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Comment by goodells | Hacker News Reader

I work as an EMT for a 911 service. The general attitude that I have and other EMS providers I’ve talked with seem to share is that this won’t end well.

The first thing we’re taught is that the scene must be safe. If it’s not safe, we stage nearby until law enforcement or fire tell us to come in. The 911 dispatch is notorious for misevaluating the nature and severity of a situation, and generally we are toned out to an address and keep getting updates with call details as we are driving there. In this country where anyone can have a gun on them, there is no way in hell that I and my partner are approaching an emotionally disturbed person with no way to defend ourselves. If something goes wrong, the most effective weapon we have is an oxygen tank. And now the public’s perception of drugs like ketamine for chemical restraint is souring, so the message seems to be “Go deal with the worst our society has to offer, with no backup in case they try to hurt you, no not even safe chemical restraints. And no sorry we can’t pay you more than a cashier at WalMart... but you’re heroes!” Just last year a firefighter paramedic in my state was shot dead after administering naloxone to a man and saving his life.

Part of it is the compensation. Law enforcement officers are paid substantially more than the EMS folks here with the understanding that they take on more risk. We make $12 hourly... not enough to accept drastically increasing our chances of being hurt or killed.

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You're an EMT. You aren't trained for this.

I don't know about NYC's new program, but Portland has been doing something like this for a couple years. They send out teams of a medic from the fire department and a counselor/social worker with specific training in deescalating acute mental health crisis.

There have been no incidents of these teams being attacked or injured.

This "under siege" mentality that the police have adopted as central dogma, which clearly has spread to you as well, is the problem.

I'd suggest reading the various interviews and comments from Patrick Skinner. He's been on a solo crusade for a more compassionate approach to beat policing for a few years now. He gets a lot more clout with police with it though, as he's ex CIA, so no one questions his machoness. The very core of his approach is "how would you solve this without a badge and gun?"

It's simple. It works. It's moral. It doesn't mean we abandon society to anarchy, it just means we stop seeing citizens and police as enemies of each other, where the default assumption is that a restraint and a gun are necessary to even have a conversation.

What sort of training helps deal with violent and irrational people?

Simply not feeling you must deal with the situation right now.

In the UK for example, the normal beat police do not have guns. If they approach a situation where they feel in danger, they're trained to back off and call for either more backup or an armed response. Turns out most of the time whatever the issue is will still be there when backup arrives. On the other hand, if it's a simple issue, they can just deal with it and there's a much smaller chance someone gets shot.

> Simply not feeling you must deal with the situation right now.

I can see that helping in some situations, but how does that help when the situation really is urgent?

Say you have someone who is violent and irrational due to drug intoxication and they need medical aid or they'll die, yet it's not safe to provide that. What is the answer in that case?

not the 'official' answer here but if they're that far gone on drugs eventually something will happen where they'll either tire themselves out or lose consciousness.

https://www.youtube.com/watch?v=r1JXhSYfLNE

I'm only half joking.

In all of the recent cases that have blown up in the US though, this was never the issue. The issue was the situation escalated way beyond where it should have. George Floyd was being arrested for using a supposedly counterfeit $20 bill. Maybe they could have just let him run. I'm sure the US economy won't be ruined by there being an extra $20 in circulation.

In the EMT case, I think we have to think about the alternative outcomes. If the EMTs can't help because the person is irrationally violent due to drugs, and the EMTs can't restrain them, I don't really see why calling the cops would make the situation any better. All they're doing is providing more hands, which could be done by simply having more EMTs. If they have a gun, then call the police. If they don't, they're unrestrainable, and you can clear out members of the the public, just let them be. The only other options simply make the situation worse for the person. Even using a taser in that situation can cause a heart attack.

> I'm sure the US economy won't be ruined by there being an extra $20 in circulation

In aggregate it would be.

No amount of "arrest random dude on the street with a potentially counterfeit $20" would address a systematic issue endangering the us economy.

It's like thinking you'll win the war on drugs by arresting weed smokers, except even less effective

I’m curious to understand why you think introducing a gun into this situation is going to make it any better?

We know from plenty of examples that in the scenario you describe there’s a high chance that the individual will end up shot by the police, and probably dead. We know police don’t have the training or the tools to handle this scenario well.

I don’t see how brining in people with better training could be a detriment. Worse case you ended up back where you started, the “violent and irrational” person ends up dead. Best case they successfully deescalate and render appropriate treatment, saving their life.

Not sure where the downside is.

Just because there have been high profile cases which fit the narrative of what you already believe doesn't mean that that is an accurate picture of reality.

