>Critics say forced sedation should be strictly limited or banned, arguing the medications, given without consent, are too risky to be administered during police encounters.
I've been a volunteer EMT for 20 years and in that time I've been punched, cut, choked, and bit on multiple occasions-- and I'm in one of the most affluent counties in the US. People in poorer areas have it 10x worse than I do.
I'm a very tall, very strong, fully grown adult man. Most of the paramedics I work with are very small, not particularly strong, women. Practically everyone I work with is young.
If forced sedation is banned the critical nationwide shortage of EMS personnel will become much worse than it already is.
Have you ever had a 30-year-old man who's lying on the ground bleeding behind a vape shop at 3am try to repeatedly bite you every time you come within biting distance?
It's either: I hold him down and the medic gives him 5mg of midazolam or he's the cop's problem.
As a citizen of a civilized country with properly funded and educated emergency services, it's baffling to me that the US faces these relatively simple problems. In my country, a police patrol would respond along with the ambulance. The three officers would restrain the person if necessary. Since there are three of them in a patrol car, since they have proper equipment (and don't carry firearms) and proper training, they don't have to hurt anyone to restrain the person and let the medics do their jobs.
By all means tell me why you think they matter. It's still a matter of funding-per-capita. Stopping someone with a knife is the same regardless of their ethnicity.
(We do have a lot of immigration, but I don't see the relevance.)
I deal with numbers and I see those (England, Wales, Australia, USofA) as "ballpark" close to each other .. relative to 170+ other countries about the globe.
The UK and Australia have similiar policing roles and behaviours, quite different to the US - more uniform within the countries, significantly less use of guns and force, etc.
The UK and Australia both get container loads of cocaine, meth and other drugs, and have thriving local drug networks.
Damn near half the population of Australia has used illicit drugs at one point or another:
According to the 2022–2023 National Drug Strategy Household Survey (NDSHS), an estimated 10.2 million (47%) people aged 14 and over in Australia had illicitly used a drug at some point in their lifetime (including the non-medical use of pharmaceuticals), and an estimated 3.9 million (18%) had used an illicit drug in the previous 12 months. This was similar to proportions in 2019 (43% and 16%, respectively) but has increased since 2007 (38% and 13%, respectively) (Figure 1).
It masks the class problems of extreme wealth inequality as racial problems so that potential solutions focus on the wrong thing, and the targets are middle-class white people instead of ultra-rich people of any race.
Notice how you fell into the race trap again, even though I said "of any race". It's not "the ultra rich minorities", it's "the ultra rich, period". Race doesn't have anything to do with what is 100% a class problem.
I think it's telling of how pernicious the racial propaganda is, that you changed my "of any race" to "minorities".
Oh I see maybe just “the ultra rich” without “of any race” - saying “white people” then “of any race” as the counter example implies non-white, still too much race emphasis (plus most of the ultra rich are white, which further confused it for me)
Presumably the vape shop owner wants the person gone, and so the cop then gets involved to remove them by force. Arguably, if medication isn't used, the outcome will be worse for everyone involved. Can a mentally unfit person be shot by a cop for trying to bite them? Yes.
>It's either: I hold him down and the medic gives him 5mg of midazolam or he's the cop's problem.
That's unacceptably dangerous without knowing what drugs the bleeding person is on. Even alcohol makes the risks of giving midazolam increase significantly.
In the case of Elijah McClain they gave him a 500 mg dosage when the maximum dosage was 350mg. He stopped breathing shortly thereafter
Is there not some way to start with a dosage that would be safe for a smaller person and to give additional drugs if needed. Is there a way to give a drug that doesn't cause death (THC maybe)?
I understand the need to calm people down, but giving them a drug that where 1/10th of a gram of error is the difference between life and death seems reckless.
Simply put, if your intervention ends in death when death wasn't a possible outcome before, I would much rather that you and the cop just drive away and leave this to professionals who are able to handle this without accidentally killing people.
Presumably there is somewhere on earth where this is a solved problem, what are they doing?
I'm sure there are legitimate cases where sedation is reasonably the best available solution. The problem is - who draws the line? There was a case the other day where a university professor was tackled to the ground, her head hitting the cement, and forcefully handcuffed because she had tapped a police officer on the shoulder asking him to stop what he was doing to a student. She was booked for assaulting a police officer, which is clearly a "combative" thing to do. Do you think the officer who tackled her down and then climbed on top of her should also have the authority to inject her with a sedative at his discretion? Do you think that, in an environment where simply not following directions promptly to the full satisfaction of the arresting officer can result in being tased or even shot, law enforcement also needs to be able to sedate people whenever they find it appropriate?
