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.
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.