The data simply do not comport with the position you are advocating. Here's some old (2005) data: https://www.bjs.gov/index.cfm?ty=pbdetail&iid=653

- 20% of people in US had contact with police in the year. - 9/10 people reported police acted properly - 44 million people with interactions, only 1% of those had violent conflict involved with the interaction, that's 440 thousand incidents

Hell, even the left-leaning WaPo tried to use data to buttress their/your argument and it's just plain embarrassing: https://www.washingtonpost.com/graphics/investigations/polic...

- 1000 people shot by police in 2019 - they actually removed the numbers for unarmed, because it was so dismal for their message - less than 50 "unarmed" black people killed by police in 2019

Take an honest look at these numbers and then please try again to justify your position about how there's a "high chance that the individual will end up shot by the police" because by the light of the data you're living in a fantasy land.

I guess my claim of "high chance that the individual will end up shot by the police" is hyperbolic.

But then my next question is, what does a police officer bring to the table other than a gun? What unique skill and tools does a police officer have that could help resolve such a scenario peacefully, that wouldn't also be available to someone specially trained in dealing with mental health issues?

You're ignoring cases (the majority I'd estimate based on 911 calls I've listened in) where others are affected.

Domestic abuse/violence, threatening behavior towards third parties or behavior that's so unpredictably out of line that you can't confidently sit back and not deal with it because you'd be wondering if others would be placed in danger by your non-action.

I'd say that most of the comments in this thread are very out of touch with reality and firmly in the realm of wishful thinking.

Most UK civilians do not have guns either.

The UK has ~5 guns (legal and illegal) per 100 civilians.

The US has 120 per 100 civilians.

https://en.wikipedia.org/wiki/Estimated_number_of_civilian_g...

Are you implying that enough people can't be trusted not to shoot at police with their guns that it justifies an armed response to every call everywhere in the entire country?

I think it’s more like if you are a first responder, the math tells you whomever you are dealing with has a gun. That changes the dynamic entirely.

The math doesn't say that - the 120 per 100 figure is misleading: obviously everyone doesn't own a gun. About 22% of people report owning a gun. So yes, a high figure, but the chance of someone owning a gun AND currently carrying it brings that number down a bit. I do agree that it's still quite a dangerous situation regardless.

1 in 5 is still far higher than UK first responders have to deal with.

Well then let's run the numbers: which math are you talking about, the number of guns? My question stands, then. After that, where is the line that changes the dynamic "entirely?"

I‘m not sure whether measuring the number of guns per citizen is a valid measure. Take a look at Switzerland.

I think it goes down with many more factors applying at the same time, not just „guns“.

Why begin with the assumption people are violent and irrational due to a random 911 call?

But to answer your question directly, there are tons of simple things you can do, from body language to tone. They aren't really a mystery to figure out either. Start with empathy and asking how you can help.

Like I mentioned above, Patrick Skinner distills this succinctly with "how would I solve this problem without my badge and my gun?" and in particular, using the example of if your next door neighbor asked you for help with some minor crisis.

Treat your neighbor that lives rough the same way and it's amazing the difference in reaction you get.

Assuming violence is necessary from the start becomes a self fulfilling thing.

Listen to some 911 calls sometimes. People are often screaming, panicked, crying.

Where can I find a representative sample of 911 calls?

The calls themselves aren't usually in the open due to privacy concerns, but you can listen to dispatch in many cities here: https://www.broadcastify.com

Exactly, which is why I'm highly skeptical of someone whose political position is justified by supposedly listening to 911 calls.

I listened to the local dispatch until recently when the cops switched to encrypted channels. Fire/EMS is still available though.

I have. Up until the recent protests dispatch here was in the open, so you could follow situations in real time. There's no reason that a taser, gun, or handcuffs help with the overwhelming majority of calls, including ones with someone who's panicked and crying.

The one where you arent trained to just shoot people until they stop moving/gun runs out of bullets.

Apparently, they usually bring police with them, and they are often called to the scene by police. Adding a trained counselor for deescalation sounds nice, but it may simply be an enhancement not an alternative. https://www.streetroots.org/news/2019/05/03/portland-mental-...

It's both. Dispatch calls it out and sometimes police show up, sometimes they don't. The main thing is the team is focused on solving the problem vs controlling people while ignoring their problem.

If people are a danger to themselves or others, the cops should be there, period. Sorry if that hurts their feelings but once a situation triggers calling for assistance it’s not just about them anymore.

There are multiple problems with that simplified model of conflict engagement. The most immediate one is that it encourages people to call nobody and just try to sort out the situation themselves, because the risk of a simple call for assistance ending in the death of a loved one is too high right now.

https://www.inquirer.com/news/west-philadelphia-police-shoot...

