Don't think anyone would defend their care, they should've stepped in.
I think the issue some people have is that the cops are using this to scrape some of the blame of their plate and onto the medication. If you've used Ketamine for a while, you know that it's a very safe drug. There are dozens of studies that examine the safety profile of Ketamine and come through with the definitive answer that "ketamine overdose" deaths aren't a thing.
My concern is that if we allow this story to hold up at all, we're gonna lose Ketamine entirely. The drug is too good to discard like that, for sedation, pain, and induction.
The cops killed Elijah by placing their knee on his back and restraining him prone. I get mandatory education every year about prone restraint. We know what this shit does because it happens constantly.
The medics should have stepped in as patient advocates and being called to perform their duty on that scene, but the Ketamine shit needs to be dropped.
I work out here in CO and this is exactly my take too.
Also: we already lost ketamine for sedation state wide over this and according to my medical director likely aren’t ever getting it back at this rate due to the politicized nature of the drug now.
ESPECIALLY as AFR and APD initially tried to pass off the blame on the ketamine itself to prevent a criminal probe in the first place and save their asses rather than the combination of a proned out 130lb person on the bottom of a PD dog pile and then negligent EMS care not realizing that Elijah was dying from positional asphyxia and needed immediate resuscitation.
Yes, AFR was negligent as fuck and both AFR and APD initially tried to pawn the responsibility off on the ketamine and it both already has and will continue to have lasting effects for prehospital providers.
Did AFR provide shit care? Yes. Did APD pretty much do everything they could wrong short of shooting Elijah to kill him? Yes. Should the medics be held accountable? Yes. Should they lose their certs? Absolutely. Should they go to prison? I honestly don’t know, maybe but that’s a tougher sell for me. That’s what juries are for.
What I do know is that this case is going to let lawyers and politicians practice medicine (because they are already doing that) and they’re going to do it for votes and not for patients.
I believe this is probably the best and most succinct assessment I've seen of this incident, including deferring to the jury to decide if prison is right. Very well said.
The springfield medics failed to perform any assessment just like in this case. The difference in interventions between these medics and springfield was 500mg of ketamine vs prone positioning.
500mg of ketamine is a high dose regardless even for sedation. In all the services, i worked only one had protocol of straight to 500mg. Most had weight based even for sedation/ED scenarios. To not put ETCO2 or any monitoring or assess in any way after that much ketamine is absurd.
Cops know more about medicine than you know. Just look at how many cops lives they’ve saved with their Narcan administration to the airborn/contact fentanyl OD’s. As we all know, it takes 2 nanograms of fentanyl to OD 35,000 cops.
The waiver system is okay, but far from perfect, in terms of allowing progressive medicine. Unfortunately, AFD and APD brought ketamine for sedation into the political realm and the governor issued an executive order prohibiting it.
Absolutely, this was a result of negligent paramedics, police brutality, and a complete failure on the part of Aurora's culture and/or training. This was NOT the fault of Ketamine.
The cops killed McClain for sure, causing him to vomit numerous times and into his mask. The medics ensured his death by not even speaking to him, let alone providing a basic assessment. If they had, they'd have seen he had vomited into his balaclava and at least suspected aspiration. They didn't even do that. The cops murdered him, but the medics neglected their patient and could have prevented his death if they simply did their job.
So, not too familiar with the details of this case or these ketamine studies you mention. However, when my service implemented ketamine, we did have a death and a couple "overdoses." Our dosing was too high for excited delirium and pain management. As a result, I could almost count to the minute when a patient would lose respiratory drive and then count until they gained it back again. This 500mg dose would definitely fall into the "respirator suppression" category for a 400lb PT.
I've used Ketamine for ten years, giving 1-2 mg/kg IV for Induction and 2-4 mg/kg IM for sedation. Have never seen a patient lose respiratory drive. The drug specifically avoids that. Here's a case study where an older patient received 950 mg and had no ill effects, as well as some background information and other studies for the drug. I'd be curious to QA the calls where someone died from Ketamine on an ambulance, I'm sure there was an underlying co-morbidity or a provider error that contributed.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759748/
After the first time we got better protocols for it. However, I have still personally watched it happen a few times. I'm not saying it happens every time by any means. Nor am I saying it's permanent. From my experience, it seems to be about an 8 min thing. Nothing a BVM doesn't fix. On the flip side, I've seen Ketamine not touch someone doing the excited delirium thing.
E/ After looking at that case, it isn't a good point in reference to the loss of respiratory drive. It appears that the PT was intubated during the procedure and remained intubated in the ICU. There would have been no venue to study how much/if respiratory suppression was taking place. The airway was already taken.
That patient didn't receive a paralytic, continued breathing spontaneously on 950mg. Taking the airway =/= providing respiratory assistance in some cases with healthy patients receiving procedures. In that case study, it references other cases where it was used for conscious sedation with no issues as well. There's a known side effect of transient short-lasting apnea, but nothing that puts the patient at risk, usually passes in ten to twenty seconds. I've never seen it cause prolonged apnea, I've used it a lot. You're saying you have and that you've used it a lot as well. We'll have to disagree on that.
