comment: >
  
  I’d like to think we should pick and choose our battles, this didn’t seem to be said with any I’ll intent other than to raise awareness about certain groups not being treated right. So yeah you are right but intonation and context are important too, and I’d rather someone accidentally word it wrong than intentionally cause harm which is a very real and serious issue transgender people are dealing with
context: “One of [the officers] said he believed McClain had reached for a holstered gun.”
  They really need to stop with this bullshit. >
  
  Not to mention the implication that him reaching for a gun led them to have the paramedic give ketamine? Sure, cops are notoriously reasonable with armed people. It’s sad when his best defense to explain why they killed this kid was a scenario in which they 100% would have violently killed him. Nobody is buying that.
  Edit: Paramedic, not EMT >
  
  
  reaching for a gun led them to have the EMT give ketamine? 
  
  A super lethal dose of ketamine, no less. >
  
  Hi.. 22 year paramedic here.  This statement is a bit misleading.  
  Based on weight he should have gotten 320-350 mg.  He got  500mg.  The lethal dose is 4+ grams depending on the patients size so no... He didn't get a lethal dose of ketamine. 
  I've used Ketamine a number of times for patients in psych crisis to get them safely restrained.  We have options though.  My rule of thumb is "is restraining this patient going to put the patient myself or others at risk for injury?" If the answer is on that is "yes" they get the appropriate weight based dose for Ketamine.  I probably would have given him 350mg.
  If the answer is "no" and we can safely get them restrained and there's a risk of the patient injuring themselves in the restraints then a combination of Versed and Haldol is the choice to mildly sedate the patient to prevent injury.  
  Ketamine is an EXCELLENT drug with a lot of uses. We've expanded its use to aid in emergency intubation for a patient who is still alive and needs their airway managed.  I've seen complications from it twice in my five or so years using it. Once with the patient salivating a lot and the other with the patient going into respiratory arrest due to the other stuff he had on board.  That patient was safely managed and ended up being fine in the long run. I know this because our Ketamine usage is heavily monitored and reviewed.  Now this brings me to my next point: there are things that come along with Ketamine usage.  
  The first is safe restraining.  First, the patient is ALWAYS put on their back.  ALWAYS.  They can't be managed on their belly and as this recent case in Illinois shows us they also die on their bellies.  
  Also I should mention here that a lot of places require restraints when transporting a patient in psych crisis.  Psych patients change their minds during transport and they always seem to do it when you're one on one with them in the back of the truck. Murphy's Law I guess.  Also I really can't comment on the "committal" policies in Colorado but if I was the medic on this scene based on the body cam footage this guy would have been an easy decision to transport.  He's REALLY altered and incapable of making his own medical decisions.  
  Second they MUST be monitored.  Cardiac monitor, blood pressure, we typically put an airway in their nose (very non invasive) to keep their airway open and apply a device that monitors their respiratory rate and gas exchange.  That way if the patients condition starts to change it's recognized.  
  As a paramedic I'm very interested in this case.  My gut tells me that this patient was probably inadequately monitored and had the decompensating patient been recognized and corrected then we wouldn't even be talking about this right now. >
  
  He was forcibly restrained by cutting off the supply of blood to his brain and in handcuffs when injected. >
  
  Handcuffs is a last resort restraint for patient transport. A combination of softs and chemicals is ideal.  
  My post deals with the safety and efficacy of Ketamine and what I, with pure speculation, see as the probable actions that could have changed the outcome of this call. 
  People fight and frankly as a paramedic I'm also responsible for making sure that a person does not hurt themselves once restrained appropriately.  I can't tell you how many times before I worked in a system that utilized chemical restraints that I had to deal with people banging their heads on cabinets or the stretcher or pulling WAY too hard on restraints resulting in them leaving marks on themselves. >
  
  In this case, the person had already lost consciousness, was in handcuffs, had 5 officers holding him on the ground on his stomach while he plead with them and committed...
  How is Ketamine needed here, exactly? They didn't call the paramedics because he needed medical attention. They called paramedics to give Ketamine under the direction of an officer. The body cam footage shows an officer saying that they're planning to have Ketamine given to him because he was super strong and must be "on something." Even if you felt a person was "on something," should you give Ketamine to someone when you don't know what drug could be in their system? As a paramedic, do you think officer-directed Ketamine injections be given?
  I would urge you to watch the body cams and familiarize yourself with this dumpster fire. >
  
  First, when did I ever justify the actions of the paramedics?  Second, I HAVE watched the body cams.  Thanks.  I fully acknowledge that this is a dumpster fire.
  Second, law enforcement does not direct EMS when it comes to patient treatment.  I've had our medics called for sedation as well.  Once they arrive its the discretion of the paramedics as to how the chemical restraint of the patient will go.  That is no different here.  The paramedics chose the dose, it was too high for the patient, and they administered the dose.
  My point remains: This patient was NOT given a "lethal dose" of Ketamine.  Second, if you research ketamine one of the reasons that it is a GREAT choice as a drug in these cases is because it does not act as a respiratory depressant like other medications do.  Typically when that happens there is something else in play.
  As I stated in my original post:
  
  Second they MUST be monitored. Cardiac monitor, blood pressure, we typically put an airway in their nose (very non invasive) to keep their airway open and apply a device that monitors their respiratory rate and gas exchange. That way if the patients condition starts to change it's recognized.
  
