I don't know what went on with this McClain guy, but yeah, guys on PCP or coke were really out of control and very strong. They arrived at ER already cuffed but still wildly agitated requiring at least 8 security guys to pin them down in order for us sedate them. Do they still use that HAC cocktail (5mg Haldol, 4mg Ativan, 1mg Cogentin) in the ER?

quote:

Originally posted by V-Tail:
McClain was already handcuffed. Can one of our LEO members explain why sedation was deemed necessary?

In general (NOT speaking to this specific case), when a patient is showing signs of “excited delirium” (note, the feds have already changed the wording of this presentation but I don’t remember what gobble-gook phrase they are having to use), the goal is to get them to the ED as quickly as possible so that they can be treated by doctors and NOT be your problem, because the cascade of acid based balance issues is simply not treatable in the field.

An early step in this is sedating them so the can be safely transported and treated. This prevents them from hurting themselves by fighting against restraints, as well as calming their system down and hopefully slowing the cascade. But you (and they) might already be damned. Especially if you don’t support their breathing when it slows or stops.

The reality is that once the metabolic cascade starts, there is a point of no return. You see in a lot of these, this one included, that the death didn’t actually happen in the field, but days later in a hospital. In most cases it absolutely does not matter what good the first responders do (though anything they do that is not perfect will come back to get them), the die is already cast. But they catch the blame.

quote:

Originally posted by ZSMICHAEL:

The guy's crimes are not the issue here. I see a lot so agitated middle class folks that are agitated and aggressive. Just watch cops or YouTube videos. The issue is the use of ketamine and improper dosing.

Hence the first sentence of my post, the one about not condoning murder.

This is one of those situations where they needed to actually be right, not just acting in good faith.

quote:

Originally posted by chongosuerte:

Takes some reading to get to it, but one thing that got them was that Ketamine has a weight-based dosage. They estimated him at 220 lbs/100 kg and dosed accordingly. He weighed (at some point afterwards) 140lbs/63.5

I’m not good at doing eyeball estimates but I think the difference is obvious between 140 lbs and 220 lbs.

The interesting point, though, is that the difference wasn’t enough to show up as a “lethal” amount in the autopsy.

To clarify, it wasn’t the ketamine that killed him. It was either them being shot paramedics and not doing their job by not monitoring his breathing, or he was already too far down the metabolic cascade after his fight with the cops. But from what I’ve read it was the first option most likely.

I’m no lawyer but this doesn’t amount to a crime in my book. Bad policy yes, poor execution yes, crime no.

If you don’t want paramedics injecting ketamine to people then why is frigging ketamine even on the ambulance ?

I hate to read this stuff because my youngest, the Marine reservist, just completed his EMT training on his way to becoming a fireman. You shouldn’t be put in jail for doing what you have been trained to do. They might have done it better but just the presence of ketamine in the ambulance means they are allowed to administer it. And yes, the dosage was off but it wasn’t a fatal amount according to the doctors either way.

Page 10 and 11 here.

https://officeofthecoroner.com...d-autopsy-report.pdf

Frankly, based on this report, I don’t think a completely unbiased person could have found them guilty based on solely facts.

So what...did they have some new shitty lawyer that had done nothing but intern for Dewie, Cheatum, and Howe????

quote:

Originally posted by pedropcola:
I’m no lawyer but this doesn’t amount to a crime in my book. Bad policy yes, poor execution yes, crime no.

That was my reaction as well. I’m not a lawyer either, but I have had training by lawyers, and one of the things that used to be taught was that the motive, i.e., mens rea, was a critical determination of whether an act was a crime. And, yes, the motive merely has to be evil and not, for example, the intent to actually kill someone as when pushing them down the stairs: the pushing, the assault, was unlawful and therefore makes the death unlawful.

I believe there should be more to a crime than just bad judgment about what was appropriate. This strikes me as yet another prosecution with a sociopolitical motive.

And what about these deaths?

“Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death.”
https://pubmed.ncbi.nlm.nih.gov/28186008/

Are a quarter of a million (or more) medical personnel being convicted of crimes every year?
Is it good? No. Is it even excusable? Perhaps not. But it is a fact of life as long as fallible human beings are involved in the process.

quote:

Originally posted by sigfreund:
I’m not a lawyer either, but I have had training by lawyers, and one of the things that used to be taught was that the motive, i.e., mens rea, was a critical determination of whether an act was a crime. And, yes, the motive merely has to be evil and not, for example, the intent to actually kill someone as when pushing them down the stairs: the pushing, the assault, was unlawful and therefore makes the death unlawful.

Different crimes have different levels of culpability, so the mens rea varies. There are four general levels of mens rea, in descending order of criminal intent:
-Purposeful
-Knowledgeable
-Reckless
-Negligent
(There are also some examples of "strict liability" crimes, which don't require any level of mens rea.)

What you said would be true for purposeful criminal acts, as well as knowledgeable criminal acts. These involve evil/criminal intent and motive.

But wouldn't necessarily be true for a reckless or especially a negligent criminal act.

Notice that the paramedics were convicted of criminally negligent homicide, a lesser offense than other homicides which has the lowest level of mens rea (negligence) that doesn't include a specific intent to commit a crime, merely a failure to follow a reasonable standard of expected conduct.

