Why this new #ketamine law in Colorado is a disaster that will cost more lives than it is intended to save, a thread:
Severe agitation is a medical emergency requiring prompt recognition and management. It causes patients to harm themselves, raises heart rate and blood pressure to dangerously high levels, and can raise temperature to levels equivalent to heat stroke.
Of the therapeutic options that exist, ketamine has the widest safe dosing range. Doses up to 13 mg/kg are safely used in children. It works faster than anything else to reduce the agitation and allow evaluation and mgmt. It is the least likely to cause the pt to stop breathing.
Police officers do not use ketamine to arrest people, nor have they ever. That is pure fiction. Large study of ketamine use showed that patients given ketamine are taken to the hospital, as they should be, and death is extremely rare. sciencedirect.com/science/articl…
In that study, ketamine could not be ruled out as contributing to death in 0.07% of patients. In this study of over 11,000 patients, ketamine was found to be extremely safe.
EMS providers do not take direction from police on what medical treatments are indicated. Police are a valuable source of information on the circumstances leading up to the EMS call and what behavior the patient has exhibited.
Police officers are first responders who play an important role in the medical team. This law effectively prevents them from discussing the patient condition with other medical providers for fear of losing their license and being criminally charged.
It is not possible to weigh a combative patient in a field environment prior to administering any drug, and the requirement to do so effectively outlaws the emergent use of a life saving drug.
Other medications used to manage severe agitation take much longer to take effect, during which the patient is physically fighting with responders. This will result in more use of physical force, not less. These drugs can also stop breathing and drop blood pressure.
An agitated combative patient is physiologically not the same as a calm preoperative patient in the hospital, so comparison of doses of medication used on these different patients are not valid.
Other alternatives to sedation of the dangerously agitated patient include chemical paralysis and placement of a breathing tube, a procedure that carries enormous risk of death when done hastily or by providers who do not practice it frequently.
Careful titration of medications through an IV line is not practical in an agitated combative patient. Even obtaining IV access is difficult to impossible when a patient is struggling with all of their strength.
Politicians with no medical training have now legislated the practice of medicine without listening to Emergency Medicine or EMS physicians, who are the only physicians that encounter or treat these kinds of patients. They have not listened to EMS providers either.
This type of legislation has been introduced at the national level as well. It is vital that this legislation not be enacted in law. Colorado patients will die as a result of their law. Let us not replicate that across the country.
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