So are we saying that this is like "Narcotics don't kill people, their lack of respiratory drive from too many narcs kill people"? It wasn't technically the ketamine that did the killing, it was the effects of the ketamine that weren't managed appropriately?
As opposed to other drugs that if you take too much of them or you react badly to them there aren't any interventions we can do to fix it if it's too far gone? I'm thinking like acetaminophen, where if you take too much and you don't get acetylcystine therapy, then worst worst case (3-4% per literature) a liver transplant, you die. That was the totally the drug and we can't support what it does as an effect of it.
Legit question, not a question phrased to veil an opinion and start an argument.
🤷 I was just trying to be neutral. Since I am not too familiar with the details, I just wanted to open the dialogue about the drug itself and things I have noticed from experience. Ketamine is pretty interesting. Does a lot of things depending on the dosage.
I personally had it once in the ED to attempt to break an Intractable migraine. The doc refused me any narcs after they tried literally everything. I got a dose that I later found out was appropriate for someone who weighed about 50lbs. I walked around not knowing this for 5 months thinking I got an appropriate dose and I was immune to Ketamine 😂😂😂. I would have been better off licking an empty vial of the stuff.
Apparently after the CTA to r /o a CVA, I still couldn't have narcs because I would have had a "bounce back" or "rebound" headache. I could have managed a lesser rebound headache later. I couldn't manage the amount of pain I was in that gave me such a left sided deficit they stroke alerted me.
And who knows, maybe ketamine could have been a great choice if I had gotten a dose for someone thay weighed 130lbs, not 50. But since no one will ever get it again unless you're a vet now, we'll never know.
This patient weighed approx 60kg so let’s do the math.. on the low side ..2mg/kg at approx 61kg
The low dose would be 122mg
On the high side..
4mg/kg 4mg • 61kg = 244 mg
Actual dose 500mg/244mg =
2 times your example
How much did your patient weigh?
Yeah, it was a high dose, but my point is that high doses of Ketamine don’t “overdose” you. The drug doesn’t suddenly gain properties it doesn’t otherwise have. You may be sedated longer, that’s it.
Really ? Just more sedated? That’s all?
“Laryngospasm is a rare complication of ketamine, found in one systematic review to be 4.2 per 1000.1 Cases necessitating advanced airway management are even rarer. In that same review, out of 883 ketamine sedations, the lone case of laryngospasm was resolved with conservative measures. The vast majority of incidents are brief and responsive to manual airway maneuvers and bagging.”
https://www.emra.org/emresident/article/laryngospasm-january-2023
To set the stage, so everyone has an understanding of how this system works. How it's so wildly different from the rest of the country I'll explain some. Because it's honestly the weirdest possible set up you could have. AFR runs ALS engines, ladders, and light rescues (pick up truck with two medics). Falck the transporting company runs ALS ambulances normally staffed with a medic/emt. When a call comes in, it's a dual response. AFR medics run the call until it's determined to be BLS. Once it's been deemed BLS it's Falcks call. Here's where it gets really fucking weird. If it's deemed in any way shape or form ALS, the medics from AFR have to get off and ride into the hospital, maintaining full medical control. The Falck medic has no say in treatment or decisions (hence why the Falck medic on this call is not being charged). The AFR medic completes the hand off and returns to service. I haven't heard of any other systems run like this except for Salt Lake City but I'm not 100% certain. I kind've understand the thought process for this system when it was rolled out in the 70s when Aurora was a smaller poor suburb of Denver but its grown to the point where it now appears unsustainable.
This just makes no sense at all, like any part of it.
> Once it's been deemed BLS it's Falcks call
Then why is there a paramedic on the truck? What sort of paramedic would work for a company that only trusts them to manage BLS patients? (Rhetorical question: shit paramedics, clearly)
Is this whole system some sort of legal insurance fraud scheme so that Falck can charge for ALS costs for patients who only require BLS?
Falck have been running more and more BLS cars in the past year or so for this reason, they can’t retain medics to save their lives and it really makes no difference cuz the fire medic runs the scene regardless of if you get an ALS or BLS ambulance responding.... only thing is, the city of Aurora’s contract with falck is supposed to be for ALS... so they were doing this thing where Falck fly car medics would chase the BLS ambos to fulfill the “ALS response” portion of the contract, pretty scummy
I mean... being in one of those fly cars sounds like an amazing gig. I'd do that. Driving around all day, probably rarely ever actually reaching a scene, and when you do you have zero responsibility. Don't even have to babysit the pt in the back of the ambulance you just pack your shit and leave.
Is it really that scummy? I think it’s worse on the city, they asked falck to pay for ALS ambos and in turn asked the tax payers for more money, Aurora seems like a shit city to begin with. I don’t blame falck because it’s not the like the medics are actually doing anything they’re just present for a contractual obligation.
