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I am an EMS provider with experience sedating patients (generally using Versed, but I have used Ketamine on occasion as well). In every instance it has been don

I am an EMS provider with experience sedating patients (generally using Versed, but I have used Ketamine on occasion as well). In every instance it has been done out of concern for safety (my own, my crew's, or the patient's). Taking the article at face value, it seems likely this procedure was being abused (and I would not be surprised if that was proven to be the case). However... Many of the circumstances described do not necessarily mean it was inappropriate to sedate the patient. Just because someone is handcuffed does not mean they are not a danger to me. Just because someone is secured to the stretcher does not mean they are not a danger (I've been kicked in the head by someone who continued to fight after being secured to the stretcher and eventually worked his leg free). Just because someone has not committed a crime does not mean they cannot be taken to the hospital involuntarily (generally after expressing an intent to harm themselves). I think the moral answer to "should we prevent someone who wants to hurt themselves from doing that" is worth some discussion, but the legal answer is quite clear... I am required to transport that patient to a hospital. In many cases is it safer for the patient to use chemical rather than physical restraints. Again, I am not defending every instance of sedation in Minneapolis. I am simply providing some examples of how this isn't always a cut and dry decision.

eesmith 8y ago
You appear to be downplaying the article. You write "just because someone has not committed a crime does not mean they cannot be taken to the hospital involuntarily". The article certainly doesn't disagree with that statement. It states: "Hennepin Healthcare staff are authorized to use ketamine when a patient is “profoundly agitated,” unable to be restrained and a danger to themselves or others, according to their policy." Instead it is pointing out times where there does not appear to be a justifiable reason, and for situations where there seemingly should be a cut and dry decision. The morality point you brought up, while true, does not appear relevant to the topic at hand. As an example of downplaying, the article talks about being handcuffed and secured to the stretcher. You turned that into two distinct cases, and gave an example of where each one separately has come up in your work. But how often have ended up in danger from people who were both handcuffed and secured to the stretcher? The other use of "handcuffed" was from someone maced while intoxicated, who suffered an asthma attack as a result. The woman, who "was not actively resisting police, asked for an asthma pump. Instead they handcuffed her to a stretcher and gave her ketamine, the report said. ... It is also important to note that it appears no crime was committed, no threat to the safety of officer or paramedics was evident, ...". Again, your abstract question of the morality of taking someone to the hospital involuntarily under any circumstance does not seem to be relevant. You write "In many cases is it safer for the patient to use chemical rather than physical restraints." Certainly. Again, I don't think anyone disagrees. However, the article points out examples where both chemical and physical restraints were used. For example, a man secured to a chair, then "[w]hen the man began to regain consciousness .. [t]hey injected him with another dose of ketamine", causing him to stop breathing. I interpret your true but abstract observations as a way to blur the concrete examples of problems highlighted in this piece.
- JshWright 8y ago
  I am not downlaying the article at all. I made it quite clear I believed it was likely the procedure was being abused. The anecdote of the asthmatic woman is particularly concerning. > But how often have ended up in danger from people who were both handcuffed and secured to the stretcher? Multiple times (I don't have a specific number). A stretcher is not intended to be used as an anchor for restraints. It's very difficult to keep someone restrained to a stretcher if they are continuing to fight. There is also a significant risk they will injure themselves. Finally, in some cases it is necessary to sedate a patient to provide treatment. The point of my comment is that it would be very easy for the article to omit details to make situations seem far less appropriate than they actually may have been (or that the abuse was more widespread than it actually was). EDIT: As your comment is starting to gray out, I think it's important to say that while I disagree with you, I think your comment is thoughtful and contributes meaningfully to the conversation (and certainly shouldn't be downvoted)
  - eesmith 8y ago
    Thank you for your support. I tried to highlight the specific reasons why it felt like downplaying. Another way to phrase my view would be, if someone did want to downplay the report, how would it come across? An outright rejection doesn't work. It's too easily dismissed. For example - and I make this comparison only to provide a well-known example - if you look at the anti-vaxxers, they don't outright reject vaccination. Instead, they argue that it should be examined more closely, there are uncertainties, and it's best to be cautious. No one can argue with those general statements. It's when you come down to specific things like "should all 6 month old babies (excepting medical reasons) be vaccinated for X" where the opposition comes into play. The opposition strategy is to take it back to the more abstract level, or bring up specific examples where vaccination might have caused a problem. I felt like your comment followed a similar pattern of switching to abstract principles that no one disagrees with. Someone who wanted to downplay the report would do that, to establish credential as being a reasonable person, and then use that credential to argue that things are more grey and nuanced than it appears. A third way to phrase my view would be as a complaint about switching to abstractions, which seems to minimize the concrete abuses of the actual people described.
mnm1 8y ago
Then why are these EMTs administering such high doses that the patient can no longer breathe? Are these people not trained properly? Seems like there are other ways to restrain someone that doesn't put their life or the EMTs life in danger. Obviously police don't give a fuck if a suspect dies or not but shouldn't the EMTs care? Not least of all because it's literally their entire job to care for and save lives?
- JshWright 8y ago
  Ketamine is a very safe drug. My guess is in many of these cases the patient was also on some other drugs (prescribed or otherwise), which a) likely contributed to the need for sedation in the first place, and b) contributed to the respiratory arrests. That is, however, only a guess, I obviously have no specific information about these cases (I can speak from personal experience that the vast majority of people I end up sedating have been using drugs or alcohol (off the top of my head I can't actually think of a single exception to that)). A very minor pedantic point... "EMT" generally refers to providers with a few months of training, and a very narrow scope of practice. The providers administering sedatives would be paramedics, who have a couple years of training (the report cited by the article does use the term "EMT" though).