> which clearly has spread to you as well

How do you know this?

It is strange to see this opinion voiced by an EMT. There are millions of people in this country that grew up in a world without EMTs. If you were hurt or sick you had to get yourself to the hospital or rely on the police getting you there. Police obviously weren't able to properly handle these situations from either a training or equipment perspective. This resulted in countless people dying unnecessarily. That was seen as an obvious failure and eventually a job was created to bring medical attention to the scene of an emergency and remove police from the handling of these medical issues.

We have already made this transition once. Police are no more able to handle someone experiencing an emergency mental issue as they are able to handle someone having a heart attack. Why not change the system to get the proper people on site as fast as possible?

99 Percent Invisible recently did a great podcast on the early history of EMT services and ambulances.

https://99percentinvisible.org/episode/freedom-house-ambulan...

Sounds to me like you’re falling right into the stigmatizing myth that the mentally ill are especially likely to be violent. Even calling them “the worst society has to offer”, and so far nobody is calling you on it. Presumably there would be some up front report and assessment of whether the person is exhibiting violent behavior. The actual “worst of society” should obviously be dealt with by police.

It sounds to me like goodells is relating their experiences.

> Presumably there would be some up front report and assessment of whether the person is exhibiting violent behavior.

That's a very presumptuous thing to presume, when the person who actually has personal experience with the matter says that dispatch is notorious for misevaluating situations (surely through no fault of their own much of the time, since dispatch is not on the scene and can only relay what they've been told.)

It's just as presumptuous that every mentally ill person is carrying a firearm and is violent.

It only takes one to kill you? I think that's op's point.

But it isn’t a good point absent the bad assumption that the mentally ill are more dangerous. It only takes one bicyclist that’s fallen off his bike to kill you. So what?

It isn't just the aspect of someone being mentally ill, it's someone being mentally ill and that their behaviour caused the police to be contacted.

This is a symptom of people being to primed to believe that mentally ill people are dangerous, not a legitimate cause for concern.

Purple call the police on someone yelling. A mentally ill person yelling isn't a danger. They might be in crisis or pain, or they might be unable to effectively communicate.

A gun didn't help in any of those, the vast, vast majority of cases.

like that one time a white woman called the cops on a black man in central park?

I don't think doing an action to have the policed called on you is the best approach, considering it can be weaponized by dishonest actors.

Nobody in this discussion has presumed such a thing.

It's the explicit expressed fear in the root comment, and the basis of the police warrior ideology.

The root commenter has said explicitly of armed violent people: "the vast majority of patients are not like that"

So to reiterate, nobody in this thread has presumed as bluntfang claims.

Yet their claim is that we need to respond as though every mentally ill person is an imminent threat.

Their claim, as I've interpreted it, is that their lived experiences have lead them to believe any situation must be treated with caution because they never know what to expect. That is simply not the same as presuming that every mentally ill person is carrying a firearm and is violent.

As I see it, that's just common sense. If you get a call from a woman telling you she's fallen down and is hurt, how likely is it that EMTs are met at the door by a drunk man who claims nothing is wrong? What first appeared to be a simple medical situation may actually be a case of domestic violence. Neither the dispatcher nor the EMT can know this before anybody arrives on the scene, so whoever gets there first needs to be cognizant of all possibilities. Recognizing the possibility that somebody might be violent is not the same as believing they will be.

But I think you've made my point for me:

> As I see it, that's just common sense. If you get a call from a woman telling you she's fallen down and is hurt, how likely is it that EMTs are met at the door by a drunk man who claims nothing is wrong

This is

1. Exceedingly unlikely

2. A situation where escalating might be warranted, but the person who knocks on the door isn't in imminent danger.

3. You wouldn't bring a police officer to this call, but as you've so clearly pointed out, there's a chance it could turn violent. The logical conclusion here would be that police should respond to all medical emergencies, but they don't for reasons that become clear if you look into the history of how separate medical emergency response came to be.

If the EMTs are being paid $12, is it any wonder dispatch is notorious for misevaluating situations?

Deep structural problems.

I don't know what dispatch is paid, but EMTs are not dispatchers so this doesn't make much sense to me.

I don't follow. Why should EMTs getting ripped off be a factor in dispatch being unable to do more than relay whatever inaccurate or incomplete information they might gave been able to extract from a member of the general public over the phone? If a woman dials 911, says "Help!" then hangs up, how is the dispatcher supposed to accurately convey the situation to an EMT? EMTs should be paid more, but paying EMTs more won't address this problem.

