Media v. Cops and Docs

E tank

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http://www.startribune.com/at-urging-of-police-hennepin-emts-subdued-dozens-with-powerful-sedative/485607381/


Hennepin EMS Medical Director Jeffrey Ho and Minnesota Poison Control System Medical Director Jon Cole dismissed the findings of the report as a “reckless use of anecdotes and partial snapshots of interactions with police, and incomplete information and statistics to draw uninformed and incorrect conclusions.”

And...

“This draft report will prevent the saving of lives by promoting the concept of allowing people to exhaust themselves to death,” Cole and Ho wrote.

Far from being comforted and the continuing militarization of many police departments, I think journalism like this just serves to reduce and invalidate genuine concerns with over reach of police powers.

Clearly this type of thing can be abused, but the medics are the ones that will suffer the professional consequences so the integrity criteria for legitimate use is somewhat safeguarded.

From the headline on down, this media outlet has an agenda, IMHO.
 

VFlutter

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What did I just read?

"EMS workers used date rape drug ketamine, stopping some suspects' hearts or breathing."

The article is full of horribly inaccurate information, dramatization, and poor understanding of medical terms.

Having said that, I do think that many times Ketamine may be too liberally used under the "Severe Agitation" Protocol. It is hard to define what severe agitation is and easy to argue how someone may be at risk of harming them selves or others but many protocols state only for Excited Delirium or after other measures (Benzos) have failed.
 

StCEMT

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There may be a valid point in there, but it is quickly drowned out by a lack of understanding about...well...everything.
 

Remi

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I don't see how this constitutes "media vs cops and docs"? What in the article implies that there's any kind of an "agenda"? Simply the fact that something was printed that doesn't make EMS look good? Where exactly is the "horribly inaccurate information" in the article?

There was an investigation into potentially abusive or inappropriate practices by government employees. The agencies involved tried to keep it hush-hush (which is always telling in itself). Someone leaked the investigation findings to the news, and the news reported it to the public because the government agencies involved apparently weren't planning on being transparent on their own. This is actually a rare example of the news media doing exactly what they are supposed to do.

Is the reporting a little hyperbolic? Sure. So what? Journalism often is. Anyone with half a brain gets it. I don't see anything here that is really over the top. Was exactly is so offensive about the article?

If what was reported in the article is an accurate reflection of what was actually presented in the draft report, and if the basic facts laid out in the draft report are true (that paramedics in this system have very often complied with police requests to innapropriately dose ketamine when it wasn't clinically indicated, and that doing so has resulted in harm to patients in a not-insignificant percentage of instances), then this is absolutely stuff that the public deserves to know about.

To the credit of the police, they don't appear to deny that it happened and reacted by implementing a policy to stop it from happening. The medical director's defensive gibberish ("this draft report will prevent the saving of lives"), on the other hand, just makes EMS look bad.
 

DrParasite

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We don't use Ketamine in my system, however we do use versed... lots of versed... one of our "7 deadly sins" is "Cardiac and/or respiratory arrest occurring after administration of midazolam (Versed), morphine, or fentanyl." It's an automatic call review, an immediate call to the medical director notifying him that is happened, and is generally something that most like to avoid. I know Ketamine can have some bad side effects, but if you have that many people going into respiratory arrest....

Are the medical providers not telling the cops no when they order them to give ketamine? is any medic going to give a drug just because a cop says so, no because it's clinically indicated? Cop says give narcan to the cocaine overdose, is the medic going to do it just because the cop tells him to?

4 doses in 2012, and 68 in 2018 are alarming numbers.... but more information needs to be obtained. was the medication given appropriately? Is the agency seeing more agitated ED patients? or are they just doing it because the cops tell them to (and based on what the medical director is saying, that isn't happening).

It looks like they are letting an outside agency review the K use:
Hennepin Healthcare will ask independent panel to review ketamine cases
 

cruiseforever

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We don't use Ketamine in my system, however we do use versed... lots of versed... one of our "7 deadly sins" is "Cardiac and/or respiratory arrest occurring after administration of midazolam (Versed), morphine, or fentanyl." It's an automatic call review, an immediate call to the medical director notifying him that is happened, and is generally something that most like to avoid. I know Ketamine can have some bad side effects, but if you have that many people going into respiratory arrest....

Are the medical providers not telling the cops no when they order them to give ketamine? is any medic going to give a drug just because a cop says so, no because it's clinically indicated? Cop says give narcan to the cocaine overdose, is the medic going to do it just because the cop tells him to?

4 doses in 2012, and 68 in 2018 are alarming numbers.... but more information needs to be obtained. was the medication given appropriately? Is the agency seeing more agitated ED patients? or are they just doing it because the cops tell them to (and based on what the medical director is saying, that isn't happening).

