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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.
Maybe try sedating the cops? They'll be less aggressive and less likely to escalate.
E: spelling
I do think that may have helped in this situation. In a more broad sense my point is I would be disappointed if a paramedic didn’t do something to stop someone from dying. We don’t have to agree on the administration of sedatives but I’d rather me or my family be sedated and transported to the hospital instead of situations continuing to escalate while fighting with law enforcement that may lead to someone being killed.
To be clear, I don’t know the full details of this specific case, as I said in my original comment, there isn’t a reason I can think of for the medics not monitoring capnography, that’s industry standard as it will show in real time when someone stops breathing and allow us to take over. If the paramedics did not monitor capnography and the patient died then that is most likely negligence that resulted in someone’s death which is unacceptable. However if they did everything appropriately and recognized the change in condition and addressed it and the patient still died then then it’s hard to fault them, apart from giving the incorrect dose of ketamine, tho just giving an extra 200mg of ketamine will not cause someone to die but it can cause unwanted side effect that if unrecognized or untreated could lead to someone’s death.
This situation isn't really about the paramedics or if sedation is a good practice. The cops never should have touched the victim. There was literally nothing going on; he was walking down the street minding his own business and the cops attacked him and caused all of this. The Aurora PD are a bunch of drunken thugs (I live where this happened). Some of the Aurora PD members took a selfie mocking the murder at the site of the murder. They get busted for being drunk at work with shocking regularity, and there are rarely any consequences. Here's one of their more stellar members: https://kdvr.com/news/local/aurora-officer-found-drunk-passed-out-in-patrol-car-3-years-ago-gets-promoted/
I am agreeing with you. I don’t have much else to say on that topic because we agree. My job forces me work around law enforcement but I sure as hell don’t enjoy it and separating the subject from work I have zero trust for or desire to be around them.
However the title of this post is “Paramedics Found Guilty in Last Trial in Elijah McClain Death”. So my comments more go to the topic of the paramedics because I am a paramedic and I’ve been in these situations, law enforcement does shitty things and I have to make decisions based on what they tell me and what I see, they might be lying to me but I have to document what they told me, not if I believe them or not. In that context I’m going to elect to sedate and take the person into my care and out of custody of law enforcement as soon as possible because I don’t want anyone to be harmed by law enforcement (well I don’t want anyone harmed at all but this is in context of law enforcement). But law enforcement escalating a situation is something I have no control over, it would be a hell of a lot easier to give them some benzos to chill the fuck out than it is for me to sedate someone and have to potentially takeover their airway if they have any sort of reaction to the sedation.
The fact that the circumstances allow you to make an immoral choice doesn't privilege you to actually make it even if you think the outcome will be better. You have no right to medicate someone against their will. It should be an incredibly high bar to override the patients own wishes. You yourself are an incredibly immoral person by any conception of medical ethics or morality. The ends don't justify the means. I'm sorry you can't see that.
I’m not here do debate the details that go into complex situations as they need to be taken on a case by case basis. I apologize that you interpret this as immoral and I assure you the bar to go against a patient’s wishes is very high. Please take into consideration the fact that in emergency situations people are not always able to provide consent and that I am forced to work under what’s called “implied consent” meaning that if someone needing help is unable to provide consent I am to act as if they would consent to help if they could.
Which means I am not only authorized to medicate someone without consent but in situations where safety comes into question I am expected to. If you don’t like this then I encourage you to get involved with your local agencies and look into your area’s laws and advocate for the changes you want to see. But your comment sounds like someone screaming “I don’t consent” while being arrested, except that’s not what’s going on here. I am required to listen and follow someone’s wishes if they are able to provide informed consent and I am required to act as if they would consent if they cannot. It’s written in every textbook I’ve ever read, it’s written in my state’s laws, and it’s written in my department’s policies.
I can only assume you’ve never dealt with complex medical emergencies if you think everything that happens in an ambulance or helicopter is the same as going into a hospital for an elective or routine surgery they requires a dozen signatures to consent and multiple doctors explaining risks and complications of the procedure being performed. If you’d like to learn more I would encourage you to see if your local fire department or ambulance service would allow you to do a ride a long.