Sorry, yes, I can see how my comment could be confusing.

I was implying that the call centre worker is probably less credentialed than the EMT.

Yours in a strong point though: dispatch can only pass on what they know, so their misevaluation may not actually be the result of mistakes or a pack of training, and I probably shouldn't have read that meaning in to OPs words.

Thank you.

Paramedics have more training and are paid more. While $12 is pretty low it’s not the ceiling.

And you're falling into the trap of "everything works in theory". Dont pretend the real world is a clear cut place. Boots on the ground experience breats armchair keyboard academics.

Spot on. In theory, it is a fantastic idea to send mental health professionals, without any guns or self defense tools, or any bodyguards (police) to an ambiguous high-intensity crisis situation that seems like it involves psychological distress. In reality, when those professionals come face-to-face with, for example, someone high off of bath salts or PCP, they might have to abandon the scene due to the imminent threat to their lives, which then results in both the drug user and random passerby being placed into harms way due to the government not sending a full complement of healthcare + police professionals to the scene.

It's too dangerous for anyone to go there. They should just launch missiles on any address 911 is called for.

There is always risk.

It sounds to me like you're saying mental illness is irrelevant when it comes to predicting a person committing harmful behavior, which is a bold claim to make, to say the least.

As a whole, people with mental health issues are more likely to be abused and harmed than those who don't. The rate of violence in those with mental health issues is the same as the general population.

Suicide rates are a separate issue.

There are a couple problems with those studies.

The first is mental health issues are a very wide umbrella. This includes anxiety, depression, and things like eating disorders which all parties can agree are probably not associated with increased rates of violence.

But if we limit it to diagnoses like bipolar or schizophrenia I'm sure there are increased risks of violence.

My mother (who had schizophrenia) for instance was fine 364 days a year. But on the 365th she'd try to claw my grandmother's eyes out because she thought she was the devil. And EMTs and other people who aren't being called out to deal with my mother on the 364 days a year she's fine.

The other issue with those studies is they control for a host of other factors to get the conclusion it's not correlated with violent crime.

If you just look at a bland, we separate people into two buckets, mentally ill and non mentally ill. Which bucket commits more violent acts per capita, the mentally ill do. You have to do a lot of statistical correction before you found that mental illness isn't correlated with violence.

As someone with a family member with schizophrenia I can support this, things tend to turn violent during a psychotic event. Bed restraints in hospitals aren't just decorations.

> The rate of violence in those with mental health issues is the same as the general population.

But what about the rate of violence among mental ill people who are committing some action that warrants a 9-11 call? What exactly leads to someone calling 9-11? It isn’t that someone is sitting in their house mentally ill — they are doing some action that is concerning enough to warrant a callout. So among that group of mentally ill, what’s the violence rate compared to the “general population.” It’s going to necessarily be higher.

I honestly think most people opining on the subject have never worked as a front line first responder before. It’s like news pundits talking about battlefield tactics when they have never been in combat. Lethal force should obviously be a last option, but when some literally insane person starts lunging at you with a knife all that theory of “the best way” goes out the window. There are thousands of mental health “dangerous” 9-11 calls happening every day and the vast majority end peacefully. Police on-duty firearms discharges are very rare but people act like it’s an epidemic because these incidents get magnified and broadcast to make people think it’s a frequent occurrence. How many mental health 9-11 calls end violently? 1 out of 10,000? 1 out of 100,000? Without knowing that number, any implication that this is a systemic problem is grounded in emotion rather than data. There are also unintended consequences. Saving that 1 out of 10,000, could result in an increase in risk that would offset any gains from such policies.

If NYC wants to experiment, good for them. I am not opposed to a better way. I am concerned about unintended consequences of policies — consequences that are often ignored.

> So among that group of mentally ill, what’s the violence rate compared to the “general population.” It’s going to necessarily be higher.

This doesn't follow. People don't call the police for mentally bill people being violent, they call for them being disruptive, or in the best case, perceiving the mentally ill person as a threat.

Neither of those implies any violent action on the part of the mentally ill person. People are primed to assume that any sort of abnormal behavior is dangerous or implies potential for violence. That doesn't really follow.

Not do we even touch on second order effects like how escalating aggression with mentally ill person will lead to more aggression in response.

What we do have, already, is fairly conclusive data that these policies do work, in other nations and our own.

I would imagine someone whose behavior triggers a 911 call is much more likely to be violent than the average person, regardless of any mentally illness

I love it when someone with direct experience on the topic gets a talking to by someone without it.

I mean, what’s does this guy know? It’s just his day to day job.

You're an EMT. Which means you aren't trained to deal with mental health issues. Just like the police.