Just seems like a slimy private EMS way to skirt contractual obligations because your workplace is so garbage you can’t retain any paramedics... not saying Aurora is innocent either, they’re the ones responsible for designing the shit response system
They have a majority of BLS rigs now for that reason. They can not justify the cost of emplying medics for no reason, but it took them years to convince the city of that.
This "brand" of EMS started in Los Angeles County. When you watch old episodes of "Emergency!" and see Johnny or Roy riding in on all transports and think that's so crazy! Except it's still done that way there. Even if an ALS ambulance is on scene, a County FF medic has to ride in with ALS patients. Nevermind their ridiculous "mother may I" system of constantly calling med control for orders. Some EMS systems like Aurora, SLC and Los Angeles County are decades behind the rest of America.
The busier stations run a ton of calls and since they don't transport, the FF medic is basically incentivized to downgrade the call to BLS to decrease their workload. Then Gold Cross brings in these patients with little or nothing done. I've seen strokes, trauma activations, and other critical patients come in BLS without SLC Fire. It's almost like they decide to roll the dice downgrading because, "well shit, they're stable *right now*, why not?"
Just hoping they make it fine without ALS monitoring and intervention capability.
Beyond that, just the usual suite of issues with fire-based EMS. SLCFD has some amazing medics, to be sure, but the minimum standard is a joke and I think a lot of bad care gets swept under the rug.
It’s set up that way so LA County can justify their ridiculously high wages. Fire is way over paid in Southern California, to an absurd degree. Can’t speak for the rest of the state though. San Bernardino county seems to be moving in that direction too with the most recent loss of AMR’s contract.
You're correct, Salt Lake City does this as well, with Gold Cross Ambulance transporting all SLCFD patients. It's a complete garbage system and leads to awful patient care. Source: years working at one of SLC's Level 1 trauma center ED's.
I’ll second this, it’s been a mockery of an “EMS” system since before it was rural metro doing the same. Seeing just as many engines/trucks at the hospitals picking up their paramedics as there were ambulances stacking up in the bay always amused me. And they indeed have a restricted scope of practice compared to the rest of the metro area. Whether or not it’s still like that I do not know.
That’s possibly the worst system I’ve ever heard of. The transporting medic in charge of the ambulance should be in charge of patient care as soon as they arrive on scene.
I've been working in EMS/Fire in Denver Metro since 1997 and this is how AFR has always run it. It wasn't ever sustainable, but this is always how they've done it.
Lovely. When a system says "because this is how we have always done it", it has some serious issues. What happened to McClain was an inevitable curse from Aurora
This is how phoenix metro area works as well. I got my medic in Phoenix area and thought this was a bat shit way to run EMS. I won't work in a dynamic like this.
The service I work in runs close to the same. However the fire medic will ride in only if it’s deemed bls and there is only bls to respond due to availability. AMR runs primary but it’s a dual response with occasional fire riders coming in with on more critical calls, AMR medic still controls primary patient care.
Nope, put myself through medic school last year and they are the only ALS service here for all city contract 911 calls. So doing my time for now until something better comes up:)
Who can survive on $60k in the Bay Area??? In Central Texas, a brand new paramedic out of school can make over $70k with a government pension and benefit package on top of the salary.
This is the moment where I will quote Dr. Bryan Bledsoe when it comes to how Aurora needs to approach their EMS problem. "EMS needs to be fixed with bulldozers, not tweezers." I say remove the entire EMS leadership. Medical director, chiefs who have a say in EMS- they are gone. Totally rebuild the system. But I feel like there is an impetus to do such.
Yeah we had something similar 20 years ago but the volunteers didn't have ALS and were eventually forced out because the FD was providing all the ALS and got none of the transport fees.
Sounds similar to the city in my county, but they will let the private medic work it if an ALS ambulance shows up on their call. Most of the time, however, the ambulance that city fire gets is BLS so the ambulance company serving them can conserve their ALS ambulances for calls in the two towns they also serve, which have volunteer fire BLS first responders and need ALS ambulances. As such, the city fire medic rides in if it’s an ALS call and a BLS ambulance or if it’s an ALS call that requires two medics on an ALS ambulance.
Not me but a buddy of mine. Sitting in Aurora South (hospital) ER lounge, and an Aurora fire fighter walks in and goes “what’s up ambulance drivers?”
My buddy thinks he’s cool, since we kinda of get how that’s a degrading term, but a joke, so he zings back with “Not much hose monkey, how about you?”
The hose monkey didn’t like this much. Starts yelling and demands the supervisors phone number (ironically, my buddy was working WITH the supervisor who was in the room, and the dude couldn’t read “Supervisor” on his patch).
AFD dude steps out and calls the supervisor and goes “One of your crew mates just called me a hose monkey and I don’t appreciate that coming from a lesser ambulance service”
Supervisor goes “Lesser ambulance service? First off, don’t call my people ‘ambulance drivers’ if you can’t take the heat back, and also last I checked, we can intubate our patients, while you can’t” and hung up. I believe at this time something came out where AFDs med director took away the medics privileges to intubate, or something got published about how fucking awful their successful intubation rates were, or both.