> Do you think the officer who tackled her down and then climbed on top of her should also have the authority to inject her with a sedative at his discretion?
The person you're replying to is, assuming they're not lying, a medical professional.
> Do you think that, in an environment where simply not following directions promptly to the full satisfaction of the arresting officer can result in being tased or even shot
Are you suggesting that a person trying to bite folks is on equal legal footing with a college professor tapping an officer on the shoulder? In any case, sedatives are unquestionably less lethal than guns (and probably tasers, where Google suggests hundreds of people die in the US from being tased by the police each year). Putting aside whether the officer's discretion in such a situation is being wielded appropriately, sedation (by the numbers) is essentially never a worse option than what police have at their disposal already, no?
There's not a single instance in the article mentioning the EMS Medical Director being consulted in any of the 94 cases gone wrong (much less being held accountable). Multiple cases where the EMTs were pressured by the police, though.
It is impossible to consult with the medical director, or even medical control, on all cases so you rely on protocols and standing orders to perform your duty.
All jurisdictions have standards for sedation.
If any clinician feels pressured by the police to do something contrary to the standard they should call their ems supervisor— they’re paid to be mean to cops and charge nurses.
People have thought of all of this already.
I expect systems to be as perfect as I am, so “im-“.
> If forced sedation is banned the critical nationwide shortage of EMS personnel will become much worse than it already is.
Nationwide shortage gets worse because people can't kill other people without consequence? Fine. At least I won't be worked on by people that have no concern[s] about killing someone - just because they're scared.
To whit: What is the point in being an EMT/EMS, if you do not care if you're killing people, as is demonstrated by the article? It seems entirely antithetical to the entire point of your role/job, does it not?
You should reread the post. He is saying it is basically impossible for to help certain people without sedating them. That means they WILL die. Instead they could sedate a person and they MAY die.
Did you RTFA? Are EMTs/EMSs - entirely - incapable of telling police to not put their body weight on the backs of "certain people" (to use your vernacular), which clearly contributes to the issue of them dying -- negating the levels of the drug being another contributing factor?
There is shared culpability in these scenarios but, sure, no one could handle these people for hundreds of years before sedation was used, so they killed them all, right? That's your and the OP's rationale, from what you're saying.
> Your policy would result in more deaths.
My policy? More deaths? Give me the numbers/statistics on how this policy has saved _more_ lives. I'll wait...
I'm not sure what you are even saying. This has nothing to do with police or putting body weight on a person. If anything not using sedatives would lead to more EMTs putting body weight on people.
I don't volunteer to be in situations that I know ahead of time I can't handle without potentially lethal risk to the other participant, is the difference here.
In fact I do volunteer to be in similar situations for different reasons, and part of that decision is the acknowledgement that as the only guaranteed willing participant, it is my responsibility to bear the risk of the encounter.
I don't get where cops and, apparently, some EMTs find the mentality of "I choose to be here, so I may harm you to ensure my safety." Simply choose not to be there! Do something else with your evenings my man.
Without commenting on the rest of the article I want to take issue with this specific line
> Gowens rushed to the hospital 500 miles away, where she was told he’d been injected with ketamine. She searched online and was stunned to read it’s used to tranquilize horses.
Medicines are used on both humans and animals all the time. Verbiage like this does nothing but spread fear, uncertainty and doubt about a medication, when used in a controlled, safe manner is absolutely helpful for humans. The fact that it’s also used as a horse tranquilizer is completely irrelevant and is really just lazy reporting intended to incite fear.
Note that I am not saying I agree with the medication’s use at all here. But the fact that it’s also used on animals for some purpose is completely irrelevant.
We went through a similar thing a few years ago with everybody calling Iv_rm_ct_n "horse medicine". I thought it was funny at first, but it is FDA-approved for humans, just not for the purpose people wanted to use it for. Jokes and ridicule may not be a good way to convince people to trust the science.
I had actually been thinking of this specific scenario whenever I wrote the above comment. People refer to the medication you are referencing as “horse dewormer” like it’s a bad thing - in reality it’s also a “people dewormer” as well that has been used safely as a first line anti-parasitic in humans for over 50 years.
