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Boys trapped in Thai cave were drugged for risky rescue dives

39 points by danso 8y ago

danso 8y ago
Note: it’s been known for awhile that the kids were probably drugged (not necessarily with ketamine), but the news hook is that there’s a new study today. I’d link to the study but there’s a subscriber wall: http://www.nejm.org/doi/full/10.1056/NEJMc1900831 http://www.nejm.org/doi/full/10.1056/NEJMc1900831
- if_by_whisky 8y ago
  Yeah, this was reported in real time while it was happening.
jngreenlee 8y ago
I think I'd want the same treatment!
- deleted 8y ago
  [deleted]
babyslothzoo 8y ago
News from a year ago...
bluntfang 8y ago
>It had a brief career as a party drug known as “Special K.” brief? the author must not party very much.
jedberg 8y ago
Anyone who has been a diver immediately understands why this was necessary. The last thing you want is your diver partner panicking underwater, which can happen even with certified divers. An uncertified diver in a cave is a massive liability to your own safety.
- nikkwong 8y ago
  How common is it for divers to start panicking underwater? It surprises me that that's even a thing. Like, if the thought of skydiving scares you, you're probably not going to try it; so I would guess the danger of the practice itself would self-select for people who are not prone to that type of anxiety. edit: ah yeah. potentially stupid question. obviously if something starts going wrong, even the most level headed people may panic.
  - Intermernet 8y ago
    I'm usually a calm diver but I once had the combination of a slight ear infection and a speed boat passing overhead. This combination of mild pain and an ever increasing high pitched whine convinced me that my eardrum was ruptured and was rapidly getting worse. I did an emergency ascent from about 8 metres and luckily didn't have any nasty side effects. As a diver you are usually calm and rational when dealing with expected risks (low air, bad visibility, etc.) but anything unknown or unexpected can trigger panic. A friend of mine is a commercial diver and he has stories of seasoned co-workers panicking for extremely weird reasons.
  - elithrar 8y ago
    You can’t always predict how you will react under pressure. If you have an equipment failure or injure yourself in a way that you have not prepared for, well...
  - Tepix 8y ago
    I've seen it happen once in a hundred dives or so. Some people are more nervous than others and when something unexpected happens while they are stressed out already for some other reason it can lead to panic.
  - throwaway5752 8y ago
    I think this makes the rounds here periodically as a submission, and may help answer your question: https://nsscds.org/wp-content/uploads/2018/05/Blueprint-for-Survival.pdf https://nsscds.org/wp-content/uploads/2018/05/Blueprint-for-... and the author (https://en.wikipedia.org/wiki/Sheck_Exley https://en.wikipedia.org/wiki/Sheck_Exley) died in a cave diving accident. To warn you, it is fairly disturbing.
Nrbelex 8y ago
This was discussed in depth in the long 1/25/19 article re the rescue: https://www.macleans.ca/thai-cave-rescue-heroes/ https://www.macleans.ca/thai-cave-rescue-heroes/ (Previously https://news.ycombinator.com/item?id=19030307 https://news.ycombinator.com/item?id=19030307) > A word about sedation. A word, too, about Dr. Harry. > Anaesthesiology requires more training than most branches of medicine; there is always some risk that when a patient is put under, he or she will never wake up. When the patient is a child, the risks are greater. When the child is yanked along underwater for hours through a dark, cold cave, the risks are incalculable—no one has ever done anything like this before. > Dr. Harry believes the risks of sedating the children beat the risks of not sedating the children. The lead divers believe the same, and the Thais believe the experts know best. The children cannot dive; the children will panic; the children will drown their rescuers and themselves. That is why Dr. Harry is going to do this: inject 12 kids with a sedative so powerful it will knock them out cold. > Ketamine: a horse tranquilizer, an operating-room drug, a soon-to-be cave-rescue pharmaceutical product in its early testing stages on rock-entombed human minors. > If only it were so simple. The children’s drugs will need to be topped up with half-doses along the way. Dr. Harry cannot dive every child out himself, but the divers are not medical doctors. Dr. Harry must give a dozen cave hobbyists and small-business owners a crash course in do-it-yourself anaesthesiology. > If anyone dies—and many divers think they will be lucky to save two or three of the kids—Dr. Harry will bear much of the burden. He is not licensed to practice medicine in Thailand, let alone teach other foreigners to practice. Though Thailand and Australia have offered some assurance that he won’t suffer legal consequences for his young patients’ probable deaths, a conscience and a name are not so easily protected.
- penagwin 8y ago
  I'm glad Thailand and Australia offered (albeit if only verbal) protection. This is one of those circumstances were typical regulations just don't make sense and need to be shortcut for a clear emergency. Edit: To add, all parties in this emergency agree it was necessary, so they didn't do anything without consent.
  - iratewizard 8y ago
    I strongly agree. This video of a cave diver describing a near death experience adds a little color to what's at stake: https://youtube.com/watch?v=or92IMcLoIc https://youtube.com/watch?v=or92IMcLoIc
dmix 8y ago
> Harris told reporters that all of the rescued children “needed re-sedation at different times on the way out.” Crazy. Definitely not an easy job.
- sliken 8y ago
  The worst case turns out not to be one of the children, it was the coach. He wasn't under and caused a few problems, turns out they hadn't adjusted the dose for his increased body weight.
penagwin 8y ago
While an interesting read for sure, I'm not sure why people are surprised by this? Given the context, the boys are already at an elevated risk for panicking, seems like a cut and dry solution that worked as intended? I don't view drugs as "scary" or "bad". They're tools, if used correctly they can effectively do what you need them to. There's risks with these tools of course, and those need to be considered, but in the end they're just tools. (Not talking about miss-using drugs, only talking about approved usage by professionals)
- russdill 8y ago
  Many medical practitioners have very strong love/hate relationship with anesthesia drugs. Any patient under anesthesia requires very careful monitoring and will often have unexplained drops in blood pressure and body temperature. Usually patients first have a blood test done (out of whack liver values mean the drugs might not metabolize and the patient will never wake up) and other vitals taken, such as temperature and blood pressure. Ketamine is much less risky than propofol, but I'm sure any doctor would understand the dangers of putting kids that young under that are already in a health danger zone and having them not be monitored.
- testvox 8y ago
  > Not talking about miss-using drugs, only talking about approved usage by professionals Well answer your question about why this is interesting to people. The difference between mis-use and proper use is the interesting question. This is not an approved use of ketamine, and the people administering and issuing the drugs were not licensed professionals.
pedo_bro 8y ago
Whay are we still fucking talking about this?
pedo_guy 8y ago
Do we still care about this because Elon Musk?

