I can't imagine any licensed medical professional taking advice from a cop, whether an order or suggestion.
Unsolicited observations and comments from an RN with 20+ years in emergency medicine follow. In Detroit, okay, so I've seen my share of the drunk, the high, the psychotic...
Consider that policies, protocols and practices will vary from state to state and even between lower jurisdictions, but...
Responders here do not sedate or "tranquilize" patients in the field. They'll improvise restraints or bring them in in handcuffs with cops.
People talk of a risk of metabolic acidosis secondary to prolonged agitation. Yeah, well that's why you're bringing them to a hospital. It can be treated, and the patients are typically less than five minutes away. These aren't people we will ignore, even if we want to.
My experience with Ketamine is limited. I've been reading about this and people are talking about taking it for depression, or to get high, whatever. We use it only to sedate children for suturing or to reduce a bone. I think I heard that it was used on an adult in the last few years. I don't know the reason.
When we use Ketamine, there's a whole team at bedside. The patient is on a monitor - cardiac, blood pressure, oxygen and carbon dioxide - rescue equipment including intubation tray within reach. We use it rarely and when we do we're prepared.
So what I've been reading tonight is that something like 60% of these people end up intubated. To the layman, that means they're not protecting their airway. This encompasses a spectrum from no gag reflex to not fucking breathing, and the only thing that's going to keep them alive is a tube down their throat and somebody squeezing a bag. This is extreme and unnecessary. Many of the cases I'm reading about describe patients with unremarkable agitation scores.
The medicines we do use for agitated customers, once they are received in a safe environment, typically include Haldol or Ativan, often in combination, or more rarely Versed. In tonight's reading I saw that something less than 0.5% of people getting Haldol were subsequently intubated, or maybe they were already intubated, but I've dosed thousands of people with Haldol and never had a bad outcome beyond them pissing themselves. And I've given massive doses of Ativan, to the point where I remember as a young nurse I though I killed some guy and touched him and he launched into, well you shoulda seen it. People can really take a lot of benzos, but don't try it. Seriously, the worst I've seen with these meds is that someone will think, uh, maybe we overdid it and they'll put the patient on a monitor for a few hours. TLDR: the meds I'm used to are relatively safe but this Ketamine is scary.
And this whole thing is part of some research study that's been going on for years. The ambulances are owned by the hospital behind the study and the police are, I dunno, recruiting subjects for this whack experiment? You tell me. Consent is assumed because, well you were agitated and we put you down, but patients can "opt out" later. I wonder how many people even understood this whole study thing after it was all done. Was it explained? Could they comprehend it?
I'm thinking of a study done here a few years ago. Medics were giving Valium instead of Ativan for seizures. First off, if you're really seizing you can't say no. Or maybe that's all you can say but this can be a true medical emergency beyond a behavioral or control or a maybe-he'll-go-acidotic-in-a-few-hours kind of thing. And both of these drugs are known to be safe and effective, they're almost the same thing, and they were just trying to see if one was better.
I don't know what they're really doing in Minnesota, I only just read some things, but even with the best explanations it sounds fucked up.
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(untitled comment)
Unsolicited observations and comments from an RN with 20+ years in emergency medicine follow. In Detroit, okay, so I've seen my share of the drunk, the high, the psychotic...
Consider that policies, protocols and practices will vary from state to state and even between lower jurisdictions, but...
Responders here do not sedate or "tranquilize" patients in the field. They'll improvise restraints or bring them in in handcuffs with cops.
People talk of a risk of metabolic acidosis secondary to prolonged agitation. Yeah, well that's why you're bringing them to a hospital. It can be treated, and the patients are typically less than five minutes away. These aren't people we will ignore, even if we want to.
My experience with Ketamine is limited. I've been reading about this and people are talking about taking it for depression, or to get high, whatever. We use it only to sedate children for suturing or to reduce a bone. I think I heard that it was used on an adult in the last few years. I don't know the reason.
When we use Ketamine, there's a whole team at bedside. The patient is on a monitor - cardiac, blood pressure, oxygen and carbon dioxide - rescue equipment including intubation tray within reach. We use it rarely and when we do we're prepared.
So what I've been reading tonight is that something like 60% of these people end up intubated. To the layman, that means they're not protecting their airway. This encompasses a spectrum from no gag reflex to not fucking breathing, and the only thing that's going to keep them alive is a tube down their throat and somebody squeezing a bag. This is extreme and unnecessary. Many of the cases I'm reading about describe patients with unremarkable agitation scores.
The medicines we do use for agitated customers, once they are received in a safe environment, typically include Haldol or Ativan, often in combination, or more rarely Versed. In tonight's reading I saw that something less than 0.5% of people getting Haldol were subsequently intubated, or maybe they were already intubated, but I've dosed thousands of people with Haldol and never had a bad outcome beyond them pissing themselves. And I've given massive doses of Ativan, to the point where I remember as a young nurse I though I killed some guy and touched him and he launched into, well you shoulda seen it. People can really take a lot of benzos, but don't try it. Seriously, the worst I've seen with these meds is that someone will think, uh, maybe we overdid it and they'll put the patient on a monitor for a few hours. TLDR: the meds I'm used to are relatively safe but this Ketamine is scary.
And this whole thing is part of some research study that's been going on for years. The ambulances are owned by the hospital behind the study and the police are, I dunno, recruiting subjects for this whack experiment? You tell me. Consent is assumed because, well you were agitated and we put you down, but patients can "opt out" later. I wonder how many people even understood this whole study thing after it was all done. Was it explained? Could they comprehend it?
I'm thinking of a study done here a few years ago. Medics were giving Valium instead of Ativan for seizures. First off, if you're really seizing you can't say no. Or maybe that's all you can say but this can be a true medical emergency beyond a behavioral or control or a maybe-he'll-go-acidotic-in-a-few-hours kind of thing. And both of these drugs are known to be safe and effective, they're almost the same thing, and they were just trying to see if one was better.
I don't know what they're really doing in Minnesota, I only just read some things, but even with the best explanations it sounds fucked up.
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