DENVER (KDVR) – A bill that would increase regulations for the how the sedative, ketamine, can be used on patients in a prehospital setting will be debated in the Colorado general assembly’s House Judiciary Committee Wednesday afternoon.
“I think that we really need to be cognizant of what medications we are giving, in what dose and when,” said Rep. Yadira Caraveo, a pediatrician and one of the prime co-sponsors of the bill.
Rep. Leslie Herod is the other prime co-sponsor.
Multiple stakeholders, including those who work in the emergency medical services field, have been weighing in on the proposed bill, which was first introduced in March, and drafters have included some proposed changes.
“We want to see improvements come out of this process,” said Scott Sholes, president of the Emergency Medical Services Association of Colorado, who said his group suggested some changes.
Sholes said when he first learned of the proposed legislation, he thought the idea was “premature,” given the Colorado Department of Public Health and Environment’s ongoing review of state ketamine regulations.
That review is being conducted in secrecy, without public input.
“We really had hoped that that process would be complete prior to any legislative action,” said Sholes, who explained that there is room for improvement in the way ketamine is used in a prehospital setting.
“We’ve been pushed into recognizing where some of the failures are,” he said. “When we talk about a couple of the videos that we’ve seen, those of us who have been in the management of emergency medical services for any length of time see things that are astonishing to us. This is not how we want to see paramedics performing in the field. We don’t want the complacency. We don’t want to see the comments. We certainly don’t want to see a patient who is – with no examination whatsoever – and then they get any medication.”
Sholes said many of those elements can be addressed through “proper quality assurance” and training rather than legislation.
The bill aims to reduce law enforcement’s influence on first responders who administer the sedative to patients, and it imposes specific requirements on medics who choose to administer the drug.
A FOX31 investigation revealed video of an Arapahoe County Sheriff’s deputy asking a South Metro Fire Rescue medic whether the medical crew could administer any medication to an intoxicated man who had been detained.
However, Colorado law enforcement officials do not have access to, nor the ability to administer the drug. Paramedics are able to administer the drug by using a state waiver obtained by the medical director who oversees them.
“We understand that there is a perception that law enforcement may be directing care,” said Sholes, “and that’s come because of a couple of videos that we’ve seen and so on. Now, if you talk a paramedic, they’re going to tell you that while a law enforcement officer may have suggested something, it was still entirely (the paramedic’s) decision as to whether or not to treat a patient, how to medicate a patient, how much to use, and so on.”
“We strongly believe that there should be a clear delineation of roles and responsibilities of authority over those scenes between EMS and law enforcement, and that’s the part of the bill we support,” he said.
The bill suggests that when a “peace officer” is present at the scene, a medic must meet certain criteria before administering the drug.
The medic must have “weighed the individual to ensure accurate dosage,” and if that is not possible, the provider must estimate the weight and be in agreement with at least five other people who are present at the scene.
“We’re not going to budge on anything that encroaches on our ability to safely manage those scenes,” said Sholes, who pointed out there is no current accepted method for weighing a patient outside of a prehospital setting.
“I think our intention is that there are other ways to sedate people, and if ketamine has a place for use in the field, then it should be done safely,” said Caraveo.
There are many other regulations that have been proposed, including discipline for officers who may attempt to influence a medic.
Under the proposed language, an agency could lose access to the drug if someone dies or suffers severe bodily injuries related to the administration of ketamine.
The bill also requests a public report on the “statewide use of ketamine by emergency medical service providers and any complications that arise” be presented to legislative leaders and posted on the state health department’s website.
The proposed legislation also aims to change the makeup of the Emergency Medical Practice Advisory Council, the group that recommends whether an agency can receive a ketamine waiver.
Sholes said that group has many other duties besides recommending whether a medical director should have a ketamine waiver.
“We’d rather find other methods to assure that the chemical restraint piece…that we have adequate provisions for oversight of that rather than change the makeup of a very smoothly functioning advisory council,” said Sholes.
Several people have said they plan to testify during Wednesday’s hearing.