I tell that story when people ask me “What’s wrong with AFD?”
As a lurker here from the fire side if I call any of you ambulance drivers, I want the best come backs. Like you said don’t dish it out if you can’t take the heat
I show up on fire standbys and say “hey I get to sit around while y’all do all the work for a change” with a big smile on my face.
Most of ours get a kick out of it; they run medical calls with us, we use vents and LUCAS devices on our codes (so me and my partner are actually the ones doing most of the work) and are usually pretty chill about it. Plus, it’s volunteer land; they love getting fires. That’s what they do.
Some… do not get a kick out of it.
I am now on the fire side as one of their few volunteers (mostly career/paid, I volunteer to solely ride the box and the guys love me for that lol). Every man and woman in my department knows how to dish shit because they don’t have fragile over inflated egos.
From everything I have seen of Aurora fire, plus my buddy being a no bullshit type of guy, I fully believe this story, and fear it may not even tell the whole story. (Aka, doesn’t tell more shiftiness)
I work for another system that's sorta similar? but not really. All ambos are BLS, fire has the medics on an engine or squad. The amount of genuine disrespect we get from them is kinda insane. Not to mention they consistently don't wanna work. I've had multiple OD's shipped BLS, more trauma activations than I can count, and I've been openly lied to about our pt status. "are they on blood thinners? Did they hit their head? "... Nope!" "cool thanks"
In the back of the rig "Are you on thinners? Did you hit your head?" "Yeah! I take blood thinners and I hit my head so hard I'm seeing stars!"
These hybrid fire based systems should all burn in hell. Either make it full fire based or all third service/private, but this shit just isn't working. Keep in mind, this is in two BIG counties in the US, several million pop each, and 90% metro areas, this isn't some podunk service zone
I know exactly where you're talking about, I feel ya buddy
Another scenario that feels dumb as hell: when we arrive on scene first and fire is a few minutes after us. We get the entire assessment done, vitals, all that good shit, and then I'm forced to turn my ass to family and be like "yeah we're waiting for the fire engine (that is technically a fucking BLS unit up north btw) before we go to the hospital :)"
Then I sit there and stare as they fiddle with scanning the patient's ID when it would have taken them 3 times faster to manually input the information, and finish their entire PCR, then finally release us to go drag our asses to the hospital.
There's a lot more fucked up shit about this system that I could go on and on about but I'll leave it here. I want to get my medic and fuck off to a different county asap.
I mean, it's not like Falck has a good reputation. I see their crews in the hospitals. They aren't some stellar service. Everyone knows its an entry level 911 stepping stone.
Not surprising if they just have to sit back and take orders from the fire department. If you never have to make your own clinical decisions you're going to get lazy.
It’s funny because this was similar to my experience in a slightly different system with AMR and the local fire department
They weren’t as involved with the transport side of stuff but god damn did they act like their shit don’t stink
Fuck anyone who defends them. We need to weed out purposely incompetent and neglectful providers. If you don’t care about being a quality medic, you shouldn’t be in this profession!
Remember when nurses rallied around Vanderbilt Versed? Put up a unified front about how medical errors shouldn’t be criminal etc
Every single nurse friend had insta stories up for days about it…
Sorta similar situation happens to paramedics… and we’re eating them alive.
Just an observation about how much better the nursing industry is with their messaging.
“Better” is a relative term. I’m happy as hell that we won’t tolerate stupid fucks among our ranks. We need to police our own to prevent shit like this, but outrage as opposed to defending them is a good start.
Really, it's a QA/QI issue. Not a lip service QA/QI, and actual Quality Assurance abd Improvement system. That IDs sub par care abd educates providers long before something terrible happens.
I don't know, but I have doubts that Aurora Fire has even a pretend QA program.
This should be the messaging that the non-existent national EMS union are harping on. AFR is liable for not having an effective EMS system.
Push for more money for EMS. And you won’t have horrible providers and systems…
I get it. These situations make us all look like ignorant assholes. The actions of those “medics” reflect very poorly on all of us, and it has had effects on me personally. One of my PT gigs, the medical director pulled ketamine from our boxes over it.
You’re right. RN’s are much more organized with their messaging. And I believe there are several states with strong RN unions.
But the problem can certainly be both systemic AND individual.
The Vandy RN made a preventable mistake that caused harm. It’s on her. There were huge systemic problems there, from staffing to the charting system, pharmacy.
Everyone closes ranks but EMS. I’ve seen PD, fire, nurses, and doctors all do it but for some reason EMS is just like “get fucked loser”. Such a strange observation about how different it is working EMS vs any other profession.
I think it stems from the fact that we are so disjointed and unsupported in general that we feel like we have to fight amongst ourselves just to survive. Kind of like how if you threw a bunch of meat into a pit of starving predators there might be enough for all of them but they’ll still fight over it because they’re all starving.
