Sjy

Sorry I missed this comment!

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?

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.

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.

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.

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.

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.

So, it is much easier and safer for everyone to sedate someone.

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.

Should we just let people die fighting with law enforcement?

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.

They did change, they removed ketamine from the units.

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.

Thank you for your kind words! I love that there is finally a topic that I can contribute to!

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 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.

Paramedic here, we don’t have access to a fully stocked pharmacy in our ambulance. Ketamine is pretty much the industry standard for situations like this. Its efficacy, safety profile, wide dose range, and rapid onset make it the ideal drug for managing violent behavior and sedation in a prehospital setting. I am not saying the medics made an appropriate decision in this situation but that is the appropriate mediation to use in situations like this. Versed would be a good runner up but is less effective in some situations with low doses and higher doses have a higher risk of respiratory compromise. Ativan is an option, if they carry it, I wouldn’t personally use Ativan in this situation because it has a longer onset/duration and higher chance of adverse reactions.

Ketamine might seem a bit excessive but it’s a very good medication for prehospital use. This is a situation that a lot of stuff went wrong and someone died. The cause of the death is more likely an adverse reaction that was not appropriate addressed by the paramedic, but that’s probably why they just got a conviction. But ketamine is used every day across the US without situations like this happening.

Absolutely! If you have any questions or want anything explained differently, just ask!

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.

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.