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They were certainly negligent in not properly assessing McClain (who was already restrained) prior to ketamine admin. Once ketamine was given, they then also failed to monitor and recognize cardiac arrest.
This case will likely lead to change in paramedic emergency care protocols.
I sort of feel sorry for the paramedics in the sense that they were too complacent and should have told the cops "no" when they tried to dictate patient care (as in, 'you need to sedate this dangerous person'). I work in healthcare too, so I'm familiar with cops trying to dictate medical care and the importance of advocating for your pt when that happens. It can be intimidating to tell a cop to fuck off, but sometimes you have to do it. If nothing else, it's your ass on the line.
I understand you work in health but I work as a paramedic and have a few thoughts. First, it is very common for us to go into a scene with law enforcement and sedate someone if we believe it to be appropriate. Excessive fighting with law enforcement and being tased repeatedly tends to be followed by death. So, it is much easier and safer for everyone to sedate someone.
What protocols do you think will change? Should we just let people die fighting with law enforcement? I have mixed thoughts on the details here if we as paramedics can be prosecuted if someone has a negative reaction to a medication, however, I don’t think that is the case here. It says they gave an extra 150-200mg of ketamine, not sure why, not sure what their protocols are but if their dose is something like 5mg/kg IM like protocols I’ve worked under then maybe they thought it was an appropriate dose because we are bad at estimating weight. Regardless, it is industry standard to monitor capnography when sedating a patient. If they didn’t because of complacency, that might be on them if there isn’t any extenuating circumstance but I can’t think of any that would reasonably justify not monitoring capnography.
Few flaws in your argument. Let’s set some egos aside and discuss this intelligently as healthcare providers.
I need to call you on this, because it calls close to the desire of some people in EMS to refer to other citizens as civilians. It’s easier for us, yes, and there can be a definite need to sedate some patients. But sedation should be based on the patient’s needs and ability to be safely sedated, not based on our comfort. I’m being really persnickety here, because I’ve seen a strong increase in the “us vs. them” mentality in EMS over the years. I don’t like it, and it’s not healthy.
You and I can both get weight right to about 5kg with any reasonable field experience. This was a bad dosing and saying “we aren’t perfect” when the dose is 40% off is dangerous. I’ve never been a fan of ketamine, but I know versed can have shortages and sometimes we play drug-of-the-week to fix that.
They did change, they removed ketamine from the units.
I feel like you’re trying to appeal to your authority here to say these are the only two options. Having transported the self purported devil at least twice (not the same dude the second time, but both apparently will here for my soul at some point), there are intermittent steps including restraint or our old friend the backboard to keep people from doing harm to themselves or others. This patient has been restrained and made unconscious by law enforcement. A horrible thing happened, and these guys did a 100kg dose on a paperweight kid and he died.
Arm chairing this call by either of us won’t fix the problem nor bring the patient back. But I wanted to clarify these points, as you have experience beyond most people in the thread. Stay safe out there and I hope you get some sleep. :)
Ego is set aside, for the discussion. I am here to discuss this intelligently like you requested. So to clarify, we don’t know the situations we are walking into and only have a few minutes to make decisions.
Why I said this is the guy was fighting with law enforcement and throwing up. This doesn’t have to be his fault but how are we to determine this isn’t a brain bleed? (I don’t remember where I read it but) Mix in him potentially going in and out of consciousness and it would be irresponsible to not intervene, any excess stimulation will make a brain bleed worse.
I don’t have any authority and I have no desire to hold any authority, nor do I conform to the us vs them mentality, however law enforcement isn’t shy about slamming heads onto the ground. As with my previous statement, if they slammed his head into the ground and kept fighting, then he may not have started with a brain bleed but may have developed one.
Also in the context of dosing, another comment says he is 140lbs or 63.6 kg. If dosing is 5mg/kg the dose would be 318mg. The other comment says 320-350mg. Sure if I round to 64kg I’d get 320mg but we are talking about this situation with nothing but time. Although I will give you that 500mg was a bit extreme of an estimation.
I don’t think this is in the best interests of the patients that the agency serves and I hope it isn’t a reactionary decision to shift liability away from doing adequate training in the r department. I think it would have been more appropriate to re-evaluate the protocols and maybe do some retraining or just limit it to airway management or online medical control orders only.
Also I appreciate the discussion, I’m not trying to arm chair this call. I am actively avoiding commenting on whether I think they did things appropriately or not because I don’t have the information I need to determine that. I don’t jump on the blame train without knowing more. I can think that there isn’t a reasonable situation that I can think of to justify this, but I don’t want to jump to blaming anyone without all the information.
I agree a horrible thing happened and discussion will not bring the patient back. Whole we might not be able to bring the patient back but we should learn from the situation to prevent it from happening again.