> You're an EMT. Which means you aren't trained to deal with mental health issues.

I don't get that - a mental health emergency is a health emergency (the clue is in the name)... which is what EMTs are for aren't they?

> We make $12 hourly... not enough to accept drastically increasing our chances of being hurt or killed.

Would you have higher hopes for this pilot succeeding if these mental health professional made as much as cops? I think that is supposed to be the logic of defund the police. But yeah 12/hr is a crime.

Maybe, and with FDNY where this pilot is being tested I don't know how the pay compares, but it'd still be a big shift in how EMS is presented from the very beginning to trainees.

I personally like EMS because even though it's not exactly _safe_, if someone is acting out the cops deal with them, and if something is on fire or spewing ethyl-bethyl-bad-stuff into the air, fire/HAZMAT deals with it. We're the smart people in the wee-woo box that primarily focus on patient care with our friends in law enforcement and fire close by.

My issue with it is that EMS and a "mental health professional" could easily get stuck in a situation with a violent, armed person and be at the mercy of police coming from a separate location to help in an emergency. Sure, the vast majority of patients are not like that, but it doesn't make sense to me to take the risk. In my experience, having police on scene but keeping their distance is fine and patients usually understand when we say they're not in trouble and anything they say to us is confidential. Some other services probably don't do it as well, especially since police get there faster most of the time.

My thoughts exactly. Also, the success rate of calming down a mentally unstable person threatening violence to self or others is only about 33% for someone who is trained and knows the patient's history. That leaves a lot of risk for that other 67% of the time.

[citation needed]

The Tactical Edge p.349

Charles Remsberg. From 1986. One of the leading minds who got us into this situation.

https://www.police1.com/columnists/charles-remsberg/page-12/

What situation is that?

Most of the abuse I've seen is by officers who either were never given the training Remsburg presents in his books or ignored it.

Why is this downvoted?

> In this country where anyone can have a gun on them, there is no way in hell that I and my partner are approaching an emotionally disturbed person with no way to defend ourselves.

It sounds like this is one of the major issues, if not the most important issue. Nobody is going to attempt to repeal the Second Amendment, and trying to do so would cause way too much upset in a country where gun culture has been ingrained in the populace since its founding.

I personally believe that so long as guns are so widely available, and mentally ill people who are predisposed not to seek or have no treatment available exist (which given human nature pretty much always will), gun violence will continue to occur, and so the police and other responders will assume that they could be killed from guns in risky encounters. All it takes is one mistake in determining that someone does not have a gun to have someone killed and make headlines and potentially be remembered for years.

I wonder how I would feel about the gun laws in the U.S. if I were born and raised in a country that prohibits firearms. I would prefer to live in such a country but very few people directly affected by the violence have the option of leaving. I also wonder how many people would be accepting of guns today if we didn't have the Second Amendment from the beginning, and people didn't end up receiving the impression that the founders of the country affirmed gun ownership. Trying to cut back on the violence with the gun culture continuing sounds very complicated to me.

In your view, what would be a good set of reforms?

Presumably they won't conscript mental health professionals into this work. It should be done on a voluntary basis. My understanding is that approaches like this work with acceptable levels of risk in other countries, so hopefully it will be likewise successful here. That being said, my gut reaction is that I would not want to be the person called upon to do this job, and I could understand any other person who felt likewise. I would want to be armed when dealing with people who are operating outside the ordinary human envelope of behavior. Maybe that's my Americanness talking.

Thank you for the risks and efforts you take and make every day.

If you make $12 an hour, you are not in NY state were the minimum wage is $15.

This is not to underrate your personal experiences, just that situations can be different in different places. Guns in NYC are fairly rare, but your comment holds true with any weapon.

NYC has an extreamly low violent crime rate, and a murder rate that is nearly non-existent. And that crime rate is dropping lower and lower: https://www1.nyc.gov/assets/nypd/downloads/pdf/crime_statist...

It is possible that our crime rate is reaching a low enough valley that this might be successful here.

> Guns in NYC are fairly rare

What, are you kidding? This is a crazy statement to make. Guns are everywhere here in NYC and everyone who lives in an actual NYC neighborhood knows this.

I've lived in NYC my whole life. I always knew kids that had handguns, I knew people that sold them, I knew people that would buy them every chance one came on their radar.

I was at my local deli today and heard a 45 year old gentleman telling another older person about the new Smith & Wesson they had for sale.

> that crime rate is dropping lower and lower

That's not really the "crime rate" that is dropping lower, but rather the number of crimes booked by police officers. Police spent months not responding to, nor intervening in, basically any crimes committed in NYC in 2020. The incidence of crimes committed against innocent citizens in NYC - as well as the gun crimes - all are rising dramatically, as anyone who lives here would be quick to tell you.