If you think someone being attacked and abused by the cops has given you implied consent you have never understood your own oath in the first place.
This will be my last reply to you as this is not a productive conversation and you are jumping to conclusions assuming we “take an oath” and refusing to acknowledge that we work on limited information while being forced to make decisions. Dislike it all you want, but by not acknowledging that this is how it works and not taking steps to change that you don’t like means you’re also allowing it to happen. If you’d like to be an adult and have an intelligent discussion instead of using fallacious attacks then by all means I am happy to discuss further.
They administered too much sedation and failed to bother to make sure he didn't die of it by monitoring him thereafter. They are not just negligent, they are outrageously negligent. It's easy to fault them which is why they were found guilty. I'm not sure why you find it hard.
If that is what happened, yes I agree that they are wrong and grossly negligent. What I find hard to believe is there is a department that would allow Ketamine to be given without monitoring capnography. Capnography would have alerted them that he stopped breathing within 15-30 seconds. The only details that are provided are too much medication was given and he died. Not monitoring capno would have made this an open and shut case.
The other reason I don’t jump on it’s their fault is because we follow something called “just culture” which says when an error is made we have to look at the totality of the circumstances and we console human error, coach reckless behavior and punish negligence. I wasn’t involved in any case reviews and I wasn’t on the jury. I don’t know the full circumstances so I’m going to remain impartial and let the jury’s verdict speak for itself.
I don't think we're being asked to believe that, as if that was the case the people in charge of policy would have been negligent, not the paramedics.
So just so I'm understanding you, you think it is appropriate for people with ~90 days of training to be administering sedatives on the side of the road under orders from law enforcement, with no doctor involvement?
Lmao, I appreciate your concern because no that would not be appropriate in any way shape or form. However an EMT cannot administer sedatives. A paramedic can. One needs to have the 4 months of EMT school plus a minimum of one year of paramedic school, to be a paramedic. The program I teach at starting from no training through paramedic school is two years.
Additionally, I understand the general population doesn’t understand or is not exposed to what the capabilities of EMS is or how it works but id be happy to answer and explain any details that you’d like. But to start no, none of this happens without a physician. The physician is present in this situation in the form of protocols which are essentially a prescription that paramedics are authorized to follow without talking to a physician in real time.
But, I will agree I think the two years is a fairly small requirement for the invasive procedure and access to anesthesia medications that we as paramedics have and are authorized to use without having a doctor near us. It gets even crazier to think that I in my current roll am authorized to perform some emergency surgeries, such as cricothyrotomy and finger thoracostomy, as well surgically placing chest tubes and even perform a pericardiocentesis.
So sure it sounds bad from the outside if I say after one year of paramedic training I can cut a hole in someone’s chest on the side of the road to stick my finger in, or stab a needle into their heart, after I sedate then paralyze them, intentionally stopping their breathing just to place a breathing tube before putting them on a ventilator. That is stuff that all requires very specific training, any sort of surgery is generally only performed by doctors, paralytics and intubation is more specifically an emergency physician or anesthesiologist and ventilators are generally a respiratory therapist’s job. But that’s the beauty of paramedicine, we can do anything as long as we are acting in good faith trying to help someone. BUT systems that allow us to do pretty much anything I just listed are not “get hired out of school” programs. The minimum is generally 3 years as a paramedic in a busy system, but most require five years. In addition to the minimum experience, the extra skills are taught to us on the job by physicians, who individually validate that we are competent and capable to perform them. If the agency is associated with a hospital more often then not we will be required to work with our medical director and perform the skills on real patients before we are allowed to perform them on our own.
If you have any more questions or would like any more information just ask! I love my job and enjoy teaching others and advocating for the profession.
Hi - I'm not the original commenter, but your text is very thoughtful and insightful. I appreciate you writing your comment, I think it cleared up at least a few of my misunderstandings in a very clear and understandable manner. Thank you for your post, internet stranger :)
Absolutely! If you have any questions or want anything explained differently, just ask!
I get and appreciate what you're saying, but I still have a problem with EMS being able to sedate people just walking home on the orders of the police.
It is literally insane to me that the police can just tell EMS to dose someone with ketamine. You might be able to convince me it was justify with a known dangerous person, in the process of fighting everyone off, maybe. But this case shows, all it takes is a cop convincing a willing EMS person to just do it and then we get dead innocent people.
