as inaction.
Was sedation appropriate?
Sedatives can be life-saving in cases of true excited agitation, but over-reliance without proper justification can turn a chaotic scene into a preventable tragedy.

Lessons for the Field

Always assess before acting.
Talking with the patient, evaluating vitals, and gathering history from officers or bystanders is not optional—it’s essential.
Understand the risks of prone restraint.
The dangers have been documented for decades. Patients who cannot ventilate are at immediate risk, and EMS must advocate for safe positioning, even when law enforcement is involved.
Sedation is not a shortcut.
Medications like Droperidol and ketamine can be useful tools but require careful dosing, justification, and monitoring. They should never be a stand-in for de-escalation or medical evaluation.
Documentation matters.
McClure also faces forgery charges for allegedly altering patient care reports. Accuracy and honesty are not only ethical obligations—they’re legal safeguards for providers.
Training must be applied, not ignored.
McClure reportedly received training on managing combative patients just months before this incident. Training only matters if it informs practice on the street.

Why This Matters

Cases like this erode public trust in EMS. They also place first responders at legal and professional risk. While prosecution of paramedics is rare, it is not unprecedented—and the expectation is clear: we must be able to defend our actions as medically necessary, safe, and within policy.

For responders, this isn’t about second-guessing under stress. It’s about pausing to see the whole picture. Restraints and sedatives change the game from “scene safety” to “patient safety.”

Final Thoughts

The Boulder case is a tragedy—for the patient, the family, and the responder community. But it must also be a teaching moment. Every EMS provider should revisit their protocols on restraint, sedation, and documentation. The central question is simple:

👉 Are our actions truly making the scene safer—for everyone involved?

When safety is defined too narrowly, preventable deaths occur. The challenge for EMS is to broaden our vision, slow down when possible, and always keep the patient’s humanity at the center of care.