I am impressed with the amount of disinformation in this post, given how few words you actually wrote.

While I believe cops could suppress reporting of a wide variety of crimes, I find it a bit difficult to believe they could do much to suppress reporting of violent gun crimes. When people show up at hospitals with bullet holes, certainly that triggers the creation of a paper trail no matter how badly the cops want to ignore it.

I have also lived in Brooklyn my whole life. I have never seen a gun outside of a person's home or a gun store.

When I was a when I was maybe 15 I was on the roof of a building when someone reported a visible gun. With 15 minutes my friends and I were surrounded by police and questioned as they looked for the gun. They did find the person about 10 minutes later.

I also had a kid in my school shoot himself in the leg by accident because he thought he'd be cool and tuck it in his pants. The closest I ever come to an active shooting.

I stick by my statement that guns are extremely rare in NYC. They are not non-existent, but they aren't at all common place.

The nypd downplaying crimes is a significant real issue, that is true. But that only fuels the the thesis that what is proposed may work here.

Are you a Stuyvesant kid?

What you are saying boggles my mind.

I grew up right outside of NYC, spent A LOT of time there. I then lived in NYC for about 8 years. I never saw, heard of or experienced what you described. Nor have I ever communicated with anyone that shared a similar experience.

Can you be more specific about what 'neighborhoods' you refer to?

You can't go more than five minutes in NYC without seeing a gun on the streets.

Only because the police themselves are open-carry.

Right - people openly carrying guns every day on every street corner. It's madness, but people don't give it a second thought. Why do they need to be armed to the teeth like this? How did this become accepted by the public?

> Guns in NYC are fairly rare

There are police openly carrying guns on every street corner in NYC. There must be like a hundred thousand guns in the city minimum. Your idea of ‘rare’ is delusional even if we just consider the police let alone everyone else.

This is true, I was not counting police guns, which are in fact everywhere. I was not also counting military guns that started showing up after 9/11. I was only referring to civilian guns, which perhaps was not clear.

Are you a mental health professional? I would imagine that's a separate skillset, and one that would allow a person to better evaluate whether or not someone acting broadly "unwell" is likely to be dangerous.

Use of Ketamine is souring due to the death of Elijah McClain, so you should refrain from claiming it's safe. There is always risk when injecting someone with a chemical in an emergency or crisis situation. No doubt your job is tough and underpaid, but it sounds like your mindset is perfect to be complicit in acts of police brutality.

Ketamine is only used to prevent the use of more force or injury in scenarios where there is potential for higher levels of force or injury to be occur. It is a mitigating agent for higher levels of force.

Well, apart from in the Elijah McCain case; or do you mean that ketamine mitigates the willingness of the responders to use lethal force?

If someone doesn't get ketamine, the alternatives are:

- they get tased, pepper sprayed, and thrown around by law enforcement officers

- they get a less safe drug like midazolam, lorazepam, or haloperidol

- they get restrained and fight against the restraints which puts them at risk of sudden death and rhabdomyolysis

....if there’s a real, imminent threat.

In some of these cases, it seems like the officers could have tried to de-escalate the situation while keeping these options in reserve in case that failed. The choices don’t have to be either immediate compliance or overwhelming force.

Even with animals—-where the use of drugs is a lot less ethically fraught—-ketamine isn’t necessarily the first option.

Sure, the indications for using it can be clarified. EMS would go for chemical restraint (i.e. ketamine) for someone where "excited delirium" is suspected. This doesn't mean literally anyone being ornery with the police - and generally we aren't even involved in those calls. A person in a normal state of mind won't break their arms or dislocate their shoulders when they're put in handcuffs. Someone who took too much meth very easily could.

In this case, it says they used 500 mg of ketamine in an injection, so basically they killed him with an excessive dose. Even though ketamine might have a higher LD50 you can't compare drugs without knowing the dose they are using.

https://en.wikipedia.org/wiki/Death_of_Elijah_McClain

True. Administering many drugs without the proper knowledge can be dangerous.

500mg? Might as well just shoot (someone) in the head. Total unprofessionalism.

"normal" dose would be something like 10-30mg

My protocols for excited delirium say ketamine 100-200mg IV/IO or 200-400mg IM.

It's worth noting "excited delirium" is a controversial diagnosis.

That doesn't sound like a very safe protocol to follow considering the max dose in a controlled environment for depression treatment is 1mg/kg.