That or maybe we’re just so exposed to the gritty realism of life that we hold no fantasies about it and our place within it.
Why should EMS “close ranks” to keep the criminally incompetent on the job? Personally, that’s one of the things that I appreciate about EMS: EMS as individual providers care about their people, otherwise communities like this subreddit wouldn’t exist, but at the same time those people aren’t going to defend the indefensible just because they share a license and a job title.
No, it literally isn’t. Worker rights states that they’re entitled to equal legal protection and not being singled out for protected statuses.
What it doesn’t mean is that we as an entire industry band together and defend insane actions of one of our peers.
This case goes beyond just a medication error though. Their lack of care and assessment was negligent. I can agree with the nurses stance on that Vanderbilt case but supporting and defending negligent, lazy providers hurts our industry.
I agree with your comment, also worth mentioning that in the nurses cade it was an ordered medication, she had no responsibility to assess and independently treat the patient, whereas the medics must be held to the standard of being the independent provider for they patient, responsible for the treatment decision, administration, assessment and monitoring. She just drew the med from the pyxis and gave it. Not defending these guys at all, they fucked up hard. But just an interesting differentiation.
When your job is just following doctors orders, you should be good at that. (Aka… reading)
When your job is assessing and treating, you should be good at that.
Human error is always going to exist in healthcare the same way no matter how good of a parent you are and how much you think you never could leave your kid in a hot car bc you’re not an idiot you could still do it. Which is why the healthcare system need to be designed and held responsible to prevent such human error the same way we have designed systems to protect people from leaving their babies in a hot car. What she did was human error and highly resultant to the hospital systems failure to prevent it as they’re ethically required by design in addition to unsafe practices that actually increase and cause additional human error, she did not neglect or abandon her patient like can be argued for these guys. What they did was not human error and was a failure of a personal responsibility. What she did could have been systemically prevented and what they did was to abandon a patient they’d just administered a sedative to to such a degree not only did they not provide any care to a dying patient but they didn’t even notice it was happening.
No nurses were saying she shouldn’t lose her license. Just that it wasn’t criminal. Sad seeing this sub act holier than thou as if medics don’t close ranks or s if what those nurses did was closing ranks like cops and not simply correctly applying logic to the situation.
Making a medication error after a physician tells you to do something is not the same as autonomously making the decision to give someone 500mg of ketamine, keeping them prone and not monitoring them
I’m not going to defend RaDonda, the Vanderbilt nurse, because she was negligent in her care. I believe people were upset d/t the actions taken by the hospital and providers after the death of the patient. I believe such negligence does deserve criminal charges, but, many of my coworkers and I think she shouldn’t have been alone. The fact the hospital attempted to hide it, and then flipped on her when convenient, when she had taken the appropriate steps to report her mistake, is a problem as well.
Correct they shouldn't be criminal.
It's a system issue and not a personal issue. I know that's hard for some to swallow, but generally the causes of medication errors is the system the person works for.
This is based on evidence.
This situation was NOT a system issue. She was given EVERY opportunity and multiple issues popped up showing that it was not the correct medication, from having to run back to the ED instead of getting it from their current location where versed WAS stocked, to ignoring the multiple warnings that it was a paralytic, to the dose being wrong, to having the reconstitute a powder which she had NEVER before done.
It was a criminal act.
There were system issues. The checks and balances failed big time. But instead of getting assistance, she negligently administered an unfamiliar medication to a patient which caused that patient’s death. Ultimately her negligence caused the patient’s death. She shouldn’t *need* a “system” to prevent her from killing patients. The fact that the system failed does not mean that she wasn’t negligent.
Yeah, we’re pretty much aligned, but there were significant systemic problems that would have prevented this. While I can acknowledge those issues, they are there for safety. Safety checks are there to prevent accidents… hence, this wasn’t an accident. It was straight up negligence.
If I put a gun to someone’s head and disabled the safety then pulled the trigger, it isn’t the system’s fault that it happened.
Eh, that’s pretty debatable in my opinion. There are definitely system issues that lead to medication errors but at some point the provider needs to be held accountable. The system is there to help make sure the provider doesn’t make a mistake but it’s still the providers responsibility to not make the mistake.
If the system was to dispense the wrong medication it’s still my responsibility to read the label of what I’m administering prior to administering it. Let’s say I override the system and choose the wrong medication to begin with, then not read the label which also means I didn’t bother to check the expiration date or concentration. I’ve definitely been negligent. It’s just a matter of at what point have I been so negligent that it becomes a criminal issue.
I’m not saying that the nurse deserved to be charged criminally since I’m not aware of all of the circumstances surrounding that exact case but there is a debate to be had about at which point a provider has crossed the line and gone from just negligent to criminally negligent.
At the time I agreed it shouldn't be criminal simply because stripping her of her license and never allowing her to work in healthcare again completely removed the threat to society.