It looks like they are letting an outside agency review the K use:
Hennepin Healthcare will ask independent panel to review ketamine cases

They have announced who will be the investigator. www.startribune.com/sally-yates-to-lead-ketamine-investigation/486303061




 

cruiseforever

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4 doses in 2012, and 68 in 2018 are alarming numbers.... but more information needs to be obtained. was the medication given appropriately? Is the agency seeing more agitated ED patients? or are they just doing it because the cops tell them to (and based on what the medical director is saying, that isn't happening).
I do not work for HCMC, but my service is in the same system. There have been changes in our protocols that allows a medic to give Ketamine for pain control, ped's sedation. My use of it has increased because of these changes. Also HCMC has had a very large change in personnel and it is possible some of the new medics are giving it instead of using another medication.
 

DrParasite

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That's the law enforcement investigation, not the healthcare one.
There have been changes in our protocols that allows a medic to give Ketamine for pain control, ped's sedation.
That's pretty much what I was saying. You saw a spike in numbers..... but that's just raw data, without any context..... the important thing is what it given appropriately? that's useful information.

By itself, it is alarming to see a 17x increase in administration for ANY medication (narcan is another example; it's use has skyrocketed, and now public health officials are getting involved, however it's administration has been mostly appropriate); however, if it's being used for other purposes (pain control being one of them), and being used appropriately, then there is a perfectly reasonable and acceptable explanation, and the reason for alarm goes away.
 

DrParasite

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Lawsuit alleges hospital improperly sedated woman with ketamine
Brittany Buckley says Hennepin Healthcare paramedics forcibly injected her with ketamine last year and enrolled her in a clinical trial
By Andy Mannix
Star Tribune

MINNEAPOLIS — A Minneapolis woman says Hennepin Healthcare paramedics violated her civil rights when they forcibly injected her with ketamine last year and enrolled her in a clinical trial without her consent.

Brittany Buckley filed a federal lawsuit this week against the hospital, alleging medical malpractice, negligence and excessive force resulting in breathing and heart complications as EMS workers drove her to the downtown Minneapolis hospital.

read the rest here: https://www.ems1.com/ketamine/articles/392857048-Lawsuit-alleges-hospital-improperly-sedated-woman-with-ketamine/
 

Eir

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I'm a paramedic student in the same system (though not HCMC). I was going to mention this particular case because we have the most information about it. Our protocols note to use caution when using ketamine with alcohol. She already had repsiratory depression from ETOH intoxication, if they gave her the dose in our protocol then it isn't too surprising that she needed intubation or had tachy.

I don't believe her claim that she was compliant. They had her in restraints. More likely she forgot the parts where she was violent. The paramedics may have given her too large of a dose, but they seem to have responded properly after that.

As for the other thousand claims about improper ketamine administration at HCMC, I believe it's more about the public not understanding what we do or how holds work than any sort of police or EMS misconduct.
 

Duke Powell

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I don't see how this constitutes "media vs cops and docs"? What in the article implies that there's any kind of an "agenda"? Simply the fact that something was printed that doesn't make EMS look good? Where exactly is the "horribly inaccurate information" in the article?

There was an investigation into potentially abusive or inappropriate practices by government employees. The agencies involved tried to keep it hush-hush (which is always telling in itself). Someone leaked the investigation findings to the news, and the news reported it to the public because the government agencies involved apparently weren't planning on being transparent on their own. This is actually a rare example of the news media doing exactly what they are supposed to do.

Is the reporting a little hyperbolic? Sure. So what? Journalism often is. Anyone with half a brain gets it. I don't see anything here that is really over the top. Was exactly is so offensive about the article?

If what was reported in the article is an accurate reflection of what was actually presented in the draft report, and if the basic facts laid out in the draft report are true (that paramedics in this system have very often complied with police requests to innapropriately dose ketamine when it wasn't clinically indicated, and that doing so has resulted in harm to patients in a not-insignificant percentage of instances), then this is absolutely stuff that the public deserves to know about.

To the credit of the police, they don't appear to deny that it happened and reacted by implementing a policy to stop it from happening. The medical director's defensive gibberish ("this draft report will prevent the saving of lives"), on the other hand, just makes EMS look bad.

Speaking from first hand knowledge of the situation, the articles from the Minneapolis Star Tribune were so full of factual errors that its hard to know where to start. To begin with, City of Minneapolis staff were monitoring police body cams and ran across footage of medics administering ketamine. They ran across multiple instances when they focused their search and jumped to conclusions. Of course, none of them had any medical training.