Well for Elijah McClain it was either given after police suffocated him or directly contributed to his cardiac arrest. He apparently was restrained when it was delivered. This does not seem to jive with what you're saying. Were they planning to extra kill him if the Ketamine wasn't there?

He can struggle while restrained, severely injuring himself, and even to the point of killing himself. Handcuffs are temporary restraints and a struggling individual can severely hurt themself or defeat them.

Also, this scenario does jive with what I'm saying. Ketamine is generally safe. Would you rather have a shot of ketamine, mechanical disablement (multiple broken bones), or a shot of 9mm? These officers could have moved higher up the force continuum without the ketamine, even killing him in other ways (intentionally or accidentally). Are you saying tasers should never be used also?

I believe the vascular restriction (that they shouldn't have used) is the reason he was brain dead.

You probably shouldn't inject Ketamine into someone who has suffered cardiac arrest or brain death after being forcibly restrained. I am not sure how Ketamine is at all a hero here, or helped provide an alternative to save Elijah McClain from excessive force by the police. If anything it may have complicated his chances of resuscitation, or possibly further contributed to his death.

Forcible injection is up there with taser and pepper spray. I don't think anyone wants to be forcibly injected with an unknown substance.

When Elijah said he's different, perhaps they could have asked how he's different? Is he autistic, does he suffer from anxiety and panic attacks? Instead you suggest the only plausible alternatives to forced Ketamine injection is him getting his bones broken or 9mm bullet in his body. That mindset is exactly the problem.

"You probably shouldn't inject Ketamine into someone who has suffered cardiac arrest or brain death after being forcibly restrained."

Pretty sure the ketamine was before cardiac arrest and brain death. Isn't that the claim - the ketamine caused those issues...

"Instead you suggest the only plausible alternatives to forced Ketamine injection is him getting his bones broken or 9mm bullet in his body. That mindset is exactly the problem."

What mindset is that? What are you suggesting as an alternative once someone has started fighting, (reportedly) grabbing for a weapon, and continuing to struggle once restrained?

It would be great if we had video to confirm that the injection was justified in this specific case. I would have also liked to see what the actions were leading up to the encounter.

I think some of the confusion is people saying the hold killed him, but he appears to actually have regained consciousness after the hold, and was then given Ketamine, then shortly after the administration of Ketamine he went into cardiac arrest.

If he was actually killed by the chokehold, then no way should someone be injecting Ketamine into someone unconscious or without pulse, especially under the guise of them resisting or being a threat.

If he lost his pulse shortly after being administered too high a dose of Ketamine, then that kinda indicates Ketamine could have been a cause or contributed.

Regarding mindset, while Elijah did resist, the transcript suggests he was eventually compliant and pleading with officers.

> I can't breathe. I have my ID right here. My name is Elijah McClain. That's my house. I was just going home. I'm an introvert. I'm just different. That's all. I'm so sorry. I have no gun. I don't do that stuff. I don't do any fighting. Why are you attacking me? I don't even kill flies! I don't eat meat! But I don't judge people, I don't judge people who do eat meat. Forgive me. All I was trying to do was become better. I will do it. I will do anything. Sacrifice my identity, I'll do it. You all are phenomenal. You are beautiful and I love you. Try to forgive me. I'm a mood Gemini. I'm sorry. I'm so sorry. Ow, that really hurt! You are all very strong. Teamwork makes the dream work. Oh, I'm sorry, I wasn't trying to do that. I just can't breathe correctly.

He was on the ground for an extended period of time and threatened with dogs. An officer determined his "need" for Ketamine before emergency medical personnel arrived, not the medical personnel themselves. The medical personnel then gave him overdose based on his actual body weight.

The police tunnel visioned into the guy being whacked out on drugs, completely ignoring his pleas and explanations, and the medical personnel were complicit in unquestionably following orders of the officers and then administered an incorrect dosage of Ketamine.

Police should consider they might be dealing with someone neurodivergent, that someone "acting suspiciously" might just be anxious or panicking, and may not actually be a criminal or on drugs. Fight or flight and adrenaline are a hell of a combo on their own.

Vascular constriction can have latent effects, such as causing a stroke which results in brain damage or brain death. I haven't seen the duration for the two instances of cardiac arrest to know if they were long enough to cause brain death, especially if they were performing compressions, etc.

Did he have any diagnosed conditions? If not, then the part about being neurodivergent wouldn't be applicable (but yes, more training on that would be good). It's possible the random language and topics in his pleas were seen as a sign of intoxication, especially with the officer's comment about strength in the struggle. Also, the incoherence could indicate the beginning of a stroke from that hold.