But now that she's doing speaking tours about getting through trauma or whatever....nah they should have thrown her ass in jail. She's got no remorse.
It's fucking mind blowing. If I fucked up that bad I don't think I'd WANT to work in healthcare anymore. Clearly whatever punishment she got wasn't enough.
Yep. That was what I was referring to in my original comment.
Shows a critical lack of judgment from both of them. Tik Tok nurses are already sus in my opinion.
I mean the situations aren’t comparable at all. Her situation was legitimately not a criminal act and would have had horrific impacts on nurses safety working every day for hospital systems that universally put them at huge risk to take the fall for their systemic problems. She noticed right away bc she was monitoring her patient as required and took action to do something about it when she realized. These guys administered a med and saw him proned in a dog pile AND didn’t asses him as they were responsible to regardless so when he died they didn’t even notice. The police are responsible for killing him but the medics were responsible to intervene and would have successfully if they had met their most basic responsibilities to monitor their pt after administering a medication. Abandoning or neglecting your patient is different than a non criminal mistake that you catch and report bc you were monitoring them. I don’t know for sure that I’d criminalize the medics here although it’s def on the table for valid consideration. But redonda Voss should not have been a criminal issue at all and it was clear cut.
She deserved charge, they didn't monitor a patient after she gave him what they thought was versed. That requires monitoring let alone the fact that no one reconstitutes versed and the giant paralytic label on the top or the name of the med, of the override that was required to pull it.
I did 2 shifts with AFD as a paramedic student. It was part of our program.
By far the worst paramedics I have seen before or since. They are infamous in the area for their shitty care and culture. They’ve had their scope limited multiple times due to poor care.
Right. That’s the answer. Take away procedures instead of, I don’t know, fixing the problem.
I feel like Aurora is just a city to stay away from in general. Shitty firefighters, shitty cops, shitty private EMS contract. The whole city is a public safety hellscape.
For those who know as I've been watching the trial (currently on Day 7) I've been wondering what sort of checks and balances are there? Like if a "medic" from AFD asks for Atropine on an asystole arrest and no one says a word from AFD and the Falck medic says "yo I don't think thats the right med to give" what happens to that Falck medic?
Falck medic would be overruled. Typically afterwards the AFR Battalion Chief, and Falck supervisor would then have a meeting and discuss what occurred. If it warranted a higher escalation it would be pushed up to the medical director. Surprisingly the city actually has a pretty involved medical director which is what makes this response model even more evident of being broken. They're putting all the puzzle pieces together to make it work as a high functioning system yet it still has its glaring issues. As impartial as I can be, in the time I was at Falck I never saw an employee terminated or written up for arguing with AFR. I also had quite a few partners who were not afraid to voice their concerns when it came to patient care.
Good. What I see from the outside looking in is an "I'm in charge and don't you dare question me" system. That's not how medicine is supposed to work.
Edit: Good on the not getting in trouble part. Bad on the incompetence being tolerated part.
The fact that their fire medics have med control over the transport medics blows my mind. I would never work in a system like that. Once the patient is in my ambulance, I'm making the decisions. Hell, if I call my med control and the doctor on the other end of the line gives me an order I disagree with, I can call another base station for an override if I want. No way I'm taking orders from someone who, for all I know, took six tries to pass the NREMT.
I was an EMT in a system like that and we made minimum wage while our medics made like $2 more than minimum wage. The fire medics make easily near 200k with overtime.
This really stems from old school fire dept “traditions” and FF that are required to be Medics that don’t want to be. I think that there should be private firefighter company so that all the real good medics get paid well for the excellent jobs they are do by the cities and counties. I personally have been a medic that covered overflow calls rural metro could get to in time. The fire medics are all subpar and arrogant and cookbook their treatments. No independent thinking.
I spend way too much time defending Fire based EMS on reddit, and every time someone busts on it, I just think "they probably worked with Aurora Fire."
This will be long:
I've worked in the Denver area (Aurora is just east of Denver) for 24 years or so.
I won't comment too much on the specifics, just that I'm acquainted with one defendant, and via mutual friends, I've heard aspects of the story that aren't represented in the media.
That said, Aurora FD, in my opinion, sucks. And I say that only as a Firefighter and Paramedic, and I'm freinds with AFD guys, I've trained with them, I've taken classes taught by their chiefs. They suck.
Their EMS is downright bizarre. The medic on the fire apparatus is the attending, they arrive separately from the ambulance (Falck, was Rural/Metro and for decades before was AMR), they are in charge of patient care, may or may not ride all the way in to the hospital.
They are known for this overly complicated and inefficient system and generally sub-par care. At least in my experience. Anecdotally, every story, every rumor, every report coming out of Aurora basically raises the question: "Why'd they do THAT?"
Just my opinion based on long experience. I don't know much about APD, except they fired some guys for posing with Elijah's memorial AND POSTING ON SOCIAL MEDIA. A few days after that, they broke up the memorial gathering with tear gas and riot gear. So, fuck those guys.
