Versed injection as a police weapon

[Math Is Hard]

NASHVILLE, Tenn. -- While the Metro police had banned the use of Tasers for a time, they still used a controversial method to subdue unruly people, according to an I-Team report.

The city's policy to use the method, which calls for the injection of a drug into a person, came as a "total surprise" to people most would expect to know all about it.

For almost two years, Metro police have had the option of calling for a needle loaded with a strong sedative to control the most unruly people they encounter on the street.

One of the doctors who came up with the protocol said it's the safest option out there and that it is used all over the country.

But many people said that the injection was news to them, and a top medical ethicist said it's a troubling precedent.

The drug is called Midazolam, which is better known as Versed. People who have had a colonoscopy have probably had a shot of the drug for the procedure.

"The drug has an amnesia effect, and we use that therapeutically because one of the nice ways to take care of the discomfort is to make people forget that they've had it," said biomedical ethics and law enforcement expert Dr. Steven Miles.

http://www.wsmv.com/news/16844880/detail.html

It surprised me to read about this. I wonder if Nashville is the only city where this is done.

 

[Moonbear]

Wow, I've never heard such a thing before either. I'd be very concerned about shooting up people with drugs...you never know what adverse effects it might have. And, when it's an amnesic, it leaves you wondering about things like forced confessions the person won't remember later.

 

[turbo]

Wow, I've never heard such a thing before either. I'd be very concerned about shooting up people with drugs...you never know what adverse effects it might have. And, when it's an amnesic, it leaves you wondering about things like forced confessions the person won't remember later.

Really! The dumb b*tch that administered the drugs ahead of my colonoscopy said things like "OK, here comes the sleepy medicine..." and I wanted to slap the condescending idiot. By the time the procedure was over, I might have kissed her as I was waking up, if she had asked nicely.

 

[LowlyPion]

Wow, I've never heard such a thing before either. I'd be very concerned about shooting up people with drugs...you never know what adverse effects it might have. And, when it's an amnesic, it leaves you wondering about things like forced confessions the person won't remember later.

What troubles me is the guy that advocates its use and calls himself a biomedical ethicist. Personally I'd say its a violation of personal rights to inject any medication willy nilly like that absent consent. Not to mention the potential for wrongful death or consequential liability incurred by any adverse reaction or heaven forbid the transmission of aids to a defendant or even a police officer from a defendant coming out of some general brouhaha. in which a used needle inadvertently punctured another person.

The drug salesman must have gotten a sweet bonus though for the sale.

 

[Evo]

It says

Slovis said the shots are given as a medical treatment, not a police function, even though ultimately they aid in an arrest.<snip>

"The decision to administer Versed is based purely on a paramedic decision, not a police decision," Slovis said.

It's up to the officer to call an ambulance and determine if a person is in a condition called excited delirium.

"I don't know if I would use the word diagnosing, but they are assessing the situation and saying, 'This person is not acting rationally. This is something I've been trained to recognize, this seems like excited delirium.' I don't view delirium in the field as a police function. It is a medical emergency. We're giving the drug Versed that's routinely used in thousands of health care settings across the country in the field by trained paramedics. I view what we're doing as the best possible medical practice to a medical emergency," Slovis said.

So it's not the police giving the injection. The police are calling paramedics and asking them to assess the individual and make the call.

They are recognizing the difference between someone just violent that needs to be thrown in the slammer and needs to be arrested and someone with a medical/mental condition.

The guy in the article that was treated was not charged by the police because they treated it as a medical issue instead.

Kalodimos reported that Beasley ended up at Metro General Hospital and was then put in psychiatric care. He was not charged in the incident on the bridge.

Personally, if I was flipping out, I would rather be treated by EMTs and given a sedative rather than be handcuffed and then thrown into a jail cell, especially if I was mentally incapactitated at the time. Medical care would by far be my preference.

