Sorry I missed this comment!

In order for you to sedate someone, they must already be under control right? Or do you jump into the dog pile with a syringe full of ketamine?

You might not like the answer to this. We don’t have the luxury of doing things the way they are done in controlled settings like doctor’s offices or hospitals. Law enforcement will restrain people and then all I need as a shoulder or a leg and about 3 seconds.

You are correct we are not generally there for the initial encounter. We do not make the determination if law enforcement is justified in fighting with people. Becoming combative is a symptom of quite a few medical emergencies. In situations like this I don’t decide who is right, that’s what court rooms are for. I do act in the way that I believe is best and safest for everyone. People in other comments don’t like this but even in this case, as a paramedic if I see someone fighting, throwing up, and going in and out of consciousness, I’m going to act as if they have a brain bleed. Which means aggressive sedation and airway management. Anything less or allowing fighting to continue significantly increases the risk of death for the patient.

Everything you described about law enforcement attacking people is why my personal philosophy is to stop the fighting. If law enforcement escalated a situation, who wins by me not doing what I can to stop the fighting? People can and do die from fighting with the police. People are much less likely to die if sedated and appropriately managed until they are discharged from the hospital.

That said, this case is an exception, the paramedics caused his death and were convicted as such. This is a very abnormal and unusual situation that disgraces the profession and it does not reflect how a competent paramedic would handle the situation.

Paramedic here, we don’t have access to a fully stocked pharmacy in our ambulance. Ketamine is pretty much the industry standard for situations like this. Its efficacy, safety profile, wide dose range, and rapid onset make it the ideal drug for managing violent behavior and sedation in a prehospital setting. I am not saying the medics made an appropriate decision in this situation but that is the appropriate mediation to use in situations like this. Versed would be a good runner up but is less effective in some situations with low doses and higher doses have a higher risk of respiratory compromise. Ativan is an option, if they carry it, I wouldn’t personally use Ativan in this situation because it has a longer onset/duration and higher chance of adverse reactions.

Ketamine might seem a bit excessive but it’s a very good medication for prehospital use. This is a situation that a lot of stuff went wrong and someone died. The cause of the death is more likely an adverse reaction that was not appropriate addressed by the paramedic, but that’s probably why they just got a conviction. But ketamine is used every day across the US without situations like this happening.

Absolutely! If you have any questions or want anything explained differently, just ask!

I do think that may have helped in this situation. In a more broad sense my point is I would be disappointed if a paramedic didn’t do something to stop someone from dying. We don’t have to agree on the administration of sedatives but I’d rather me or my family be sedated and transported to the hospital instead of situations continuing to escalate while fighting with law enforcement that may lead to someone being killed.

To be clear, I don’t know the full details of this specific case, as I said in my original comment, there isn’t a reason I can think of for the medics not monitoring capnography, that’s industry standard as it will show in real time when someone stops breathing and allow us to take over. If the paramedics did not monitor capnography and the patient died then that is most likely negligence that resulted in someone’s death which is unacceptable. However if they did everything appropriately and recognized the change in condition and addressed it and the patient still died then then it’s hard to fault them, apart from giving the incorrect dose of ketamine, tho just giving an extra 200mg of ketamine will not cause someone to die but it can cause unwanted side effect that if unrecognized or untreated could lead to someone’s death.

Lmao, I appreciate your concern because no that would not be appropriate in any way shape or form. However an EMT cannot administer sedatives. A paramedic can. One needs to have the 4 months of EMT school plus a minimum of one year of paramedic school, to be a paramedic. The program I teach at starting from no training through paramedic school is two years.

Additionally, I understand the general population doesn’t understand or is not exposed to what the capabilities of EMS is or how it works but id be happy to answer and explain any details that you’d like. But to start no, none of this happens without a physician. The physician is present in this situation in the form of protocols which are essentially a prescription that paramedics are authorized to follow without talking to a physician in real time.

But, I will agree I think the two years is a fairly small requirement for the invasive procedure and access to anesthesia medications that we as paramedics have and are authorized to use without having a doctor near us. It gets even crazier to think that I in my current roll am authorized to perform some emergency surgeries, such as cricothyrotomy and finger thoracostomy, as well surgically placing chest tubes and even perform a pericardiocentesis.