I also think people should look at the Karen involved in this story. You have no reason to report any crime or threat, but you call the police anyways?

Is Ketamine advisable to inject into someone who has had deadly force used against them which could lead to stroke?

Did they ask if he had any conditions before grabbing him and instigating the struggle? Did they ignore his explanations while on the ground, and his breathing complaints? It certainly is applicable, the entire point is to find ways for people to survive interactions with the police, not excuse away deaths caused by police intervention.

There are plenty of instances where 911 calls are outright lies or incomplete information is provided. It is up to the responding officers to take the reports with a grain of salt. Again, your focus seems to be to find ways to redirect blame away from the officers who directly contributed to Elijah's death.

https://en.wikipedia.org/wiki/Shooting_of_John_Crawford_III

https://en.wikipedia.org/wiki/Shooting_of_Tamir_Rice

https://en.wikipedia.org/wiki/2017_Wichita_swatting

What explanation did he give? Why would they ask if someone has a condition as soon as they approach someone (and did he have even one)? Most people won't answer that because it's none of their business. The breathing complaints are common and with the right training (which it sounds like they didn't have), you are supposed to know which ones are legitimate.

I'm not making up excuses. As I've said in my previous comments, I believe the vascular constriction killed him, via a stroke or stroke-like event. What I am saying, is that you seem to be living in a fantasy land where you have some aversion to drugs being part of the force continuum and don't understand reasonable suspicion standards as well as the obligations and rights of citizens during an investigation.

He said he was an introvert and asked the officers to respect his boundaries. Do officers not know what an introvert is? Do they not know some people react poorly to bring touched? He also had asthma, which might be good to know before you decide to chokehold someone. There's tons of people in this world, who act differently to different stimulus, and mental healthcare in the US has historically been poor, so there are probably plenty of undiagnosed people walking around. Most people don't announce they're introverts during a police stop, this should have been a clue.

It seems a lot of police have trouble spotting the "fakers". Literally they did a chokehold on him, how much training do you need to understand that causes harm? More excuses from you.

You seem to live in a land where just because it's written on paper and police can legally kill people, that it makes it okay. Maybe policies need to change in light of so many of these tragedies, and the willy nilly use of Ketamine and chokeholds should actually be reconsidered. Hopefully this pilot program is a success, and we can avoid the amateur hour antics that lead to Elijah's death.

You clearly haven't been reading my comments.

From what I understand of ketamine, it would take several grams to kill a man while Elijah was given half a gram (which was evidently more than he should have been given, but should still have been well short of lethal.) It seems to me he was killed by the chokehold. If somebody fed you a pot brownie then kicked you in the face, would you say weed broke your nose?

Do you think the Ketamine helped his chances of survival? Even at therapeutic levels drugs can cause adverse effects. Why are EMTs injecting Ketamine into effectively dead people at the behest of the police?

Ketamine not helping is not the same as ketamine killing. If paramedics had instead applied bandaids, those bandaids would not have helped him, but that's no reason to claim he was killed by bandaids.

On one hand, you have cops trying to pull the man's head off, starving his brain of oxygen. On the other hand, you have a sedative that is renowned for being safe, administered in a quantity that should be safe a few times over. How in the world people look at this situation and blame ketamine instead of the cops is completely beyond me.

In this case though it actually looks like he was given an overdose when considering his body weight, and he suffered the cardiac arrest enroute to the hospital, not on site. Coroner suggests drug reaction, the hold or asthma attack might have all played a role in the death.

Also the recorded audio sounds like he was pleading with the officers and compliant, not that he needed further restraint or sedation.

It sounds like this pilot is using a specific subset of workers who are being given some degree of specialized training to deal with these situations, and it sounds like you have not been given this training, is this accurate to the best of your knowledge?

We have some level of training at my level (EMT), and the paramedics I work with have more. But the stuff we're expected to cover is really broad - anything from a sexual assault victim and preserving evidence to your garden variety suicidal ideation. So given our role it's mainly geared towards identifying potential medical causes for their behavior. The best thing we can do for a patient is keep an open mind to why they're acting strangely. It could be an infection, stroke, overdose, withdrawal syndrome, postictal state after a seizure, tons of stuff.

My point is that even the best training probably won't make the tradeoff of not having law enforcement on scene worth it. Patients with the kinds of issues I listed above - they tend not to respond to being talked down. No amount of babying is going to make the person who's been high on meth and awake for 4 days straight stop seeing the shadow people.

Just wanted to say that I am absolutely astonished that "chemical restraint" with ketamine is a thing. I am confident it is not a thing where I am from (UK).

How have you people not realised that a country full of guns will generate constant escalating violence?

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