
At urging of Minneapolis police, EMS workers subdued dozens with ketamine - tomohawk
http://www.startribune.com/at-urging-of-police-hennepin-emts-subdued-dozens-with-powerful-sedative/485607381/
======
JshWright
I am an EMS provider with experience sedating patients (generally using
Versed, but I have used Ketamine on occasion as well). In every instance it
has been done out of concern for safety (my own, my crew's, or the patient's).

Taking the article at face value, it seems likely this procedure was being
abused (and I would not be surprised if that was proven to be the case).

However... Many of the circumstances described do not necessarily mean it was
inappropriate to sedate the patient. Just because someone is handcuffed does
not mean they are not a danger to me. Just because someone is secured to the
stretcher does not mean they are not a danger (I've been kicked in the head by
someone who continued to fight after being secured to the stretcher and
eventually worked his leg free).

Just because someone has not committed a crime does not mean they cannot be
taken to the hospital involuntarily (generally after expressing an intent to
harm themselves). I think the moral answer to "should we prevent someone who
wants to hurt themselves from doing that" is worth some discussion, but the
legal answer is quite clear... I am required to transport that patient to a
hospital.

In many cases is it safer for the patient to use chemical rather than physical
restraints.

Again, I am not defending every instance of sedation in Minneapolis. I am
simply providing some examples of how this isn't always a cut and dry
decision.

~~~
eesmith
You appear to be downplaying the article.

You write "just because someone has not committed a crime does not mean they
cannot be taken to the hospital involuntarily". The article certainly doesn't
disagree with that statement. It states: "Hennepin Healthcare staff are
authorized to use ketamine when a patient is “profoundly agitated,” unable to
be restrained and a danger to themselves or others, according to their
policy."

Instead it is pointing out times where there does not appear to be a
justifiable reason, and for situations where there seemingly _should_ be a cut
and dry decision. The morality point you brought up, while true, does not
appear relevant to the topic at hand.

As an example of downplaying, the article talks about being handcuffed _and_
secured to the stretcher. You turned that into two distinct cases, and gave an
example of where each one separately has come up in your work. But how often
have ended up in danger from people who were both handcuffed and secured to
the stretcher?

The other use of "handcuffed" was from someone maced while intoxicated, who
suffered an asthma attack as a result. The woman, who "was not actively
resisting police, asked for an asthma pump. Instead they handcuffed her to a
stretcher and gave her ketamine, the report said. ... It is also important to
note that it appears no crime was committed, no threat to the safety of
officer or paramedics was evident, ...".

Again, your abstract question of the morality of taking someone to the
hospital involuntarily under any circumstance does not seem to be relevant.

You write "In many cases is it safer for the patient to use chemical rather
than physical restraints." Certainly. Again, I don't think anyone disagrees.
However, the article points out examples where both chemical and physical
restraints were used. For example, a man secured to a chair, then "[w]hen the
man began to regain consciousness .. [t]hey injected him with another dose of
ketamine", causing him to stop breathing.

I interpret your true but abstract observations as a way to blur the concrete
examples of problems highlighted in this piece.

~~~
dang
"Please respond to the strongest plausible interpretation of what someone
says, not a weaker one that's easier to criticize. Assume good faith."

[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

~~~
eesmith
I believe I did that.

Regarding that guideline, are commenters supposed to follow a similar
guideline in how to interpret the source material, or are they free to make a
weaker interpretation that is easier to criticize?

Because one of my objections was how the article said that sedation was used
on someone both handcuffed and strapped down, while the OP gave examples where
someone handcuffed was sedated, and someone strapped down was sedated, but not
both. That seems criticizing a weaker topic than what the article described.

Similarly the article presented a case where someone was both physically
restrained and chemically sedated, while the OP described chemical sedation as
an alternative to physical restraint. That too feels like criticizing a weaker
topic than what the article described.

JshWright, to whom I replied, in another branch of this thread kindly
commented "I think your comment is thoughtful and contributes meaningfully to
the conversation."

