Aurora leaders evaluate ketamine policy for agitated patients

Problem Solvers

AURORA, Colo. (KDVR) – The medical director for Aurora Fire Rescue says the department uses the sedative ketamine on patients who exhibit symptoms of the agitated medical condition excited delirium because it is “the best medication for this condition.”

Dr. Eric Hill answered questions about the drug from community members during a public meeting Tuesday night.

“It’s done for the safety of the patient as well as for the safety of the responders on the call,” said Hill.

Aurora Mayor Pro-Tem Nicole Johnston said she prioritized the meeting after watching a FOX31 Problem Solvers report about the drug’s use on an agitated patient, Elijah McClain, who later died.

“When your story aired, I did get some constituents bringing up questions, wanting to know more information,” Johnston said.

A coroner could not rule out an unexpected, adverse reaction to the drug as a possible contributor to McClain’s death among several other things, including a carotid hold used on him by police.

However, many physicians have said ketamine is one of the safest sedatives to use in similar scenarios.

“(Elijah McClain’s) death was an impetus and is going to bring change to how we do things,” said Johnston, who is also organizing a task force to improve police oversight and community relations.

A FOX31 Problem Solvers investigation found at least one ambulance medic who helped provide ketamine to McClain felt the 23-year-old should have been given a lower dose of the medication, based on his weight.

While Hill and other first responders did not speak specifically about McClain’s case, Hill said Aurora Fire Rescue tries to use medications that have a “wide safety profile” that will not have a detrimental effect on patients if the dose that’s given isn’t exact.

“We don’t want to choose a medication that has – you know – if I give them too much, it’s highly toxic and harmful to them, and I also don’t want a medication that if I give them just under that amount that it’s also not effective,” said Hill.

One community member asked why a sedative must be used at all, if the patient is already handcuffed or otherwise restrained.

“If they’re handcuffed and have to be physically held down, that actually increases the struggle, and increasing the struggle actually adds to increased mortality for the patient,” said Hill.

“So, in order to stop that struggle – to stop the fight – the best way to do that is to give them the medication to calm them down.”

City Council members who sit on Aurora’s Public Safety, Courts, and Civil Service committee also had an opportunity to ask questions of first responders during a Thursday afternoon presentation.

“While we can’t – in these community meetings – because of legal issues around it and a legal case – dive into what happened with Elijah McClain, we can still step back and look at what we can do to make sure that never happens again,” said Johnston.

An attorney for the McClain family recently put the city on notice that she intends to sue over the incident.

The FOX31 Problem Solvers previously reported that ketamine is not FDA approved for the sedation of agitated patients, but many physicians say the drug is a safe, important and an effective medication that can save a person’s life when they are a danger to themselves or to others.

In Colorado, an agency’s medical director must apply for a waiver from the state health department for paramedics to use the drug on patients who experience excited delirium. The FOX31 Problem Solvers found Colorado Department of Public Health and Environment has issued waivers that currently allow 98 agencies to utilize the drug for that reason.

“That’s one of the reasons it is a waivered drug, so that it can be monitored in addition to how the drug actually operates or how it performs in the field. We’re also watching for any errors in administration which indicate…the personnel are not being able to keep their skills up,” said Randy Kuykendall, director of health facilities and the Emergency Medical Services Division at the CDPHE.

Hill said local protocols are frequently reviewed for best practices.

“We look at protocols on a monthly basis. We issue updates on a twice-a-year basis, so yes, we can always look at protocols, but we always look at a protocol and make decisions on whether to change it based on the best medical evidence that we have,” he said.

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