That was because FDA pressure campaigns made it impossible to obtain the human formulation for off-label use. I had a prescription filled in January 2021 before it became a political hot potato. Ten months later the same pharmacy practically hung up the phone on me when I asked if I could get it filled.
sure but it’s not a drug to treat viruses (covid in this case), these weren’t people looking for valid off label use
sometimes pointing out people are being dumb is completely valid - if you buy horse dewormer from a vet to treat yourself ineffectively you kind of have it coming
You can't attack other users like this, no matter how wrong they are or you feel they are.
We've had to warn you about breaking the site guidelines before. If you keep this up we're going to have to ban you, so it would be good if you'd review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here.
"Trusting science" was a ship that had long since sailed for them. There is an enormous overlap with creationists and climate deniers, among others.
That doesn't make mockery the right approach either. But let's not kid ourselves that they were one friendly ear away from listening to the overwhelming majority of scientists. This is just one piece of a decades long conflict.
As I understand it, part of the reason it became that joke was that the horse medicine formulation was the only one that was available (maybe for humans it's prescription-only or maybe it was just another everything-was-sold-out).
Absolutely fucking bonkers that it's legal to just eyeball a stranger and inject them with drugs if working under the watchful eye of a badge, that this "technique" is approved without any evidence that it actually helps.
> Ho was a leading researcher on Taser safety and an expert witness for the company in wrongful death lawsuits. In a 2007 deposition in one such case, he argued for a potentially “life-saving tactic” of having sedative injections quickly follow Taser shocks, saying the combination could shorten struggles that, if prolonged, might end in death.
> Some doctors at his public hospital in Minneapolis were using “something called ketamine, which is an analog to LSD,” he said. “It’s sort of an animal tranquilizer.”
> The drug became more common outside the hospital in 2008 when Hennepin County paramedics were given permission to use it.
> An American College of Emergency Physicians panel that included Ho said in 2009 that ketamine had shown “excellent results and safety” while acknowledging no research proved it would save lives.
These people come off as a bunch of clowns, holy cow.
The police also use "mental reasons" as an excuse to arrest anyone they don't like or who challenges their egos. It's often used to cover-up uses of excessive force.
are you saying that their reasons were mental; aka totally bonkers logic, or that they are claiming the person has mental issues? I'll agree with the former, but if the latter, then that's even more infuriating that someone suffering gets physically assaulted because Officer Bumpkin is untrained in deescalation and only trained in ratcheting up to use of violence.
It happened to a late friend of mine in Los Altos who was minding his own business walking in a parking lot while playing the augmented reality game Ingress. The cops beat the shit out of his arms and legs, and then dumped him off in the county's lockdown ward to coverup their misdeeds. They knew they could get away with it and did so.
Perhaps there are legitimate uses of appropriate doses where there is immediate risk of harm, but reckless and unregulated use of using serious medications like ketamine to control people violates informed consent and the spirit of the hippocratic oath.
Most of these responses reveal a fundamental problem with individuals not realizing the limits of their knowledge. The issues with sedative administration deaths almost uniformly have nothing to do with the administration but everything to do with the assessments (or lack of) and treatments performed at the same time. In the McClain case this issue wasn't the dosing (people have frequently been given doses ten times above intended without harm) but rather the lack of monitoring of his airway. The gentleman was aspirating during the restraint prior to EMS arrival and this was not treated for some time. It makes no sense to blame a drug with an incredibly wide therapeutic index such as ketamine when the real issue is the lack of proper assessment.
I wonder how many of the victims were already under the influence of other drugs that might have had a horrible interaction (and, of course leading to the desire to subdue with drugs instead of tasers, etc.)
A very large percent, surely. It's why barbiturates or benzodiazepines or opioids have very rarely been used for strong sedation outside of a hospital setting. One person's sedating dose is another person's lethal overdose, with even slight mixing with alcohol or prescription antianxiety medications or painkillers.
It is true ketamine doesn't affect breathing as badly as those drugs, and has fewer interactions, and is sometimes used in medical emergencies for sedation when the airway is a concern. That seems to have been what gave people the idea it could be used in paramedic settings, but less is not the same as no risk.
Which is why responsible medical practitioners get a medical history, a list of medications, and monitor people closely instead of trusting a cop to diagnose someone with "excited delirium", an affliction very much not accepted by real doctors.
