Colorado panel issues guidelines for injecting ketamine

Dec 1, 2021, 3:33 PM | Updated: Dec 2, 2021, 3:47 am

DENVER (AP) — Colorado’s health department announced Wednesday that emergency workers should not use a condition involving erratic behavior by people as a reason to inject them with the drug ketamine. The announcement came two years after the fatal arrest of a Black man in suburban Denver who had been injected with the drug.

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

Officially, ketamine is used in emergencies when there’s a safety concern for medical staff or the patient. But the use of the drug by paramedics drew renewed scrutiny after the death of Elijah McClain, who was diagnosed with excited delirium and injected with ketamine after being stopped by police in August 2019.

The report done by an expert medical panel found that determining if a person is experiencing excited delirium is open to interpretation and has been “associated with racial bias against African American men.”

“It has subjective and non-medical criteria such as hyper-aggression, increased strength and police noncompliance — all of which are very subjective and inherently biased,” said Dr. Lesley Brooks, a family and addiction medicine physician on the panel.

The panel’s recommendations follow last year’s nationwide protests for police reform and racial justice reckoning prompted by the police killing of George Floyd in Minneapolis.

Locally, Colorado advocates also angered by racial injustice took to the streets in the name of McClain, the 23-year-old man who was stopped by Aurora Police officers responding to a 911 call about a suspicious person wearing a ski mask and waving his arms. Police put him in a chokehold twice and multiple officers pressed their body weight on him. Paramedics injected McClain with ketamine, and he died less than a week later.

Colorado’s health department last year announced an expert panel would review the state’s ketamine waiver program. The program allows emergency medical service directors to get the waivers allowing their personnel to use ketamine outside hospital settings, such as in ambulances.

The panel recommended that paramedics administer ketamine only when there are no other safe options to monitor, treat or transport patients, or when patients show “serious, probable, imminent threat of bodily harm to self or others.”

One focus of the panel was an examination of bias and structural racism that affects paramedics’ decision-making leading up to injecting people with ketamine, according to the report.

“Given the dialogue that our country has been having … we understand that bias exists in a variety of places both implicit and explicit and it exists in health care,” Dr. Brooks said.

She added that the panel wanted to ensure that field personnel like paramedics “aren’t exempt from needing to understand where bias happens and how it plays out in the care that they deliver.”

The recommendations came after the September indictments of three Aurora Police officers and two Aurora Fire paramedics on various charges including manslaughter, second-degree assault and criminally negligent homicide in the McClain case.

The paramedics called to the scene with McClain incorrectly estimated his weight, giving him more than 1.5 times the dose he should have received, officials have said. McClain got 500 milligrams because they thought he weighed 220 pounds (99.8 kilograms).

He was only 140 pounds (63.5 kilograms) and should have received 315 milligrams, the officials said. McClain suffered cardiac arrest and was later declared brain dead and taken off life support.

The panel also addressed dosing requirements for ketamine and suggested paramedics use a standard, fixed dose “based on the patient’s body stature rather than a strictly weight-based dose.”

The panel’s experts also emphasized the importance of immediately monitoring people who receive ketamine with physiological assessments and physical exams.

The report also called on the Colorado Legislature to consider state standardization of emergency medical service programs and training, noting that “in all but two states” ambulance agencies are licensed at the state level — one of those exceptions being Colorado, where agencies are licensed by counties.

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

The report also emphasized the need for more training on the interactions and communication between police and emergency workers at the same scenes.

That would involve clear guidance on the roles of emergency workers and police and the ability of paramedics to have authority for medical decisions without input from police.

___

Nieberg is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

AP

FILE - The Flint water plant tower is seen, Thursday, Jan. 6, 2022, in Flint, Mich. A Michigan Supr...
Associated Press

EXPLAINER: Years later, Flint water court fight drags on

DETROIT (AP) — Michigan authorities have long promised to hold key officials criminally responsible for lead contamination and health problems arising from a disastrous water switch in Flint in 2014. There’s not much to show more than eight years later. The latest: an extraordinary rebuke Tuesday from the state Supreme Court, which unanimously dismissed indictments […]
12 hours ago
FILE-- Gas is advertised for more than $6 per gallon at a gas station in Sacramento, Calif., Friday...
Associated Press

California lawmakers to vote on $307.9 billion spending plan

SACRAMENTO, Calif. (AP) — California lawmakers on Wednesday will vote on a plan to spend $308 billion in taxpayer money over the next year as the coffers of the world’s fifth largest economy continue to swell during the pandemic. The centerpiece of the operating budget crafted by Democratic Gov. Gavin Newsom and legislative leaders is […]
12 hours ago
FILE - President Joe Biden speaks during the Major Economies Forum on Energy and Climate in the Sou...
Associated Press

Most say nation on wrong track, including Dems: AP-NORC poll

WASHINGTON (AP) — An overwhelming and growing majority of Americans say the U.S. is heading in the wrong direction, including nearly 8 in 10 Democrats, according to a new poll that finds deep pessimism about the economy plaguing President Joe Biden. Eighty-five percent of U.S. adults say the country is on the wrong track, and […]
12 hours ago
Lev Parnas, a former associate of Rudy Giuliani, arrives at the federal courthouse with his wife Sv...
Associated Press

Giuliani’s former Ukraine fixer gets 20 months in prison

NEW YORK (AP) — Lev Parnas, an associate of Rudy Giuliani who was a figure in President Donald Trump’s first impeachment investigation, was sentenced Wednesday to a year and eight months in prison for fraud and campaign finance crimes. Parnas, 50, had sought leniency on the grounds that he’d cooperated with the Congressional probe of […]
12 hours ago
This Feb. 26, 2021, file photo shows an oil well east of Casper, Wyo. The Biden administration is r...
Associated Press

Biden administration holding its first onshore oil sales

BILLINGS, Mont. (AP) — The U.S. government this week is holding its first onshore oil and gas drilling lease auctions since President Joe Biden took office after a federal court blocked the administration’s attempt to suspend such sales because of climate change worries. The online auctions start Wednesday and conclude Thursday. About 200 square miles […]
12 hours ago
Follow @ktar923...
Sponsored Content by Arizona Department of Health Services

Great news: Children under 5 can now get COVID-19 vaccine

After more than two years of battle with an invisible killer, we can now vaccinate the youngest among us against COVID-19. This is great news.

Sponsored Articles

...
Day & Night Air

Tips to lower your energy bill in the Arizona heat

Does your summer electric bill make you groan? Are you looking for effective ways to reduce your bill?
...
Christina O’Haver

BE FAST to spot a stroke

Every 40 seconds—that’s how often someone has a stroke in the United States. It’s the fifth leading cause of death among Americans, with someone dying of a stroke every 3.5 minutes.
...
Arizona Division of Problem Gambling

Arizona Division of Problem Gambling provides exclusion solution for young sports bettors

Sports betting in Arizona opened a new world to young adults, one where putting down money on games was as easy as sending a text message.
Colorado panel issues guidelines for injecting ketamine