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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.
It is not our job to determine who is innocent and who is guilty. Law enforcement does not direct medical care, if the medic gives meds it is their responsibility to ensure they are giving them appropriately.
In this situation, there was a patient fighting with law enforcement and EMS was requested. They don’t know what the patient was doing before they showed up but they have to make a decision about what to do with what they see and what they are told. A sign that someone has a brain bleed is becoming combative. If they let a patient with a brain bleed continue to fight with law enforcement, the patient will die, which means failing to act will result in the death of an innocent person. Appropriately sedating and managing a patient with a brain bleed and they might live. We don’t get the details of what’s doing on with someone the same way doctors in a hospital do.
Do not apply what happened in this situation as if it is a common occurrence, it isn’t. The negligent actions of these medics lead to them being charged criminally. I don’t know everything that happened so I do not want to comment on what I this is or is not appropriate in this case, however a jury that was given the details of this case determined that they were negligent and cause someone’s death and convicted them of that.
You don’t need to like that it is part of our job and our training but it is and we do it appropriately every single day. This time they did it in a way that lead to a jury convicting them of charges after their actions lead to a patients death. Go spend some time around EMS, we might be a bit strange but most of us joined this profession to help others, not force our will on others.