~~~
JshWright
> while the OP gave examples where someone handcuffed was sedated, and someone
> strapped down was sedated, but not both

Ah, I think that's a case where my existing context led to a lack of
clarity... If someone is "strapped" to the stretcher (i.e. not just the usual
seatbelts), then their wrists are restrained (either in handcuffs, or using
"soft restraints" to the side rails of the stretcher). The reality is, a
stretcher is not designed to serve as an anchor for restraints, and someone
who continues to fight over the course of a 20-30 minute transport will
eventually work themselves free (at least enough to start kicking).

Similarly, chemical restraint is always preceded by physical restraint. It's
only when physical restraint isn't working (i.e. someone is fighting hard
enough that there's a risk of injury) that chemical restraint is employed.
It's in those cases that chemical restraint is safer (obviously continuing to
wrestle with someone is more dangerous for everyone involved).

~~~
eesmith
Thank you for the additional clarifications.

------
staticautomatic
As more and a wider variety of stories emerge about police malfeasance around
the U.S., it should become increasingly difficult to credibly say it's just a
few bad apples here and there responsible for isolated incidents. It is
ubiquitous? I don't know. But empirically it does seem to be pervasive.

~~~
bootlooped
The biggest refutation of the few-bad-apples theory in my mind is that for
each bad apple there are a dozen other officers that either did nothing or
actively covered for them, plus the policeman's union which will zealously
assert that basically no policeman is ever to blame for anything.

It would be a whole different story if the police rooted out bad actors within
their ranks on their own, but it seems like it takes a lot of kicking and
screaming and, most importantly, public scrutiny, to get anything done.

~~~
digi_owl
Their theory seems to be that if i don't back him, then him or his cohort will
throw me to the wolfs at a bad moment.

Sadly this line of thinking just reinforce the mentality that the police is at
war with the public, in that the only people they can "trust" (in a tit for
tat sense) are fellow officers.

------
azernik
Interesting and encouraging use of bodycams:

"To evaluate how the sedative was being used, the Office of Police Conduct
Review investigators looked for mentions of the word in police reports, and
then reviewed body camera footage from those cases."

------
ggchappell
It seems to me that this article is concentrating on the wrong thing. The
biggest problem in the incidents in question is not misbehavior by police; it
is misbehavior by EMS workers.

Consider: a police officer and an EMS worker are dealing with someone who is
difficult to subdue. The police officer -- who does not have the expertise to
know whether it is a good idea -- requests that the person be injected with
ketamine. The EMS worker -- who does have the expertise -- does so, knowing
that it is a bad idea.

What most needs to change here is the EMS system.

\-------------------

EDIT. I guess I mean to say that the people involved here (as opposed to the
article) are concentrating on the wrong thing. The police are the ones that
have changed their policies. But it seems to be the EMS system that has the
more serious problem.

~~~
eesmith
How do you infer that the article concentrates on the misbehavior of police
more than misbehavior by EMS workers?

I have read it a few times now, and I don't get that interpretation.

If anything, the medical system comes off worse. For example, compare:

> Hennepin EMS Medical Director Jeffrey Ho and Minnesota Poison Control System
> Medical Director Jon Cole dismissed the findings of the report as a
> “reckless use of anecdotes and partial snapshots of interactions with
> police, and incomplete information and statistics to draw uninformed and
> incorrect conclusions.”

with

> Minneapolis Police Chief Medaria Arradondo would not comment on the
> specifics of the draft, but credited it for changing his department’s
> approach to interacting with EMS workers.

~~~
ggchappell
> How do you infer that the article concentrates on the misbehavior of police
> more than misbehavior by EMS workers?

Well, I guess it's not so much that the _article_ concentrates on police
misbehavior, but that the actual people involved did so. The article does not
give us complete information, of course, but it appears that the police
basically said, "We messed up, and we're fixing things," while the EMS people
said, "There isn't any problem." And since the EMS people apparently _are_ the
problem, I find the response disturbing.

~~~
eesmith
The article is based on "the findings of an investigation conducted by the
Office of Police Conduct Review", so I think it's reasonable that it
concentrates on the police conduct.