eesmith 8y ago

You appear to be downplaying the article. You write "just because someone has not committed a crime does not mean they cannot be taken to the hospital involuntarily". The article certainly doesn't disagree with that statement. It states: "Hennepin Healthcare staff are authorized to use ketamine when a patient is “profoundly agitated,” unable to be restrained and a danger to themselves or others, according to their policy." Instead it is pointing out times where there does not appear to be a justifiable reason, and for situations where there seemingly should be a cut and dry decision. The morality point you brought up, while true, does not appear relevant to the topic at hand. As an example of downplaying, the article talks about being handcuffed and secured to the stretcher. You turned that into two distinct cases, and gave an example of where each one separately has come up in your work. But how often have ended up in danger from people who were both handcuffed and secured to the stretcher? The other use of "handcuffed" was from someone maced while intoxicated, who suffered an asthma attack as a result. The woman, who "was not actively resisting police, asked for an asthma pump. Instead they handcuffed her to a stretcher and gave her ketamine, the report said. ... It is also important to note that it appears no crime was committed, no threat to the safety of officer or paramedics was evident, ...". Again, your abstract question of the morality of taking someone to the hospital involuntarily under any circumstance does not seem to be relevant. You write "In many cases is it safer for the patient to use chemical rather than physical restraints." Certainly. Again, I don't think anyone disagrees. However, the article points out examples where both chemical and physical restraints were used. For example, a man secured to a chair, then "[w]hen the man began to regain consciousness .. [t]hey injected him with another dose of ketamine", causing him to stop breathing. I interpret your true but abstract observations as a way to blur the concrete examples of problems highlighted in this piece.

JshWright 8y ago
I am not downlaying the article at all. I made it quite clear I believed it was likely the procedure was being abused. The anecdote of the asthmatic woman is particularly concerning. > But how often have ended up in danger from people who were both handcuffed and secured to the stretcher? Multiple times (I don't have a specific number). A stretcher is not intended to be used as an anchor for restraints. It's very difficult to keep someone restrained to a stretcher if they are continuing to fight. There is also a significant risk they will injure themselves. Finally, in some cases it is necessary to sedate a patient to provide treatment. The point of my comment is that it would be very easy for the article to omit details to make situations seem far less appropriate than they actually may have been (or that the abuse was more widespread than it actually was). EDIT: As your comment is starting to gray out, I think it's important to say that while I disagree with you, I think your comment is thoughtful and contributes meaningfully to the conversation (and certainly shouldn't be downvoted)
- eesmith 8y ago
  Thank you for your support. I tried to highlight the specific reasons why it felt like downplaying. Another way to phrase my view would be, if someone did want to downplay the report, how would it come across? An outright rejection doesn't work. It's too easily dismissed. For example - and I make this comparison only to provide a well-known example - if you look at the anti-vaxxers, they don't outright reject vaccination. Instead, they argue that it should be examined more closely, there are uncertainties, and it's best to be cautious. No one can argue with those general statements. It's when you come down to specific things like "should all 6 month old babies (excepting medical reasons) be vaccinated for X" where the opposition comes into play. The opposition strategy is to take it back to the more abstract level, or bring up specific examples where vaccination might have caused a problem. I felt like your comment followed a similar pattern of switching to abstract principles that no one disagrees with. Someone who wanted to downplay the report would do that, to establish credential as being a reasonable person, and then use that credential to argue that things are more grey and nuanced than it appears. A third way to phrase my view would be as a complaint about switching to abstractions, which seems to minimize the concrete abuses of the actual people described.

mnm1 8y ago

Then why are these EMTs administering such high doses that the patient can no longer breathe? Are these people not trained properly? Seems like there are other ways to restrain someone that doesn't put their life or the EMTs life in danger. Obviously police don't give a fuck if a suspect dies or not but shouldn't the EMTs care? Not least of all because it's literally their entire job to care for and save lives?

JshWright 8y ago
Ketamine is a very safe drug. My guess is in many of these cases the patient was also on some other drugs (prescribed or otherwise), which a) likely contributed to the need for sedation in the first place, and b) contributed to the respiratory arrests. That is, however, only a guess, I obviously have no specific information about these cases (I can speak from personal experience that the vast majority of people I end up sedating have been using drugs or alcohol (off the top of my head I can't actually think of a single exception to that)). A very minor pedantic point... "EMT" generally refers to providers with a few months of training, and a very narrow scope of practice. The providers administering sedatives would be paramedics, who have a couple years of training (the report cited by the article does use the term "EMT" though).