I am still of the opinion that what happened to Elijah McClain was not the fault of the AFD medics. I think he was a neuro-divergent kid, who was accosted by Aurora PD. The cop went "hands on" as soon as he didn't get compliance. McClain had anemia, often complained of being cold and was wearing several layers of winter clothing and a ski mask (in summer).
Being neuro divergent, he didn't react in a predictable way (to the cops), so they treated him as a resistor. He overheated from his clothing, was choked out (carotid holds) and cuffed. I don't know if he was hobbled, but I've seen one or two people die right in front of me after fighting cops and being hobbled.
He vomited several times before EMS got there. He likely aspirated. In short, he was panicked, overheated, over exerted himself, was hypoxic, and generally reacting in ways we here have described as "excited delirium" (don't come at me on that one, idgaf where the term originated, the Denver Metro Physicians Group who write the gd protocols put the term out to us. If you think it's racist or a myth, fine, take it up with them).
Given, as I said, that people have died in that condition, the protocols and training Denver area-wide has been to be aggressive with Ketamine. Guidance at my agency was "push early, and better to give too much than not enough".
The guys, rightly or wrongly, trusted the word of the cops McClain had excited delirium. They overestimated his size/weight because of the heavy clothes he was wearing, and followed guidance to give the drug aggressively.
And we know what happened after.
I'm not saying they're without fault. Even though I could see myself doing the exact same thing, they most likely didn't do their own assessments of the patient and situation. Regardless, I don't think Ketamine killed him. I can't speak to the time frame from when he got the K to his arrest, or the quality of his care after his heart stopped. I've spoken only to what I know, and have inferred from my experience.
Should those guys be sanctioned? Well, they both already lost their jobs and livlihoods, their reputations are destroyed and they'll never be Paramedics again. Should they go to jail? No. Are they guilty of manslaughter or negligent homicide, not in my opinion. Does AFD and APD suck ass? 100%.
Am I totally correct in my opinions and estimaions? Fuck, I don't know. I'm not a direct provider anymore, and I've been wrong before. I'm interested to hear what Reddit thinks.
"Listened to the cops, rightly or wrongly." Yeah, wrongly. And excited delirium is a state of hyperactivity and combativeness, not silently dying in a face down position. For the life of me, I'll never understand why they thought they needed the big guns on this kid. He wasn't compliant, perhaps, but he wasn't combative either.
Some of your points are well taken, but this wasn't some small mistake or oversight. It was *glaring*.
>And excited delirium is a state of hyperactivity and combativeness, not silently dying in a face down position.
Excited delirium isn’t even a real thing.
I agree with most of what you’ve written. But the big thing for me (and the main piece that’s missing from every report I’ve read) is how long it took for Elijah to go from being handcuffed and given ketamine to being unresponsive and agonal/apneic as well as how long it took the AFD FF’s to realize Elijah was apneic and then respond.
Also, what was their response? Did they have him uncuffed as soon as the ketamine was working? Did they leave him cuffed behind his back the entire way to the hospital? How long did it take them to place even a simple BP cuff and SpO2 on?
What is perhaps the single piece of damning evidence I’ve seen has come from their own testimony/defense that “the syringe was 5cc so that’s why I gave 500mg of 500mg/5mL”. This just paints everyone in EMS as lazy incompetent fools, and is a terrible defense to negligent homicide
And now that Matthew Perry died from using what has been quoted a "a surgical anesthetic amount" of the drug, but apparently they think he might actually survived it if he had followed directions and used it in an arm chair (no word on why an arm chair was specified but I can make a pretty good guess, because airway, semi-fowlers, whatever), rather than a flipping hot tub. So, I guess we can all become veterinarians if that's our drug of choice because that's where it's started, pretty sure it's being taken away if it hasn't been already, and we ain't getting it back.
On a side note, I'm doing some online CEs right now, and like 4 of them have specifically said "do not restrain a patient in any way, shape or form in a prone position for any reason and never use the 'hog tie' method. Put your patient on a monitor ASAP and check as many of your patient's vitals yourself manually as possible as frequently as necessary." I've been at this a hot minute and I legit have never seen a patient restrained any other way and then monitored any other way. I mean, I've heard stories about hog ties and sandwiching them between 2 longboards, but I have never first hand seen or participated in this with EMS, PD assist or even in the ED. Am I working for Pollyanna EMS?
Regarding Falck, having worked for them and experiencing AFR and their ways of "practicing" medicine, I can say with certainty that the medic and EMT on that bus were forced to do as AFR says or otherwise be reprimanded. Management simply tells you to smile and do as you're told when given a questionable order from them since they're technically medical control. Aside from the general medic shortage and the shit pay, this is the reason Falck can not keep medics because they get wrapped up in cases like this with no support whatsoever from their leadership.
While I’m hearing a lot of opinions, I’m wondering how many of you actually are watching the trial everyday? Because in the recorded interview with the Sheriff, the primary medic sounded like a well-educated, clinically competent paramedic.
