Across the country, Scripps News has been digging into how paramedics are using a drug called ketamine to sedate people many of whom are already in police custody.
Ketamine isnt the issue here. The safety profile of ketamine is much, much higher than any other sedatives carried on an ambulance. Even in high doses, transient apnea is extremely rare, and could easily be managed by any competent paramedic. The issues I see are One, paramedics are given more-or-less a weekend of instruction on behavioral emergencies and deescalation techniques. Beyond that it is entirely up to them to improve their ability to safely handle with psychiatric/behavioral/ETOH/substance calls. Two, these paramedics didnt properly monitor their patient following the administration. Place them supine, monitor and/or secure their airway, cardiac monitoring, pulse oximetry, end tidal co2 monitoring, and bag them if they become apneic. Chemical restraints are no substitute for taking extra time on scene to deescalate the patient and have an easy ride to the hospital. I *maybe* sedate one a year, and those are generally drug related.
Shall we assume the dosages were too high in both cases?
Ketamine is used quite often in pain management yet most patients are still alive.
When I think emergency mental health care, the first people that come to mind is the police.
(said no-one)
Ketamine isnt the issue here. The safety profile of ketamine is much, much higher than any other sedatives carried on an ambulance. Even in high doses, transient apnea is extremely rare, and could easily be managed by any competent paramedic.
The issues I see are
One, paramedics are given more-or-less a weekend of instruction on behavioral emergencies and deescalation techniques. Beyond that it is entirely up to them to improve their ability to safely handle with psychiatric/behavioral/ETOH/substance calls.
Two, these paramedics didnt properly monitor their patient following the administration. Place them supine, monitor and/or secure their airway, cardiac monitoring, pulse oximetry, end tidal co2 monitoring, and bag them if they become apneic.
Chemical restraints are no substitute for taking extra time on scene to deescalate the patient and have an easy ride to the hospital. I *maybe* sedate one a year, and those are generally drug related.