Ketamine injected during arrests raises new controls

DENVER – Police arrested Elijah McClain on a street in downtown Denver last year after she suspected the young Black man. He was thrown into a chokehold, threatened with a dog and stun gun, and then subjected to another tool for enforcement before he died: a drug called ketamine.

Paramedics inject it into people like McClain as a sedative, often following police who believe suspects are out of control. Officially, ketamine is used in emergencies when there is a safety concern for medical personnel such as the patient. But it is increasingly being found in arrests and has become another flashpoint in the discussion of law enforcement policy and brutality against people of color.

An analysis by The Associated Press of policies regarding ketamine and cases in which the drug was used during police conferences revealed a lack of police training, conflicting medical standards and non-existent protocols that resulted in hospitalizations and even deaths.

On Monday, it will be a year since McClain, 23, was stopped by officers who responded to a 911 call about a suspect wearing a ski mask and waving his arms. Police put him in a chokehold twice and several officers pressed their body weight into him.

Paramedics were called and injected McClain with ketamine, but they misjudged his weight, giving him more than 1.5 times the dose he should have received. He was given 500 milligrams because they thought he was weighing 220 pounds, but he was only 140 pounds and should have received 315 milligrams.

He suffered cardiac arrest, was later pronounced brain dead and life support taken away.

‘The case where someone has six officers on them, in a chokehold, and needs ketamine is really quite exceptional. That just doesn’t happen very often, “said Dr. George Lindbeck, president of the National Association of State EMS Officials Council of Medical Director’s Council.” The vast majority of these scenarios are managed at a much lower level with much less physical limitation, no. needs chemical restraint or sedation. “

Following McClain’s death, the Colorado Department of Health opened an investigation into the increasing use of ketamine, first approved for use in 2013, after the case received new attention in nationwide protests seeking police reform.

There are no federal standards for law enforcement or medical personnel for emergency assistance regarding drug use. State policy and reporting requirements vary, so it is not clear how regularly it is used during policing and why.

Most states and agencies say that ketamine can be administered when someone exhibits “excruciating delirium” or agitation, which is typically associated with chronic drug use, mental illness, or both. The medicine sows them, is believed to have limited side effects and is not meant to make anyone lose consciousness.

Medical professionals say that raised delirium is a “wastebasket term” and has no standard definition. The most commonly cited characteristics include superhuman strength, impotence for pain and wildness, uncontrollable behavior, said Dr. Paul S. Appelbaum, director of the Department of Law, Ethics and Psychiatry at Columbia University.

‘It’s not at all clear that these people are desperate. Moreover, it seems pretty clear that they are not one thing, that this term is applied in the field by police officers who are certainly not expert in diagnosing neuropsychiatric syndromes, ‘he said.

Police are not trained in diagnosing medical conditions, but most know first aid and CPR. Each police agency has different criteria for paramedics, on appeal, according to Jimmy Holderfield, secretary of the National Fraternal Order of Police.

“The best rule of thumb here is what a ‘careful and reasonable’ person would do,” Holderfield said in an email. “Officers are accused of the duty to protect lives and property.”

Medical emergency personnel administer ketamine if they believe it is needed, police say. But there is growing concern about whether officers are involved in the decision and in conflict medical advice on its use in arrests.

The American Society of Anesthesiologists opposes it and other sedatives for law enforcement purposes, saying, “These effects can end in death if they are administered in a non-health care facility without appropriate medical personnel and necessary equipment.”

Those who are in favor of ketamine have its rapid action and short life effects as well as scientific reports that it does not cause serious respiratory problems compared to other sedatives.

For police, the goal is to help detect an exciting situation and limit constraints they must use, Lindbeck said. Other options include drugs such as Valium or Xanax and anti-psychotics.

But Chris Burbank, vice president of law enforcement strategy for the Center for Policing Equity and a former Salt Lake City police officer, is suspicious of the statements for use.

“I always go back to why we do the business we do,” Burbank said. “This is going to stop, this is going to stop for pedestrians, this is going to search and seize. Some of these things are not necessary. “

The Food and Drug Administration approved ketamine in 1970, and its first major widespread use was as anesthesia on the battlefield during the Vietnam War. In the 1980s, recreational use of the drug, as Special K, became popular for its hallucinogenic effects. In recent decades, ketamine has been studied as a treatment for depression, and the FDA approved a nasal spray last year.

In July, a Black man was injected in Minneapolis and hospitalized after his girlfriend believed he had a diabetic seizure. But paramedics asked what drugs Johnson had taken, apparently unbelievable, Abby Wulfing wrote in a Facebook post that received widespread attention.

In May 2016, Marine veteran Willard Truckenmiller got into a fight at a bar in Naples, Florida, showing signs of “alcohol-induced aggravated delirium.” When medical workers arrived in an emergency, Truckenmiller was given 500 milligrams of ketamine, then suffered cardiac arrest and died.

Another Colorado man, Elijah McKnight, 25, received two doses totaling 750 milligrams of ketamine after a drunken altercation with police. He landed in August 2019 on a fan, the same month that McClain was injected in Aurora, Colorado.

An official autopsy found that ketamine in McClain’s blood was at “tolerable levels”, but it could not rule out an unexpected reaction to the drug, asthma attack or irregular heartbeat.

His parents filed a lawsuit this month, claiming that Aurora Fire Rescue’s uncontrolled policy and its de facto dose of 500 milligrams violated their son’s constitutional rights. The lawsuit alleges that the officers used McClain in a medical emergency, which increased the “substantial overdose” and led to his death.

There were 902 reported instances of Colorado paramedics administering ketamine from 2018 to 2020, and nearly 17% had complications, including cardiac arrest and deprivation of oxygen, the state Department of Health said.

In other states, police were found to be involved in the decision to use the drug. In Minneapolis, a report by the Office of Police Conduct Review found eight of those cases between 2016 and 2018, ranging from officers asking paramedics to use the drug to medical staff asking officers for their advice on seducing someone .

The report concluded that the lack of uniform policy on how police should interact with paramedics means that police officers could potentially meditate in medical decisions.

“Even if it’s a murder suspect, we would protect that person, but we do not get in the middle – nor should we – of how that person is treated for their injuries or crisis, whatever that may be. the doctor or paramedics deem appropriate to treat this person, ”said Burbank.


Nieberg is a corps member for the Associated Press / Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that puts journalists in local newsrooms to report on undercover issues.