  As I said, I'm paying close attention to this because my gut tells me that that they probably failed to adequately monitor this patient.  Had they done so, and had they recognized respiratory depression in the patient they could have easily treated it.  My speculation (again, pure speculation) is they missed it. >
  
  I appreciate your response! I really believe his monitoring was... less than stellar, to put it nicely. I've spent so much of my time (and university resources, another wonderful use of my tuition money) reading about ketamine in the last two days. From what I can tell, there really hasn't been a ton of research in what counts as a lethal dose and I don't believe there is a set plasma concentration of it that says definitively "this is toxic levels of ketamine" (like you can look at INR levels for definitive clotting data or creatinine clearance for kidney function or blood glucose levels for, well, blood glucose). Did you read the autopsy report? A lot of indication that there was significant oxygen deprivation to the brain and lungs, the coroner believes from the ketamine dose. (it's a long but worthy read, linked in the article but also here so you don't have to go looking). I curious on your thoughts based on that. >
  
  I have not a had a chance to peruse that yet.  Again that comes down to failure to monitor IMHO.
  Monitoring oxygen saturation and End Tidal capnography gives you a pretty clear picture of the respiratory cycle.  Now they stated they were going to put an end tidal on but again I'd love to see the report to see if that happened.
  hyp9eprcapnic before it became a serious problem and take steps to correct it. Failing to do so could certainly create those results.  That sort of thing doesn't just happen and can be corrected. >
  
  
  An amended autopsy report released by the county coroner in September 2022 revealed McClain had died from a ketamine injection after being forcibly restrained.
  
  Sounds a hell of a lot like murder to me. >
  
  I remember this episode, excited delirium is pure bullshit and news stations spout it constantly. What it is is murder >
  
  Can you provide some sources on excited delirium being bs? >
  
  His last words:
  "I can't breathe. I have my ID right here. My name is Elijah McClain. That's my house. I was just going home. I'm an introvert. I'm just different. That's all. I'm so sorry. I have no gun. I don't do that stuff. I don't do any fighting. Why are you attacking me? I don't even kill flies! I don't eat meat! But I don't judge people, I don't judge people who do eat meat. Forgive me. All I was trying to do was become better. I will do it. I will do anything. Sacrifice my identity, I'll do it. You all are phenomenal. You are beautiful and I love you. Try to forgive me. I'm a mood Gemini. I'm sorry. I'm so sorry. Ow, that really hurt! You are all very strong. Teamwork makes the dream work. [after vomiting] Oh, I'm sorry, I wasn't trying to do that. I just can't breathe correctly."
  Fuck those cops and EMTs. >
  
  “I’m just different, that’s all.”
  Sadly those are fighting words to the sort of bullies and creeps who are all too often drawn to law enforcement. >
  
  I was in an abusive relationship that pushed me into a full mental health crisis while alone in my apartment. I called a suicide line to talk and they sent a wellness check on me. The first officer was a lady who was very nice and sympathetic and talked to me for about 45 minutes to bring me down. I calmed down completely but was a little shaken still and she asked if I would please allow the EMTs to transport me to the hospital for an overnight observation and I agreed. She called down that I was allowing transport.
  Two male officers who had been waiting outside came in to "escort me" downstairs. They cuffed and beat the absolute holy hell out of me, made a ton of trans slurs and insults towards me when they realize I was transgender, drug me out of the apartment weapons in hand, while other residents watched, and shoved me down the outside stairs onto the sidewalk and twisted my wrist. The EMTs and other officer (the woman) lost their shit and pled with them to fuck off but they didn't care. They even "forgot" to uncuff me even though I wasn't a danger and they didn't follow to the hospital. A doctor had to call the police department to send someone to take my cuffs off.
  I went from having an awful day and mental health crisis to one of the worst days of my life because of police abuse. >
  
  If only cops were that enthusiastic about saving kids from an active shooter as they are about beating up a transgender or killing a black man.. >
  
  Please don't say 'a transgender'. A trans person or a transgender person would be correct.