The High Cost of Death following Restraint and Sedation
The financial liability for cities and towns is hundreds of millions of dollars and is increasing. Revamping the approach to restraint and sedation has the potential to reduce future liability.
Eric Jaeger, JD, NRP
Sept. 26, 2026
Summary
Cities and towns across the United States have paid out hundreds of millions of dollars in connection with deaths of individuals associated with restraint and sedation. While most of these deaths have involved law enforcement, an increasing number involve EMS providers. Historically, EMS providers received limited training on the management of agitated patients and the risks of restraint and sedation. A restructured program, emphasizing de-escalation, limited use of prone restraint and a more rigorous approach to sedation, has the potential to dramatically reduce risk and financial exposure.
Financial Exposure
The Associated Press, in their groundbreaking 2024 series Lethal Restraint,1 found that over the course of a decade, cities and towns experienced $374 million in financial liability following restraint-related deaths involving law enforcement (and in some cases EMS). The risk increases as the volume of mental health calls continues to increase. Similarly, 9News in Colorado found $126 million in settlements and verdicts arising out of restraint-related cases.2 This is against a larger backdrop of financial liability in connection with alleged police and EMS misconduct for cities and towns; a 2025 article noted that restraint and excessive force claims represented a significant portion of $320 million in liability payouts in Los Angelese related to alleged police misconduct.3
EMS, Not Just Law Enforcement
While most of the restraint-related deaths involve only law enforcement, an increasing number of these deaths involve EMS providers, often in connection with sedation. Aurora Colorado paid out $15 million in connection with Elijah McCalin’s death in 2019.4 And a county in North Carolina has paid out $1.7 million in connection with two lawsuits involving sedation by EMS.5 As of this writing, multiple cases involving EMS sedation remained pending.6,7 While much of the financial exposure involving EMS has been in connection with deaths, there have also been cases that arose in connection with sedation alone.8
A Path Toward Reducing Risk and Financial Liability
Our evolving understanding of the pathophysiology of death in custody points toward a modern, evidence-based approach to agitated patients suffering behavioral emergencies that can enhance safety for our patients and reduce the risk of liability for our providers.9 This paradigm includes a focus on de-escalation, a better understanding of physical restraint and a more rigorous framework for pharmacological management/sedation (akin to ED procedural sedation). Deaths from restraint, at times accompanied by prehospital sedation, continue to occur despite the attention brought by high profile cases. Meaningful change requires leadership focus, rewritten protocols and reconfigured training that involves discussion of real-world cases and hands-on simulation. While improved training alone is not a panacea, it can begin to reduce the risk of death and of financial exposure for affected communities.
Bibliography
1. Dunklin R, Foley RJ, Martin J, McDermott J, Mohr H, Seewer J. Why Did More Than 1,000 People Die After Police Subdued Them With Force That Isn’t Meant To Kill? Published online March 28, 2024. Accessed September 26, 2026. https://apnews.com/article/associated-press-investigation-deaths-police-encounters-02881a2bd3fbeb1fc31af9208bb0e310
2. Vanderveen, C. PRONE: At least 121 people across the U.S. have died while held prone by officers. Why? KUSA.com. June 25, 2021. Accessed September 26, 2026. https://www.9news.com/article/news/investigations/prone-restraint-police-deaths/73-a4ae192c-ceb6-4815-9e72-2f8a8072765c
3. Rynning J. As LA veers toward a financial crisis, $320M in liability payouts play a big role. LAist. March 14, 2025. Accessed September 26, 2026. https://laist.com/news/politics/los-angeles-liability-payments-rise-nearing-fiscal-emergency
4. Franklin J. Aurora, Colo., will pay a $15 million settlement over the death of Elijah McClain. NPR. November 18, 2021. Accessed September 26, 2026. https://www.npr.org/2021/11/18/1056974723/city-of-aurora-pays-15-million-settlement--elijah-mcclain-death
5. Rockett, A. Charleston County EMS under fire for using ketamine as lawsuits, settlements mount. Post and Courier. October 18, 2023. Accessed September 26, 2026. https://www.postandcourier.com/news/charleston-county-ems-ketamine-lawsuit-settlement/article_682c754c-6d10-11ee-ac1b-ef7daf1ea208.html
6. Lawsuit questions paramedic use of midazolam after Hayward in-custody death. Accessed September 26, 2026. https://www.ems1.com/legal/lawsuit-alleges-paramedic-sedation-failures-in-calif-in-custody-death
7. Mom of 5 died after ketamine injection by a paramedic, family alleges in wrongful death suit. Accessed September 26, 2026. https://www.nbcnews.com/news/us-news/family-mom-5-died-ketamine-injection-paramedic-files-wrongful-death-la-rcna55509
8. South Metro Fire Rescue to pay man $115,000 for ketamine use | 9news.com. Accessed September 26, 2026. https://www.9news.com/article/news/local/elijah-mcknight-arapahoe-county-settlement/73-e59b09b2-e093-49cd-a6df-dc83d36a5280
9. Jaeger E, Mehkri F. Revamping Our Approach to Behavioral Emergencies. NAEMSP. July 24, 2026. Accessed July 24, 2026. https://naemsp.org/revamping-our-approach-to-behavioral-emergencies/
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