It is not our job to determine who is innocent and who is guilty. Law enforcement does not direct medical care, if the medic gives meds it is their responsibility to ensure they are giving them appropriately.
In this situation, there was a patient fighting with law enforcement and EMS was requested. They don’t know what the patient was doing before they showed up but they have to make a decision about what to do with what they see and what they are told. A sign that someone has a brain bleed is becoming combative. If they let a patient with a brain bleed continue to fight with law enforcement, the patient will die, which means failing to act will result in the death of an innocent person. Appropriately sedating and managing a patient with a brain bleed and they might live. We don’t get the details of what’s doing on with someone the same way doctors in a hospital do.
Do not apply what happened in this situation as if it is a common occurrence, it isn’t. The negligent actions of these medics lead to them being charged criminally. I don’t know everything that happened so I do not want to comment on what I this is or is not appropriate in this case, however a jury that was given the details of this case determined that they were negligent and cause someone’s death and convicted them of that.
You don’t need to like that it is part of our job and our training but it is and we do it appropriately every single day. This time they did it in a way that lead to a jury convicting them of charges after their actions lead to a patients death. Go spend some time around EMS, we might be a bit strange but most of us joined this profession to help others, not force our will on others.
That's the contention, that's why they're going to jail, there is no proof this man was fighting anyone. The police put him in a choke hold seconds after the encountered him then order paramedics to sedate him!
That this as a default in our system where they "just follow orders" and sedate people is troubling and I don't know why you don't understand that...
Because that is not why they were convicted. They were convicted because they did not assess the patient before administering sedation, then continued to not assess or monitor him in any way after administering sedation.
The “just follow orders” to sedate someone is not how this works. When we give a med it’s on us, that’s why they were convicted.
I would love to remain impartial without seeing all the evidence but the more I see and learn about this incident I’m losing that ability. Partially because I don’t think I could stomach all the evidence due to how grossly negligent these individuals were. They are a disgrace to paramedicine.
I will continue to stand by my previous comments as I was speaking in terms of how things should work, situations like this are part of the job. However these two assholes should be ashamed to have ever called themselves paramedics.
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.
In order for you to sedate someone, they must already be under control right? Or do you jump into the dog pile with a syringe full of ketamine?
Furthermore, you're unlikely to have been there for the initial encounter so who are you to judge whether someone is trying to hurt police versus someone who is being assaulted by the police after having committed no crime and is only trying to protect themselves from a bunch of roided-out criminals? These fights often involve police kneeling on people's arms and legs, immobilizing them completely, while shouting "give me your hands" or "stop resisting" so that it appears to bystanders that it's a two-way fight and not just a motionless person getting the shit beat out of them. I can't count the number of bodycam videos I've seen where you can clearly see the 'suspect's' hands pinned down by other police while being punched in the face for not putting their hands behind their back.
Sorry I missed this comment!
You might not like the answer to this. We don’t have the luxury of doing things the way they are done in controlled settings like doctor’s offices or hospitals. Law enforcement will restrain people and then all I need as a shoulder or a leg and about 3 seconds.
You are correct we are not generally there for the initial encounter. We do not make the determination if law enforcement is justified in fighting with people. Becoming combative is a symptom of quite a few medical emergencies. In situations like this I don’t decide who is right, that’s what court rooms are for. I do act in the way that I believe is best and safest for everyone. People in other comments don’t like this but even in this case, as a paramedic if I see someone fighting, throwing up, and going in and out of consciousness, I’m going to act as if they have a brain bleed. Which means aggressive sedation and airway management. Anything less or allowing fighting to continue significantly increases the risk of death for the patient.
Everything you described about law enforcement attacking people is why my personal philosophy is to stop the fighting. If law enforcement escalated a situation, who wins by me not doing what I can to stop the fighting? People can and do die from fighting with the police. People are much less likely to die if sedated and appropriately managed until they are discharged from the hospital.
That said, this case is an exception, the paramedics caused his death and were convicted as such. This is a very abnormal and unusual situation that disgraces the profession and it does not reflect how a competent paramedic would handle the situation.