39 points by danso 8y ago

Note: it’s been known for awhile that the kids were probably drugged (not necessarily with ketamine), but the news hook is that there’s a new study today. I’d link to the study but there’s a subscriber wall: http://www.nejm.org/doi/full/10.1056/NEJMc1900831 http://www.nejm.org/doi/full/10.1056/NEJMc1900831

if_by_whisky 8y ago
Yeah, this was reported in real time while it was happening.

jngreenlee 8y ago

I think I'd want the same treatment!

deleted 8y ago
[deleted]

babyslothzoo 8y ago

News from a year ago...

bluntfang 8y ago

>It had a brief career as a party drug known as “Special K.” brief? the author must not party very much.

jedberg 8y ago

Anyone who has been a diver immediately understands why this was necessary. The last thing you want is your diver partner panicking underwater, which can happen even with certified divers. An uncertified diver in a cave is a massive liability to your own safety.

nikkwong 8y ago
How common is it for divers to start panicking underwater? It surprises me that that's even a thing. Like, if the thought of skydiving scares you, you're probably not going to try it; so I would guess the danger of the practice itself would self-select for people who are not prone to that type of anxiety. edit: ah yeah. potentially stupid question. obviously if something starts going wrong, even the most level headed people may panic.
- Intermernet 8y ago
  I'm usually a calm diver but I once had the combination of a slight ear infection and a speed boat passing overhead. This combination of mild pain and an ever increasing high pitched whine convinced me that my eardrum was ruptured and was rapidly getting worse. I did an emergency ascent from about 8 metres and luckily didn't have any nasty side effects. As a diver you are usually calm and rational when dealing with expected risks (low air, bad visibility, etc.) but anything unknown or unexpected can trigger panic. A friend of mine is a commercial diver and he has stories of seasoned co-workers panicking for extremely weird reasons.
- elithrar 8y ago
  You can’t always predict how you will react under pressure. If you have an equipment failure or injure yourself in a way that you have not prepared for, well...
- Tepix 8y ago
  I've seen it happen once in a hundred dives or so. Some people are more nervous than others and when something unexpected happens while they are stressed out already for some other reason it can lead to panic.
- throwaway5752 8y ago
  I think this makes the rounds here periodically as a submission, and may help answer your question: https://nsscds.org/wp-content/uploads/2018/05/Blueprint-for-Survival.pdf https://nsscds.org/wp-content/uploads/2018/05/Blueprint-for-... and the author (https://en.wikipedia.org/wiki/Sheck_Exley https://en.wikipedia.org/wiki/Sheck_Exley) died in a cave diving accident. To warn you, it is fairly disturbing.

