Monday, January 17, 2022

Colorado Expert Group Releases Ketamine Injection Guidelines

DENVER (AP) – The Colorado Department of Health announced Wednesday that emergency workers should not use the condition associated with erratic behavior as a reason for injecting ketamine. The announcement came two years after the death of a black man injected with the drug in a Denver suburb.

Most states and agencies allow ketamine to be administered when people exhibit “agitated delirium” or agitation, usually associated with chronic drug abuse, mental illness, or both. The drug is used as a sedative and should be fast-acting with limited side effects.

Officially, ketamine is used in emergencies when there is a danger to medical personnel or the patient. But the use of the drug by paramedics gained renewed attention following the death of Elijah McClain, who was diagnosed with agitated delirium and was injected with ketamine after he was stopped by police in August 2019.

A report by a group of medical experts found that determining whether a person is experiencing agitated delirium is open to interpretation and “linked to racial bias against African American men.”

“He has subjective and non-medical criteria such as hyperactivity, increased strength and disobedience to the police — all very subjective and inherently biased,” said Dr. Leslie Brooks, a family and drug addiction physician who served on the commission.

The commission’s recommendations follow last year’s nationwide protests against police reform and racial justice sparked by the police assassination of George Floyd in Minneapolis.

At the local level, human rights defenders in Colorado, also outraged by racial injustice, took to the streets on behalf of McClane, a 23-year-old man who was stopped by Aurora police in response to a 911 call about a suspicious person wearing a ski mask waving his arms. … The police put him in a choke hold twice, and several police officers pressed on him with their whole bodies. Paramedics administered ketamine to McClane, and he died less than a week later.

Last year, the Colorado Department of Health announced that a panel of experts would review the government’s ketamine phase-out program. The program allows directors of emergency services to receive exemptions to allow their staff to use ketamine outside of hospitals, such as in ambulances.

The group advised paramedics to administer ketamine only when there are no other safe ways to monitor, treat, or transport patients, or when patients show “a serious, likely, imminent threat of injury to themselves or others.”

One of the group’s primary concerns, according to the report, was to examine the bias and structural racism that influence paramedics’ decisions leading to ketamine injections.

“Given the dialogue that our country has had … we understand that bias exists in many places, both overt and overt, and it is present in health care,” said Dr. Brooks.

She added that the commission wanted to make sure that field personnel, such as paramedics, were “not relieved of the need to understand where bias arises and how it manifests itself in the assistance they provide.”

The recommendations came after three Aurora police officers and two Aurora Fire paramedics were indicted in September on various charges, including manslaughter, second-degree assault and reckless homicide in the McClane case.

Paramedics called to the scene with McClane miscalculated his weight, officials said, giving him more than 1.5 times the dose he should have received. McClain got 500 milligrams because they thought he weighs 220 pounds (99.8 kg).

He weighed only 140 pounds (63.5 kilograms) and should have received 315 milligrams, officials said. McClane suffered cardiac arrest, later it was announced that his brain had died and his life support system was turned off.

The group also reviewed the dosage requirements for ketamine and suggested that paramedics use a standard fixed dose “based on the patient’s body height, not a strictly weight-based dose.”

The group’s experts also stressed the importance of immediate observation of people receiving ketamine through physiological assessments and physical examinations.

The report also called for the Colorado Legislature to consider standardizing emergency care and education programs at the state level, noting that “in all but two states” ambulance agencies are licensed at the state level – Colorado is one of those exceptions. where agencies are licensed by the county.

Dr. Eric France, the state’s chief physician, said the state’s licensing authority allows for increased oversight of local emergency medical services.

The report also highlights the need for additional training in the interaction and communication between police and emergency workers in the same locations.

This will require clear guidance on the roles of emergency responders and the police, and on the ability of paramedics to make medical decisions without the involvement of the police.


Nyberg is a member of the Associated Press / Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that sends journalists to local newsrooms to cover hidden issues.

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