 

[edward]

Holy cow versed has interactions with a lot of other drugs, including alcohol.

http://sleep.emedtv.com/versed/versed-drug-interactions.html

 

[Evo]

Holy cow versed has interactions with a lot of other drugs, including alcohol.

http://sleep.emedtv.com/versed/versed-drug-interactions.html

Edward, please find a drug that doesn't have interactions or side effects.

Most of my medications can't be taken with alcohol, two of them list "sudden death" as a side effect and an antibiotic I took once listed "sudden death" if taken with alcohol!

I guess "sudden death" is preferable to "slow death" though.

 

[LowlyPion]

Personally, if I was flipping out, I would rather be treated by EMTs and given a sedative rather than be handcuffed and then thrown into a jail cell, especially if I was mentally incapactitated at the time. Medical care would by far be my preference.

So we'll take this then as your medical release to be injected involuntarily if necessary, at the diagnosis and sole discretion of someone who is not a trained medical physician?

 

[Evo]

So we'll take this then as your medical release to be injected involuntarily if necessary, at the diagnosis and sole discretion of someone who is not a trained medical physician?

Uhm, they "ARE" trained EMT's. Did you not read the article? The police are merely calling an ambulance and letting the EMT's take over. "THAT" is the change in the police policy. Police are now recognizing that some people may be having medical problems and calling for medical help instead of throwing the person into a jail cell. OY!

 

[TheStatutoryApe]

So we'll take this then as your medical release to be injected involuntarily if necessary, at the diagnosis and sole discretion of someone who is not a trained medical physician?

So I suppose you would prefer being forcibly restrained and hogtied if ever you have a mental break and let the cops just hope you don't injure yourself?

I've heard about this before and I don't find it all that suprizing or unethical. I wonder how many times police departments were sued for allowing a prisoner to inflict serious harm upon themselves before they were allowed this option.

Something similar, yet more unethical in my opinion, that I have learned about California law recently is that it is illegal to refuse a test of your blood alcohol content if pulled over by the police. If you refuse they arrest you, take you in, forcibly strap you down, and take your blood. Then, since you refused, you get to go to jail regardless of the outcome of the test.

 

[tribdog]

I guess "sudden death" is preferable to "slow death" though.

the hell it is. give me a long slow death every time. about 100 years or so should be just about slow enough for me

 

[Moonbear]

Uhm, they "ARE" trained EMT's. Did you not read the article? The police are merely calling an ambulance and letting the EMT's take over. "THAT" is the change in the police policy. Police are now recognizing that some people may be having medical problems and calling for medical help instead of throwing the person into a jail cell. OY!

EMTs and paramedics aren't the same thing.

Regardless, using something like Versed in the field without a full medical evaluation is NOT good medicine. Paramedics are not diagnosticians, they are just there to get someone to the hospital for evaluation, and if the medication they are giving in the field could complicate the case or would hinder diagnosis (wait until it wears off before a proper psychiatric evaluation can be done, when you don't even know if it's the right drug for that patient), then it is NOT an ethical medical practice. Paramedics and physicians are not in the job of law enforcement. If they can hold someone still enough to give them an i.v. injection (that's how Versed is given), then they can hold them still enough to put restraints on them and transport them to the hospital for proper evaluation.

The really disturbing and concerning things in the story are parts like this:

"I woke up -- I don't know how much time had passed -- with a sergeant standing over me telling me to sign here. I didn't know what I was signing Ms. (Channel 4 I-Team reporter Demetria) Kalodimos. I just signed a piece of paper and was immediately right back out," he said.

This is probably the real reason this guy was never charged...they realized they wouldn't have a snowball's chance in hell of getting a court to consider evidence when they had someone signing forms without awareness of what they were signing. When someone is treated with Versed, they can look perfectly awake and aware, be capable of signing forms, giving confessions, etc., but really still be quite loopy and then never remember a bit of what happened while they were under the influence. If for some reason it's determined a person requires a shot of a narcotic out in the field, from the moment the injection is given, they should be treated as a patient with medical rights and under medical care and completely separated from police...no having police handing them forms to sign or trying to conduct interviews.