Nrbelex 8y ago

This was discussed in depth in the long 1/25/19 article re the rescue: https://www.macleans.ca/thai-cave-rescue-heroes/ https://www.macleans.ca/thai-cave-rescue-heroes/ (Previously https://news.ycombinator.com/item?id=19030307 https://news.ycombinator.com/item?id=19030307) > A word about sedation. A word, too, about Dr. Harry. > Anaesthesiology requires more training than most branches of medicine; there is always some risk that when a patient is put under, he or she will never wake up. When the patient is a child, the risks are greater. When the child is yanked along underwater for hours through a dark, cold cave, the risks are incalculable—no one has ever done anything like this before. > Dr. Harry believes the risks of sedating the children beat the risks of not sedating the children. The lead divers believe the same, and the Thais believe the experts know best. The children cannot dive; the children will panic; the children will drown their rescuers and themselves. That is why Dr. Harry is going to do this: inject 12 kids with a sedative so powerful it will knock them out cold. > Ketamine: a horse tranquilizer, an operating-room drug, a soon-to-be cave-rescue pharmaceutical product in its early testing stages on rock-entombed human minors. > If only it were so simple. The children’s drugs will need to be topped up with half-doses along the way. Dr. Harry cannot dive every child out himself, but the divers are not medical doctors. Dr. Harry must give a dozen cave hobbyists and small-business owners a crash course in do-it-yourself anaesthesiology. > If anyone dies—and many divers think they will be lucky to save two or three of the kids—Dr. Harry will bear much of the burden. He is not licensed to practice medicine in Thailand, let alone teach other foreigners to practice. Though Thailand and Australia have offered some assurance that he won’t suffer legal consequences for his young patients’ probable deaths, a conscience and a name are not so easily protected.

penagwin 8y ago
I'm glad Thailand and Australia offered (albeit if only verbal) protection. This is one of those circumstances were typical regulations just don't make sense and need to be shortcut for a clear emergency. Edit: To add, all parties in this emergency agree it was necessary, so they didn't do anything without consent.
- iratewizard 8y ago
  I strongly agree. This video of a cave diver describing a near death experience adds a little color to what's at stake: https://youtube.com/watch?v=or92IMcLoIc https://youtube.com/watch?v=or92IMcLoIc

dmix 8y ago

> Harris told reporters that all of the rescued children “needed re-sedation at different times on the way out.” Crazy. Definitely not an easy job.

sliken 8y ago
The worst case turns out not to be one of the children, it was the coach. He wasn't under and caused a few problems, turns out they hadn't adjusted the dose for his increased body weight.

penagwin 8y ago

While an interesting read for sure, I'm not sure why people are surprised by this? Given the context, the boys are already at an elevated risk for panicking, seems like a cut and dry solution that worked as intended? I don't view drugs as "scary" or "bad". They're tools, if used correctly they can effectively do what you need them to. There's risks with these tools of course, and those need to be considered, but in the end they're just tools. (Not talking about miss-using drugs, only talking about approved usage by professionals)

russdill 8y ago
Many medical practitioners have very strong love/hate relationship with anesthesia drugs. Any patient under anesthesia requires very careful monitoring and will often have unexplained drops in blood pressure and body temperature. Usually patients first have a blood test done (out of whack liver values mean the drugs might not metabolize and the patient will never wake up) and other vitals taken, such as temperature and blood pressure. Ketamine is much less risky than propofol, but I'm sure any doctor would understand the dangers of putting kids that young under that are already in a health danger zone and having them not be monitored.
testvox 8y ago
> Not talking about miss-using drugs, only talking about approved usage by professionals Well answer your question about why this is interesting to people. The difference between mis-use and proper use is the interesting question. This is not an approved use of ketamine, and the people administering and issuing the drugs were not licensed professionals.

pedo_bro 8y ago

Whay are we still fucking talking about this?

pedo_guy 8y ago

Do we still care about this because Elon Musk?