------
walterbell
Is there an industry code of conduct for EMS personnel?

~~~
ropeadopepope
From what I've seen, it's 'do what the cops say or go to jail.'

[https://nypost.com/2017/09/01/nurse-arrested-after-
refusing-...](https://nypost.com/2017/09/01/nurse-arrested-after-refusing-
blood-test-on-unconscious-patient/)

~~~
Volundr
Whilst I suspect in general we agree about the systemic problems, in this
particular case, the officer was fired and his supervisor demoted:

[https://www.cbsnews.com/news/detective-jeff-payne-fired-
nurs...](https://www.cbsnews.com/news/detective-jeff-payne-fired-nurse-alex-
wubbels-video/)

------
resu_nimda
_Minneapolis police previously had no policy addressing the drug, and the
department manual classifies it as a “date rape drug” for its powerful
sedative impact and ability to erase or alter memory._

That's funny, because the World Health Organization classifies it as an
"essential medicine." I'm being somewhat disingenuous as I do understand it
has potential for abuse, but "date rape drug"? I've never once heard of
ketamine used for that. Meanwhile it's being looked at for treating depression
and other things. This over-the-top drug war rhetoric is so frustrating.

~~~
eesmith
I am surprised as your surprise. For example, the term "date rape" occurs
twice on the Wikipedia page for ketamine:

> In December 2013, the government of India, in response to rising
> recreational use and the use of ketamine as a date rape drug, has added it
> to Schedule X of the Drug and Cosmetics Act requiring a special license for
> sale and maintenance of records of all sales for two years.

> Because of its ability to cause confusion and amnesia, ketamine can leave
> users vulnerable to date rape.

It's not hard to find things like:

> "Tests for “date rape” drugs, such as Rohypnol and ketamine, were conducted.
> Those tests came back negative." \-
> [https://chicago.suntimes.com/news/attorneys-for-kenneka-
> jenk...](https://chicago.suntimes.com/news/attorneys-for-kenneka-jenkins-
> mother-file-motion-to-preserve-video/)

> "Three teenagers are being praised for a straw they invented to detect the
> presence of date rape drugs in drinks. ... two common drugs used in assaults
> — GHB and Ketamine" \- [https://www.sfgate.com/business/article/straw-
> detect-date-ra...](https://www.sfgate.com/business/article/straw-detect-
> date-rape-drugs-teen-inventors-miami-11200401.php)

> It’s called ketamine, a class III scheduled drug .... The drug is the most
> commonly used among veterinarians for anesthetic purposes, according to
> Medical News Today, but is often illegally used in clubs and as a date-rape
> drug. -
> [http://www.miamiherald.com/article206350184.html](http://www.miamiherald.com/article206350184.html)

~~~
resu_nimda
But did you actually know of it as a date rape drug before you googled
"ketamine date rape?" Not one of those articles (including the two referenced
in the Wikipedia quote) even attempts to substantiate any connection between
ketamine and date rape. They just put the terms together, sometimes in the
headline, to create an association without actually supporting it. One of them
contains a statement from an Indian FDA official that "Its misuse is rampant.
Its powdered form has been associated with sexual assault cases world over."
Not exactly convincing.

You may deduce that I am a user of ketamine. I do think it has potential and
it is clearly deemed safe by health professionals. Putting "KETAMINE DATE
RAPE" in headlines/subtitles of articles that have nothing to do with someone
being date raped is not useful.

~~~
DanBC
Ketamine is used as a drug rape drug. Here's a government level organisation
listing ketamine as a drug rape drug.

Ketamine has the advantage of being easy to get hold of; quick acting; and
memory affecting.

[https://www.nhs.uk/live-well/healthy-body/drink-spiking-
and-...](https://www.nhs.uk/live-well/healthy-body/drink-spiking-and-date-
rape-drugs/)

Notice that drugs are not commonly used in sexual assault, and they're only
talking about a few hundreds of spiked drinks. (In the UK about 90,000 people
are raped each year. Many more are sexually assaulted.) If someone's drinking
it's far easier to just give them more alcohol.

I get that you enjoy ketamine, but it's a bit worrying when drug users deny
any possible harm that happens with their drug of choice. It means Public
Health workers have to spend time debunking both sides of the discussion.

~~~
resu_nimda
I did say in my first post that I understand it can be abused. I don't mean to
claim that nobody has ever used ketamine for such purposes.