This is another concerning part:

Kalodimos reported that while doing research for this report, she found a post on a paramedics Internet chat site that said, "One good thing about Versed is that the patient won't remember how he got that footprint on his chest."

What if the reaction is an overreaction, and excessive force is being used? You've just rendered the person incapable of testifying against the officers. They damn well better be videotaping every moment of this if they have left someone unable to defend themself.

And, it's being used in situations contraindicated by the medication inserts, in other words, for off-label, non-FDA-approved uses. A physician can make that decision to prescribe a medication for off-label use, but will also be legally liable for malpractice if it turns out to be a bad decision. A paramedic should NOT be departing from SOPs for treatment...they are not trained to the level of making those sorts of diagnoses or judgement calls. If they need to depart from approved drug uses, it should ONLY be in consultation with a physician.

 

[Evo]

In agreement with all you say, and perhaps a milder sedative would be more appropriate, I don't know what their reason for choosing Versed was. Do they need to sedate or completely knock the person out?

It's not ideal, but then, trying to take down a violent crazy person without them harming themselves or others never is. I would have to know more about exactly what the situation was before I could pass judgement. I could see this guy filing a lawsuit if they had thrown him in jail when he needed medical treatment.

I just know that of the two options, being mentally incapacitated and thrown in jail or being sedated and taken to the ER, I would choose the latter.

I would assume that Versed is only given in extreme cases, like the one mentioned in this article. Perhaps Berkeman can give us his perspective since he is an EMT?

 

[Topher925]

Whats wrong with tasers? Its better than getting shot isn't it? Mase is still good too, why do police have to be so nice to criminals?

 

[tribdog]

because they are humans

 

[robertm]

Whats wrong with tasers? Its better than getting shot isn't it? Mase is still good too, why do police have to be so nice to criminals?

With enough adrenaline, meth, or speed in the blood stream; mace, bean bag shots, and even tasers are completely useless. You should never underestimate what people are capable of in a drasticly altered state of mind.

 

[tribdog]

In agreement with all you say, and perhaps a milder sedative would be more appropriate, I don't know what their reason for choosing Versed was. Do they need to sedate or completely knock the person out?

It's not ideal, but then, trying to take down a violent crazy person without them harming themselves or others never is. I would have to know more about exactly what the situation was before I could pass judgement. I could see this guy filing a lawsuit if they had thrown him in jail when he needed medical treatment.

I just know that of the two options, being mentally incapacitated and thrown in jail or being sedated and taken to the ER, I would choose the latter.

I would assume that Versed is only given in extreme cases, like the one mentioned in this article. Perhaps Berkeman can give us his perspective since he is an EMT?

but how does this stuff help take down a violent crazy person? If it has to be given in an IV then they have already got the guy taken down. It's pretty difficult to get an IV in if the guy is jumping around like a mad man

 

[NeoDevin]

Load it into darts?

 

[LowlyPion]

Uhm, they "ARE" trained EMT's. Did you not read the article? The police are merely calling an ambulance and letting the EMT's take over. "THAT" is the change in the police policy. Police are now recognizing that some people may be having medical problems and calling for medical help instead of throwing the person into a jail cell. OY!

Sure I read the article. And it's a slippery slope you're playing on. You're citing an anecdotal about one case where one individual was seen to be in medical distress and they may or may not have been treated in a medically satisfactory way.

But what you lay bare and seem satisfied to deploy is a tool - the administration of drugs in the field - at the discretion of police and relatively untrained EMTs or paramedics - a system that relies on indeterminately trained individuals and the opportunity for abuse and misuse is far greater than immediate benefit.

How do you weigh a loss of life or reduction to vegetative state against the convenience of placing an individual under control with less effort? And if you think that judgment won't be made in the field then I think you have an idealized view of people placed in such positions.

How do you weigh the Hippocratic Oath against the convenience of momentary control? Just what is best for a patient? And who is to make that judgment? I see it as a very slippery slope, and hence I am quite surprised that the doctor quoted, would be so blithe about its use and so ready to call himself a biomedical ethicist.