No, there they'd just beat you into submission or perhaps shoot you (and there would be little domestic uproar about it, unlike in the US). Sedatives, Tazing, pepper spray — these are all attempts to avoid physically injuring the subject more than what's absolutely necessary to stop them from doing whatever it is that is problematic (e.g. attacking people).
If avoiding injury isn't a concern, a good ole' baton works pretty well, as do firearms.
> Holy cow what could be more dystopian than police wielding sedatives and needles.
Tanks, a la Tienanmen Square, that's what.
The problem is that phasers set to stun haven't been invented yet. Mechanisms for subduing combative individuals currently range from bad to worse in terms of risk to the subject (and sometimes to officers, because if they don't "work" then often the fight is on). It's a terrible situation and unfortunately there aren't any obvious solutions.
There's plenty of obvious solutions and many countries apart from the US have solved them. One of the solutions is properly educated and trained police. This includes operating in coordinated teams using riot shields and less lethal, deescalation, coordination with mental health professionals and so on. Another is bigger police patrols and not just singleton officers, to allow these teams to operate and to give the overwhelming power needed to neutralize someone in relative safety for all involved.
Of course, these things cost money. It's cheaper to shoot everyone who don't follow instructions precisely and to inject potentially lethal drugs into everyone where it's convenient.
Would you prefer that people sufficiently hopped up on drugs are allowed to run rampant over anything in civilization?
Obviously an extreme scenario but the reality is that civilization must maintain order and yeah, people in general have no problem giving drugs to people who are actively attacking them.
The trick, of course, is how to allow that to happen^ while also not authorizing a total descent into authoritarian rule.
Maybe people in these orderly civilizations should figure out how to do that with less death? Let’s push ourselves to be better here.
I don’t see the suggestion made anywhere that we let society fall to rampant running drug users. Arguably this is already happening though, see Diana Kipyokei.
The suggestion is literally not to sedate violent people “without due process.” Of course sedating actively violent people is within due process (which is why it’s able to happen repeatedly), but presumably GP is suggesting something closer to acquiring a specific warrant or court order to authorize it. Of course this doesn’t address an emergency situation, so the alternatives are 1) more aggressive/more likely-to-be-deadly force, or 2) don’t stop them at all.
Yes obviously we should strive for zero deaths in these encounters.
What does due process have to do with subduing combative subjects, preventing persons from harming themselves or others, or other lawful uses of force? Due process doesn't come into whether or not a police shooting is justified, for example. Or the use of a Taser, nightstick, carotid restraint, pepper spray, or a simple arm bar.
> Why are you quoting things that are not in the article you linked?
It is literally the title of the linked article. So the problem is not with the quoting.
That being said the article very much does not support their own title. The title makes it sound like these vans capture people and then immediately kills them. When the rest of the article makes it clear that these offenders are convicted following the legal process, and they are executed only after.
> Mainstream medicine does not recognise the label as a diagnosis: it is not listed in the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases, and is not recognized by the World Health Organization, the American Psychiatric Association, the American Medical Association, the American Academy of Emergency Medicine, or the National Association of Medical Examiners.
> In 1985, an article titled "Cocaine-induced psychosis and sudden death in recreational cocaine users", co-authored by deputy chief medical examiner for Dade County, Florida, Charles Victor Wetli. The article was published in the Journal of Forensic Sciences and reported that in five of the seven cases they studied, deaths occurred while in police custody.
> In 1988, Wetli claimed that a series of nineteen women, all Black prostitutes, had died of the condition due to "sexual excitement" while under the influence of cocaine, but police later announced they had found a serial killer responsible for those deaths.
I've been a volunteer EMT for 20 years and in that time I've been punched, cut, choked, and bit on multiple occasions-- and I'm in one of the most affluent counties in the US. People in poorer areas have it 10x worse than I do.
I'm a very tall, very strong, fully grown adult man. Most of the paramedics I work with are very small, not particularly strong, women. Practically everyone I work with is young.
If forced sedation is banned the critical nationwide shortage of EMS personnel will become much worse than it already is.
Have you ever had a 30-year-old man who's lying on the ground bleeding behind a vape shop at 3am try to repeatedly bite you every time you come within biting distance?
It's either: I hold him down and the medic gives him 5mg of midazolam or he's the cop's problem.