Sedation Deaths

[Phillyrube]

Study out of Florida showing fatalities where sedation was administered by medics.

At least 17 people died in Florida after medics injected sedatives during encounters with police

Critics argue that the medications, given without consent, can be too risky to be administered during police encounters.

www.wesh.com

 

[E tank]

Maybe 2News Sunrise didn't know they'd been scooped, nor is it a bad thing that we don't depend on PBS for direction on this topic...stopped at 3...

Adverse events following emergent prehospital sedation of patients with behavioral emergencies: A retrospective cohort study

Patients presenting to emergency medical services (EMS) with behavioral emergencies may require emergent sedation to facilitate care, but concerns about sedation-related adverse events (AEs) exist. This study aimed to describe the frequency of AEs following ...

www.ncbi.nlm.nih.gov

https://www.annemergmed.com/article/S0196-0644(21)00152-9/abstract

Prehospital Agitation and Sedation Trial (PhAST): A Randomized Control Trial of Intramuscular Haloperidol versus Intramuscular Midazolam for the Sedation of the Agitated or Violent Patient in the Prehospital Environment | Prehospital and Disaster Med

Prehospital Agitation and Sedation Trial (PhAST): A Randomized Control Trial of Intramuscular Haloperidol versus Intramuscular Midazolam for the Sedation of the Agitated or Violent Patient in the Prehospital Environment - Volume 30 Issue 5

www.cambridge.org

Now comparing these with pre-hospital medical/trauma analgesia/sedation adverse effects and ER psych sedation adverse effects would give a little clarity that PBS and 2News Sunrise may lack or just not be interested in. 94 deaths nationally in 9 years is all they could associate with out of hospital sedation?

Tylenol kills 250 people per year in unintentional OD's. At the risk of straw manning the argument or reducing the deaths of individuals to an insignificant statistic, this is a non story that I hope some dumb politicians wouldn't run with and try to take away a valuable tool or continue to demonize the police.

oh...and an "investigation by the AP" is not a "study".

 

[Akulahawk]

I have seen ketamine fail, Ativan fail, Geodon fail in these patients. These patients are not always high on some medication, but for whatever reason they present in delirium. Sometimes with these patients, the best course of action is RSI. Excited delirium patients are at risk for death simply because they’re that highly agitated… In short, that news story is looking to sensationalize something that should be a non-story.

 

[FiremanMike]

One also needs to consider shock index, sympathetic storm, and oxygenation prior to sedation. Similar to what we have found when studying RSI deaths, when the patient is barely hanging on and only surviving based on their body's sympathetic release and we sedate and blunt that internal response, the patient has a high propensity for crashing and dying.

Obviously, we're not going to be able to establish these things in a violent patient, but it needs to be in the back of your mind. We should probably do a better job of immediate assessment and prepare for aggressive management in anyone we chemically sedate as soon as it's safe to do so.

I have given my fair share of ketamine for chemical restraint, thankfully I've not had a patient crash on me. With that said, many areas (including my own) have gone to a more staggered approach to chemical sedation, scaled based on the level of agitation we see, which has shown to be safer.