 

[LowlyPion]

With enough adrenaline, meth, or speed in the blood stream; mace, bean bag shots, and even tasers are completely useless. You should never underestimate what people are capable of in a drasticly altered state of mind.

And so into an indeterminate pharmaceutical cocktail already swirling in the blood stream, you are going to add another narcotic?

Into the maelstrom of a physical struggle you are going to ask someone to inject a dose?

There are too many things that can go wrong that far outweigh the things that can go right.

 

[berkeman]

I would assume that Versed is only given in extreme cases, like the one mentioned in this article. Perhaps Berkeman can give us his perspective since he is an EMT?

This is the first I've heard of it, and no, it's not part of the national protocols. Local jurisdictions have the ability to add or subtract from the national protocols, under the authority of their Medical Director for the jurisdiction (it's by county here in California).

EMTs generally do not give injections or start IVs, under the national protocol. There are some situations where we can, but those don't apply to the OP situation. Paramedics can give injections and start IVs, when the medication is indicated and five other criteria are met. I have no idea how they get around the contraindication considerations of giving this drug in Tenn. My impression is that this is an isolated experiment by their Medical Director, probably in cooperation with the chief of police in that jurisdiction. IMO, it's doubtful that it will ever make it into the national protocols.

And as others have said, if you can hold the person down steady enough for me or anybody else to start an IV or give an IV injection, you sure as heck can hook them up and hobble them so they are not a danger to themselves or others, without having to drug them.

 

[Evo]

Thanks Berkeman, going back it seems they ARE paramedics and not EMT's, so that would make the difference.

It is a medical emergency. We're giving the drug Versed that's routinely used in thousands of health care settings across the country in the field by trained paramedics. I view what we're doing as the best possible medical practice to a medical emergency," Slovis said.

"We're very careful in Nashville," Slovis said. "Every instance of Versed use is reviewed by the both medical director, myself, our head of EMS quality assurance. We make sure that our paramedics treat patients right."

 

[LowlyPion]

Thanks Berkeman, going back it seems they ARE paramedics and not EMT's, so that would make the difference.

Except of course that the process seems a bit flawed. Such reviews are retrospective. Is there a convening of a medical board and involvement of a doctor when the decision is made to inject- prior to actual injection? Is there any review of the patients medication history, or blood analysis as to what drugs may already be on board in his blood stream? As to what best practice for his situation may be as far as suitability, tolerance and advisability?

Of course such information is unavailable and silly to consider having time to collect or convene in exigent situations, but without it how are these "trained paramedics" able to render snap informed decisions that, if not yet, can easily become more of convenience for police officers than would be beneficial to the health of the individual?

 

[turbo]

The retrospective nature of the reviews bothers me, too. How long will the retrospective reviews continue? Until a recipient of the drug dies of cardiovascular collapse or of some other fatal interaction with some other drugs that the recipient has in their systems? Then, it's oops!

Versed has a long list of anti-psychotic medicines with which it interacts. If a person is having a psychotic episode, and has a load of any of these drugs in their system, how is the paramedic to know about it? How is the paramedic to know how powerful a drug-drug interaction might be, and if the effects might not be linear (additive/subtractive) but synergistic? If you can restrain a psychotic person well enough to inject him/her, you can certainly apply restraints, and transport that person to a place where observation and evaluation is possible. Making snap decisions about tranquilizing somebody (even with a medically-trained person involved) is a bad idea.

http://sleep.emedtv.com/versed/versed-drug-interactions.html

 

[robertm]

And so into an indeterminate pharmaceutical cocktail already swirling in the blood stream, you are going to add another narcotic?

I didn't condone the policy. I think that it is ridicules and completely unnecessary.

 

[tribdog]

I suppose you wouldn't have to worry about possible side effects or interactions if this stuff was being used instead of shooting the suspect, which has for sure side effects.
I want to know how one guy can say every metropolitan area in the country except for two cities are using this stuff. And the other guy says no other city in the country uses it. one of these people is flat out lying and there's not much wiggle room.

