AURORA, Colo. (KDVR) — Aurora Fire Rescue’s medical director presented plans for adding a new sedative to the department’s protocols during the city’s Public Safety, Courts and Civil Service Committee meeting Thursday morning.
“We’ve done extensive training over the last two years,” said Dr. Eric Hill, as he presented the case for adding a drug called droperidol as a medical tool for paramedics who encounter agitated people in a pre-hospital setting.
Hill said his team has trained on how to de-escalate situations and how to determine whether a calming drug is necessary in situations when a person needs medical attention.
“When you cannot manage it any other way, and you have to render aid to that patient in a safe way, that’s what those medications are for,” he said.
The department stopped using the drug ketamine after Elijah McClain died in 2019 following a dose of the sedative and a rough police altercation.
“The goal of a sedative is not to render someone incapacitated,” Hill said. “The goal is to make a calming effect so that you can properly render aid to that patient safely.
What is droperidol and how is it used?
Droperidol, an anti-psychotic medication, is used by many Denver-area emergency medical providers, including Denver Health.
It is a sedative that works much differently than ketamine, and unlike ketamine, it does not require a special state waiver if paramedics want to use it on a patient.
“This one works on the dopamine receptors in the brain,” Hill said.
According to Dr. Vik Bebarta, a professor of emergency medicine, toxicology and pharmacology at the University of Colorado Anschutz Medical Campus, the drug, which also can be used to treat nausea and vomiting, does not affect a patient’s breathing.
“It doesn’t affect breathing. It doesn’t slow the breathing, so it’s commonly used in ICUs, operating rooms, emergency departments, across the country,” he said.
Bebarta said the drug is used “quite commonly if not hundreds or thousands of times a day” by EMS agencies, hospitals, paramedics and physicians.
FDA: Droperidol has potential risks
The Food and Drug Administration confirmed to the Problem Solvers that the drug does currently have a black box warning, describing a potential risk for problems with heart rhythm.
“Due to its potential for serious proarrhythmic effects and death, Droperidol should be reserved for use in the treatment of patients who fail to show an acceptable response to other adequate treatments,” the warning says.
Bebarta said the warning was put in place about 20 years ago. He said there have been several studies since that time that show the risks are low.
“They have said in small doses or moderate doses it’s safe to be used as long as you are watching those patients carefully through the course, monitoring them closely after you give the medication, there should be no issue,” he said.
“There is no one, ideal medication that is always the best medication,” said Hill, who explained that droperidol provides another option for relaxing a combative patient who is intoxicated with alcohol.
Other drugs might interact with the alcohol to cause respiratory depression, he said. Droperidol, he said has a “better safety profile” for those patients.
“They all have side effects – both of them – every single one has risk and benefits from their use,” Bebarta said.