So sure it sounds bad from the outside if I say after one year of paramedic training I can cut a hole in someone’s chest on the side of the road to stick my finger in, or stab a needle into their heart, after I sedate then paralyze them, intentionally stopping their breathing just to place a breathing tube before putting them on a ventilator. That is stuff that all requires very specific training, any sort of surgery is generally only performed by doctors, paralytics and intubation is more specifically an emergency physician or anesthesiologist and ventilators are generally a respiratory therapist’s job. But that’s the beauty of paramedicine, we can do anything as long as we are acting in good faith trying to help someone. BUT systems that allow us to do pretty much anything I just listed are not “get hired out of school” programs. The minimum is generally 3 years as a paramedic in a busy system, but most require five years. In addition to the minimum experience, the extra skills are taught to us on the job by physicians, who individually validate that we are competent and capable to perform them. If the agency is associated with a hospital more often then not we will be required to work with our medical director and perform the skills on real patients before we are allowed to perform them on our own.

If you have any more questions or would like any more information just ask! I love my job and enjoy teaching others and advocating for the profession.

Fair enough, I don’t think I have an direct answer to the big picture of your question but in my own experience improving my confidence and the mentality I’ve adopted to do so has in turn reshaped how I view myself. So as you stated there might be an overlap of the two topics.

I’m not trying to advertise it (I have it as a pdf and would offer to send you a copy if I knew how to do that on here) but the book i was referring to is called “The confident mind” It’s by Nate Zinsser. It felt a little dry but it isn’t trying to be a science fiction novel and makes it points very well. An example being from my last comment just repeating something to yourself over and over leads to you starting to believe it. It also uses pro athletes and their mentality and talk about how one could apply the same approach to everyday life. It’s not earth shattering revelations, but for me it did connect things in a way that helped shift my perspective.

I might be misinterpreting your post but it sounds like you’re talking a little bit more about confidence. The key to having confidence and fighting away imposter syndrome is to find and focus on the positives, how you got to the spot you’re in and all of the times you’ve had to succeed. Forget about the failures and spend time every day reflecting on your accomplishments.

It’s that simple. You don’t even need to believe the stuff you tell yourself, but if you keep repeating it to yourself, you will start the believe it. Confidence requires active effort to build, independent of how good at something someone is. I struggled with my confidence and occasionally still do but had a friend recommend a good book that legitimately changed how I view myself. I can’t remember the name of it off the top of my head but if you want I will look it up and edit my comment.

I also don’t like talking to the police, even more so when I’m off duty, but I work in Florida and I’ve worked in a few counties, some after I attempted resuscitation I’d call the medical examiner’s office and tell them what’s going on and then they’d say if they wanted to come investigate or not, but currently where I work operates the same as you’re describing medical examiner comes out and investigates any death that didn’t happen under direct care of a physician.

Anyway, I’m sure you’ve got a lot going on so please toss that bag of garbage, it isn’t worth your time and effort to think about and I wish you the best in this tough time.

Happy to help. Seriously tho, just toss it all. Even that little bit of blood isn’t significant. But don’t let this bag bother you too much it’s nothing to do with your dad it’s just the packaging for the meds they used plus probably some saline. You said in another comment that they were waiting for the medical examiner, which if that’s true then it would be illegal for them to remove anything that they had in place for the attempted resuscitation.

OP, sorry. Resuscitation can be chaotic and there is a chance that the bag got pushed off to the side and then they missed it cleaning up.

That does not make it okay because it looks like their BVM is in the bag, which means that was placed their after the resuscitation. Your picture doesn’t show anything aside from the little bit of blood that isn’t just garbage, so don’t worry about how to get rid of it, just throw it in the trash. But again, sorry, I’ve never personally and I haven’t worked with anyone who would intentionally leave garbage on a scene after an attempted resuscitation, it’s a small detail that someone’s family shouldn’t have to think about in this kind of situation.

It isn’t common but some places do charge for an “assessment” in the US. It’s relatively cheap compared to a transport, like $50-75 at least that’s what I know from my experience and I’ve only ever worked at one place that did that.

It isn’t common but some places do charge for an “assessment” in the US. It’s relatively cheap compared to a transport, like $50-75 at least that’s what I know from my experience and I’ve only ever worked at one place that did that.