 

[LowlyPion]

Unfortunately I think this is one of those things that when they work out OK, seem to be suitable to use in further circumstances.

All it takes is one unexpected - oops - we didn't know or we wouldn't have episodes - but for the individual wronged it will be too late. The bell will be rung and it can't be unrung.

Why wait for a punitive action to reverse what can easily be prevented in the first instance, and irreparable harm can be avoided?

This clearly meets the test of negligence as to knowing or should have known, by virtue of the fact that such adverse reactions are possible, and even likely in a situation that does not permit adequate evaluation of contra-indications. Where contra-indications would be neither obvious nor available through proper disclosure.

 

[LowlyPion]

I want to know how one guy can say every metropolitan area in the country except for two cities are using this stuff.

I thought this was only in Memphis? I guess I better carry my medical records with me the next time I plan on going on a berserk binge.

Maybe wear a Versed Allergic tee shirt?

 

[turbo]

Maybe wear a Versed Allergic tee shirt?

Probably a good idea. The cops are going to have to restrain you before they can read your Versed Allergic Med-Alert bracelet or pendant.

 

[mgb_phys]

Maybe wear a Versed Allergic tee shirt?

These are now required on the London underground
http://shop.cafepress.com/design/8068153

 

[HallsofIvy]

So we'll take this then as your medical release to be injected involuntarily if necessary, at the diagnosis and sole discretion of someone who is not a trained medical physician?

Uhm, they "ARE" trained EMT's. Did you not read the article? The police are merely calling an ambulance and letting the EMT's take over. "THAT" is the change in the police policy. Police are now recognizing that some people may be having medical problems and calling for medical help instead of throwing the person into a jail cell. OY!

Evo, I tend to be with you but in fairness to LowlyPion, he did say "physician" not "EMT".

 

[LowlyPion]

These are now required on the London underground

In the US the sign would merely serve as a target that might as well read "Shoot Here".

 

[Moonbear]

Thanks Berkeman, going back it seems they ARE paramedics and not EMT's, so that would make the difference.

Not enough of a difference for me. Versed is given in controlled clinical settings normally, where there is resuscitation equipment available in the event of overdose (while paramedics have this equipment, it sure isn't make a situation better to need to use it in the field...resuscitation equipment is meant to stabilize an unstable patient, not to fix the mistakes of paramedics). Before one is administered Versed in a clinical setting, one would answer a lengthy questionnaire to assess any contraindications including both health conditions and other medications, sign a consent form for treatment, and have trained medical professionals with resuscitation equipment present in the event of an adverse reaction. Giving a drug of that class to someone in the field without knowing any history could very easily be a death sentence. They're trying to tout it as safer than physical restraint, but to administer it, they need to physically restrain the suspect...and the physical restraint to get someone hogtied in handcuffs or 4-point restraints to a guerney would be far less than to hold someone still enough to get an IV into them. Versed is administered IV, which is NOT easy to give to a even a squirming person let alone someone outright fighting and resisting arrest. If they can be restrained and need medical care, they can be strapped to a guerney and transported to a hospital where a medical team can evaluate what treatment is needed.

Just because they've been lucky so far and not killed anyone or caused birth defects when giving it to a pregnant woman doesn't mean it's safe or should continue to be used, or should ever have been used.

 

[Evo]

I'm not necessarily pro Versed use, as I mentioned before, is it really necessary to knock the person out or simply sedate them? I am all for the recognition that a person with a serious mental problem should be sent to the hospital and treated as a mental patient and not as a criminal and dumped in the county jail.

 

[Math Is Hard]

I was given Versed for sedation when I had my wisdom teeth surgery. They checked my weight and blood pressure a few days before and I had to fill out lots of questionnaires about my medical history and any meds I might be taking. I was restricted from eating after midnight the night before, and before I went under they hooked me up to machines to monitor my heart rate and blood pressure. It just seems like Versed isn't something to mess around with.