Just to illustrate their cluelessness they decided that several patients required pre-hospital intubation. This did not occur. City staff witnessed insertions of nasopharyngeal airways and thought that was intubation. They also asserted that a number of cardiac arrests occurred as a result of ketamine use. No patient had arrested after given this drug. One would think that performance of CPR would be easily recognizable.

They also made a major point of the fact that ketamine was administered to agitated patients against their will. I personally injected agitated patients using this drug. It is true that none of them consented. Its use is to protect the patient and those around him from their out of control behavior.

Lastly, the main concern of city staff was that police were ordering medics to use ketamine. If that were the case, then that's the medics fault. The medic is in charge of medical treatment on the scene. Police, in their role as first responders, work under the direction of the medic. Our department could find no evidence of medics taking orders from police. Ketamine use was medically indicated in every instance. One possible explanation is that Minneapolis police are trained as medical first reponders by our department. They have been trained, continuously, over many years about the dangers of excited delirium and how to properly restrain patients. My experience has been that they have a very good working knowledge of this syndrome and the proper treatment. In my opinion, for the police to opine that the patient needs ketamine is the same as telling a arriving medic to "bring your suction."

I could go on and on and on.........about the inaccuracies found in the city's draft report and the newpaper's reprehensible reporting of this issue. Let me end with this; City staff issued a draft report that was going to be submitted to EMS and the hospital for review. Before that could happen, a city staffer leaked the draft to the newspaper. The "journalist" who received the draft gave the hospital only 48 hours to respond prior to publication. This, of course, was an impossible time frame. Hence, the Minneapolis Star Tribune ran the story with a banner headline on the front page, above the fold, in their Sunday edition. This whole story is BS from hello to goodbye.
 
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Tigger

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Lastly, the main concern of city staff was that police were ordering medics to use ketamine. If that were the case, then that's the medics fault. The medic is in charge of medical treatment on the scene. Police, in their role as first responders, work under the direction of the medic. Our department could find no evidence of medics taking orders from police. Ketamine use was medically indicated in every instance. One possible explanation is that Minneapolis police are trained as medical first reponders by our department. They have been trained, continuously, over many years about the dangers of excited delirium and how to properly restrain patients. My experience has been that they have a very good working knowledge of this syndrome and the proper treatment. In my opinion, for the police to opine that the patient needs ketamine is the same as telling a arriving medic to "bring your suction."
I have not connection to Minnesota EMS so will withhold any commentary on this "story."

What I will say is that EMS is not immune to pressure from law enforcement to utilize Ketamine in situations where pharmacological restraint is not appropriate. I am not saying that this happened in Minneapolis. I have no idea.

But I can certainly think of more than a few times where law enforcement has requested we "put the guy in the K-Hole." Sometimes this is appropriate therapy, sometimes it is not. Sometimes the party really shouldn't be even receiving contact from law or EMS. But we all (hopefully) wish to build relationships with other agencies and sometimes the pressure to "help the cops out" can create situations where poor judgements are made. To think otherwise is silly and bears repeating to staff every now and again.
 

johnrsemt

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We haven't started using Ketamine yet, but will be soon. So I don't have much to add to the above, but I have a couple of questions.

Does Ketamine work where Haldol or Versed doesn't? Because we have had a few patients that have been given Versed or Haldol and it didn't touch their combativeness; which is going to make the next 90 minutes extremely fun (105-130 miles 1 way to hospitals).
 

NomadicMedic

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We haven't started using Ketamine yet, but will be soon. So I don't have much to add to the above, but I have a couple of questions.

Does Ketamine work where Haldol or Versed doesn't? Because we have had a few patients that have been given Versed or Haldol and it didn't touch their combativeness; which is going to make the next 90 minutes extremely fun (105-130 miles 1 way to hospitals).
Yes. IM ketamine is fast and provides reliable results. You'll be amazed when you use it and disappointed that you've been suffering with haldol and versed for so long.
 

Remi

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We haven't started using Ketamine yet, but will be soon. So I don't have much to add to the above, but I have a couple of questions.

Does Ketamine work where Haldol or Versed doesn't? Because we have had a few patients that have been given Versed or Haldol and it didn't touch their combativeness; which is going to make the next 90 minutes extremely fun (105-130 miles 1 way to hospitals).
Sufficient doses of midazolam are generally reliable. I know there have been cases where even massive doses of midazolam don't work, but those are unusual. When people say "versed often doesn't work but ketamine is awesome" they are often comparing moderate doses of versed to massive doses of ketamine.

Ketamine's big advantage is that it has very little effect on upper airway tone, where large doses of benzos can certainly contribute respiratory compromise.
 

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