I do think that the original article and some of the other ones linked draw
wholly unnecessary connections between ketamine and date rape. As you note, it
is a very minor use case, and alcohol itself is far more often implicated in
these situations, yet we don't read articles that casually mention "the date
rape drug alcohol."

I don't think there is any special conspiracy against ketamine, but it's just
part of the way major media outlets distort these things to play up
shock/outrage/drama.

~~~
eesmith
You said "I've never once heard of ketamine used for that." and asked me "But
did you actually know of it as a date rape drug before you googled "ketamine
date rape?""

Yes. I heard about that putative connection from one of the times when the
"date rape drug detection straw" or something similar made the rounds. At this
point I can no longer find the specific link. I think it was from last year.
Two possibilities from the media I frequent are:

* HN 5 years ago at [https://news.ycombinator.com/item?id=6122049](https://news.ycombinator.com/item?id=6122049) . (The link to the original article no longer exists.)

* Phyrangula from 6 years ago [https://freethoughtblogs.com/pharyngula/2012/12/04/its-a-goo...](https://freethoughtblogs.com/pharyngula/2012/12/04/its-a-good-idea-its-depressing-that-its-necessary/)

Looking at the other media sites I read:

* Neatorama from 8 years ago [https://www.neatorama.com/2010/06/30/10-weird-items-people-t...](https://www.neatorama.com/2010/06/30/10-weird-items-people-tried-to-smuggle/) says "tests on the liquid found the animal tranquilizer ketamine, a hallucinogenic drug often used in date rape"

* a comment on BoingBoing last year is the comment "From horse tranq, to date rape drug, to therapy. Is there anything Special K can’t do?", at [https://bbs.boingboing.net/t/dissociative-psychedelic-ketami...](https://bbs.boingboing.net/t/dissociative-psychedelic-ketamine-may-help-suicidal-children/104636) . A 12 year old BoingBoing article at [https://boingboing.net/2006/09/20/willie-nelsons-myste.html](https://boingboing.net/2006/09/20/willie-nelsons-myste.html) references the commentary:

> For instance, one report called the disassociative hallucinogen Ketamine a
> “date rape drug.” There is, of course, no such thing as a date rape drug.
> There are drugs that were developed to be used – and are used – for other
> purposes that are, on rare occasions, used for date rape. And then there’s
> alcohol, which has been the more easily available and frequently used
> substance of choice for date rapists since time immemorial.

I completely agree that the association with ketamine as a "date rape drug" is
hyped-up drug-war propaganda, and alcohol is a far more common date rape drug,
and ketamine has has many therapeutic uses. (Look at how many people are
allowed to carry explosives with them on a plane - nitroglycerin is a common
heart medicine.)

But I think I have demonstrated enough examples which show why I don't think
you should be surprised when someone makes that connection. Instead, I think
you should be pushing back against the propaganda.

------
nextstep
I’m very confused about the legal status of ketamine in the United States.
It’s seemingly illegal (schedule 1?) but also there have been stories about
ketamine therapy for depression symptoms and now this? I don’t understand US
drug laws.

~~~
stochastic_monk
Schedule III. Of course, there are studies on cannabis/psilocybin, which are
both schedule I.

It's still a terrible and terrifying drug for subduing people.

~~~
drb91
I’m not terribly familiar with ketamine. Thorazine is often used for this
purpose, as an injection, a gas, or a pill. How does it compare in how it
affects the target?

I’m emphatically not in favor of police using this except as an alternative to
other types of violence, but sedation is useful in other contexts.

~~~
stochastic_monk
Thorazine is an antipsychotic, for schizophrenia, stimulant overdoses, and
stuff like PCP.

Ketamine is more of a dissociative; it's a little like long-lasting injectable
nitrous oxide. It causes hallucinations, but more like a loss of connection
from reality than seeing things that aren't there.

------
adamnemecek
Is the US a dictatorship yet

~~~
kpil
It has a inadequately trained police force, apparently with some cultural and
management issues, probably under-staffed and wearing down under a high
workload and too many encounters with the worst kind of people in some
districts, where there is absolutely no time to take it slow.

~~~
adamnemecek
It's not just the police force though, is it.

