Aurora council votes to temporarily stop ketamine sedation by paramedics

State

AURORA, Colo. (KDVR) — The Aurora City Council voted unanimously Monday to temporarily stop paramedics from using ketamine to sedate patients.

“It’s important to me, while the City of Aurora is undergoing an investigation into the use of ketamine to take a pause and say, ‘Let’s look into this more,’” Aurora council member Curtis Gardner told the FOX31 Problem Solvers.

Gardner sponsored the resolution and said the city received “several thousand” emails about the issue prior to the vote.

“For me it’s really important to make sure that we’re providing our paramedics not only with the best tools to do their job, but also the best protocols, and that’s why I say, ‘Let’s take the approach of a moratorium. Let’s not take this tool away from them permanently, but let’s put a pause on its use. Let’s look at our protocols and really make sure we’re providing our paramedics with the best tools possible for them to do their jobs,” he said.

Paramedics would be trained on new protocols before the moratorium begins, and the moratorium would expire 30 days after council receives results of the independent investigation into the death of Elijah McClain.

McClain died in August 2019 after an altercation with police and after a paramedic sedated him with a 500 mg dose of ketamine.

The state health department recently announced that it would review the state’s program that allows paramedics to administer the drug, but Aurora Mayor Pro-Tem Nicole Johnston said she was disappointed that the Colorado Department of Public Health and Environment isn’t doing more to address the ongoing concerns related to the use of the drug on people who have been involved in law enforcement situations.

“If there are these complication rates, if there are these questions and concerns, I feel it’s very important to put a moratorium and not grant any more waivers, and for waivers that are already in place, to stop those. So, I was disappointed that it didn’t go to that next step,” she said.

Last year, the complication rate associated with ketamine administrations to people with excited delirium was 24.07%. So far this year, the complication rate is 16.11%.

Johnston said she also has major concerns about the definition of the agitated condition, excited delirium, that allows paramedics to administer the drug to a patient. State guidelines show “many physicians question the existence of an excited delirium syndrome,” and that the use of the drug for that purpose “does not have a large body of evidence-based support in the literature.”

“Expecting our EMS staff to make that diagnosis on something that could also share characteristics of anxiety or drug use or other issues is something that we really have to make sure we’re clear about for using that in the cases of ketamine,” said Johnston.

Aurora Fire Rescue released this statement Monday evening:

Earlier this evening, Aurora City Council voted unanimously on a proposal sponsored by Council Member Curtis Gardner to enact a moratorium on the use of ketamine by Aurora Fire Rescue and the ambulance transport provider Falck Rocky Mountain. The moratorium will continue at a minimum until 30 days after the city receives the results of an independent investigation into the August 2019 death of Elijah McClain. Ketamine is currently listed in the Aurora Fire Rescue authorized version of the Denver Metro Prehospital Protocols for the treatment of excited delirium. The department will remove all ketamine from service units beginning at 8 a.m. Tuesday, Sept. 15.

Consistent with their training, the paramedics of Aurora Fire Rescue are directed to contact medical control for guidance if they encounter a situation that is unique or challenging while treating a patient.

The Aurora Fire Rescue authorized version of the Denver Metro Prehospital Protocols will continue to be the guiding document for emergency medical service providers in Aurora. These protocols are written, evaluated and updated by physicians with an expertise in emergency medicine and can be found on the department website at www.AuroraGov.org/Fire. The men and women of Aurora Fire Rescue remain focused on providing compassionate and professional care to our community, both through emergency medical service and all-hazard emergency response.

Aurora Fire Rescue

“The paramedics and EMTs of Aurora Fire Rescue, as with all EMS agencies across the state, rely on physicians to write, evaluate and update the medical protocols which they follow,” said Sherri-Jo Stowell, a spokesperson for the AFR.

In March, Dr. Eric Hill, the medical director for AFR, said, “The reason why we choose ketamine is ketamine is considered to be the best medication for this condition (excited delirium). It’s the medication that we can use to control the situation the quickest.  It’s been used in hospitals for decades. It’s the number one sedative that we use actually on kids in the hospitals when we need to do a sedation procedure.”

The American Society of Anesthesiologists has questioned the quantities of the drug and how the drug is being monitored by paramedics, who are not in a hospital setting.

“I am still not convinced that we are doing the best protocol for the use of ketamine, particularly in law enforcement cases,” said Johnston.

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