So the argument is that a different set of paramedics would not have used ketamine in this scenario? If I was a paramedic would this ruling not predispose me to do NOTHING extraordinary to help a person? Ie, if I was a paramedic wouldn't I rather just let that person go nuts while restrained, drive as fast as my happy ass could drive to the nearest hospital, and then let the ED handle this psycho? Minimal effort, minimal exposure to homicide charges.

That doesn't seem like what we would like to happen.

Paramedics operate inside a set of very specific guidelines called protocols. You can get into trouble if you operate outside those guidelines…that means these guys would have been in trouble if they DIDN’T give the ketamine as well…..the mistake they made was over-estimating the patients weight which really is a guessing game…unfortunately ketamine dosage is less forgiving than most of the meds medics carry. Meds carried varies by State and even county where I am…and, new ones get added and done get taken out of protocols on a regular basis….being convicted if a crime here is something new….med errors just like this one are made by medics, nurses and docs every day…it’s amazing how common it actually is…shouldn’t be but it is.

But one problem with what they did is they didn’t form an independent opinion from an assessment that the Ketamine was necessary. The subject was not combative when they arrived, according to everything I’ve read.

Just messy all around. Obvious I’m intrigued. I teach this stuff. I’m still not 100% sure where I stand because the information isn’t readily accessible in a non-biased manner.

^^^^^^^^^^
I agree. There need to be clear protocols for administration of ALL drugs by EMTs. I am puzzled as to why ketamine is now used as opposed to Haldol Ativan and cogentin. The patient remained in cuffs until the drugs took effect. If it was a psychiatric issue the cops or an ambulance provided transport.

quote:

Originally posted by chongosuerte:
But one problem with what they did is they didn’t form an independent opinion from an assessment that the Ketamine was necessary. The subject was not combative when they arrived, according to everything I’ve read.

Just messy all around. Obvious I’m intrigued. I teach this stuff. I’m still not 100% sure where I stand because the information isn’t readily accessible in a non-biased manner.

I agree Chongo….with limited info and not certain what’s accurate I won’t pass judgement. Was there any body cam footage of the incident? That may be partially helpful in what exactly the behaviors were that helped direct decisions.
I also wouldn’t be surprised if the current political cop hating attitude is now bleeding over into all emergency services blame game.

Yes, body camera footage was provided to the Medical Examiner (ME) after the original ME Report.
See Amended Opinion, page 10 & 11 of the .pdf ME report.

ME Autopsy report.

A bit of bias is evident in the ME report.
Someone wanted to pin these EMT’s with a crime regardless of the facts or lack there of.

With my limited knowledge solely from reading this thread and the ME report, it seems the EMT’s were unfortunately caught up in the social justice war.

My guess is the EMT’s are of the white persuasion.

Sadly with today’s judicial system and jury make-up, we must first ask ourselves, if the races were reversed would we have the same outcome.

The Judicial System has been degraded to the extent, that we can never be as confident in the truth coming out as we once were.

I haven't found the route for the ketamine dose. That matters a bunch because there is a big difference. I'm going to assume that they gave it IM (a shot in the arm or butt)

The dosage range for IM (intramuscular) Ketamine is 5-10mg per kg of body weight (some recommend range 6.5mg./kg-13mg/kg). This fellow weighed somewhere in the neighborhood of 143# (I believe). 143= 65kg. 65kg x5=325mg of ketamine (lower recommended dose) 65kg x10= 650mg ketamine (higher recommended dose).

Now, I'm retired but it used to be that the dose he received (500mg) is less than 650mg. IMO....the EMTs could be criticized for not monitoring this person adequately, but it's not an overdose. Adult's hearts don't stop because of 500 mg of IM ketamine, they stop because nobody noticed that the patient has developed airway issues such as obstruction or laryngospasm or aspiration of stomach contents.

It appears that the EMTs did drop the ball.... but it wasn't a dosage issue. Is this a reflection of poor practice or poor training? I don't know.... I'm always a bit ambivalent about non-anesthesia folks giving anesthesia drugs. I guess I'm funny that way ....( it didn't work out well when some cardiologist started a propofol infusion on Michael Jackson and then went to the john....)

IMO...drugs can NEVER be depended on to act reliably and that is why a trained person should always be there to monitor the patient ( or he becomes the victim). Sorry for the preaching....

This message has been edited. Last edited by: mike28w,

quote:

Originally posted by ZSMICHAEL:
^^^^^^^^^^
I agree. There need to be clear protocols for administration of ALL drugs by EMTs. I am puzzled as to why ketamine is now used as opposed to Haldol Ativan and cogentin. The patient remained in cuffs until the drugs took effect. If it was a psychiatric issue the cops or an ambulance provided transport.

In our (Michigan) protocols 3-6, its listed as HYPERACTIVE DELIRIUM SYNDROME WITH
SEVERE AGITATION. Our choices are Ketamine or Versed under this. We don't carry Haldol or Ativan in our drug boxes.

^^^^^^^^^^^^^^^^^
Thanks for the response. Interesting that Versed is an option.

quote:

The subject was not combative when they arrived, according to everything I’ve read.

^^^^^^^^^^^
Sadly I have seen the administration of these drugs when the patient is not combative. It shuts them up and their work is easier.