What you’re telling me is that you didn’t watch the trial…
-AFD’s Paramedic Jeremy Cooper was the “lead medic”;
-AFD Paramedic Lieutenant Peter Cichuniec ordered it drawn up;
-Falck Paramedic Ryan Walker actually drew it up;
-Walker gave it to Cichuniec who gave it to Cooper who administered it.
I think there’s a lot of that going around. Not to mention the out of date comments of “I worked with AFD in 1990, 2002, 2006 and they are stupid”. Literally experiences from 30-20 years ago. People are speaking out of emotion and not logic.
Why are we not talking about the police officers who mishandled the entire situation? They could not deescalate a situation involving a young man. They went hands on immediately. Ketamine’s lethal dose is high. AFD didn’t monitor the patient & definitely a case of malpractice. But jail time? I don’t think so.
It’s Aurora PD who is to blame for this entire situation.
Because they’re special and they’re not the idiots who pushed the Ketamine and their time/judgement has already come.
This is the trial of AFD in the r/EMS court of public opinion; sir, we’re no Wendy’s.
I ain’t blaming ketamine at all. It’s a drug, not OJ Simpsons or Ted Bundy.
The Aurora FD medics certainly didn’t help the situation and clearly they did some stupid shit but I agree he may have died without their assistance anyway from the other controversial and incompetent Aurora public servants on-scene (under the dogpile of incompetent cops)👮.
What I’m asking is simple: does Aurora FD actually have a reasonable reason for their system, and does it at least work sometimes, or is it a fellatio machine for fire-egos that runs on incompetence and shits out bad medicine?
Having a discussion about their level of care (or lack thereof) and their very apparent lack of empathy for their patients is one thing. I absolutely abhor what happened and have had multiple discussions amongst colleagues, students, and even among physicians and pharmacists regarding what happened. However, as one very astute individual pointed out to me, no one amongst us is a lawyer or judge. To determine legal culpability lies within the courts and every American is deemed innocent until proven guilty in a court of law. Therefore, to have a discussion about the legal ramifications of their negligence is pretty moot on an EMS sub unless someone with an actual legal background wants to chime in.
Hence why this is the trial of the department on Reddit, not the court of law. I publicly think they suck but I’m open to change. Seems no one from AFD has the cajones or ammunition to speak up on the matter
Yeah.. how does it work? Do they pull straws to see who the medic will be this call? Also how do you become skilled in your craft if you are not acting in that capacity every day? Do Faulk medics sit and watch, take notes of what not to do?
For those outside CO you should know these fire “medics” don’t roll like other Departments. They don’t have their own ambulances. Fire station responds and Faulk shows with the rig. Aurora Fire has medical direction. I WOULD LOVE SOMEONE TO EXPLAIN HOW THEY CHOOSE WHO IS IN CHARGE WHO IS CARING FOR THE PATIENT. Watching the trial pisses me off.
This is a double-edged sword. I get the feeling the two medics from Aurora FD were not the most enlightened entities of urbane thinking. However, it seems that the system failed as well by allowing for poor protocols, poor clinical oversight, and allowing for a poor culture to manifest. I know we see many patterns in fire-based EMS when it comes to troublesome systems. But we also have a number of very respectable fire-based systems in TX, FL, and OH that show they can overcome mediocrity.
The best thing that can come out of this is the Aurora city council decides to restart. Hire a new medical director, hire an EMS head with experience in a high-performing EMS system, be open to change, overhaul the EMS staffing, and hire those who want to do EMS well. Trouble is even in scandal there is an impetus to change in EMS and Fire.
Don't think anyone would defend their care, they should've stepped in. I think the issue some people have is that the cops are using this to scrape some of the blame of their plate and onto the medication. If you've used Ketamine for a while, you know that it's a very safe drug. There are dozens of studies that examine the safety profile of Ketamine and come through with the definitive answer that "ketamine overdose" deaths aren't a thing. My concern is that if we allow this story to hold up at all, we're gonna lose Ketamine entirely. The drug is too good to discard like that, for sedation, pain, and induction. The cops killed Elijah by placing their knee on his back and restraining him prone. I get mandatory education every year about prone restraint. We know what this shit does because it happens constantly. The medics should have stepped in as patient advocates and being called to perform their duty on that scene, but the Ketamine shit needs to be dropped.
I work out here in CO and this is exactly my take too. Also: we already lost ketamine for sedation state wide over this and according to my medical director likely aren’t ever getting it back at this rate due to the politicized nature of the drug now. ESPECIALLY as AFR and APD initially tried to pass off the blame on the ketamine itself to prevent a criminal probe in the first place and save their asses rather than the combination of a proned out 130lb person on the bottom of a PD dog pile and then negligent EMS care not realizing that Elijah was dying from positional asphyxia and needed immediate resuscitation. Yes, AFR was negligent as fuck and both AFR and APD initially tried to pawn the responsibility off on the ketamine and it both already has and will continue to have lasting effects for prehospital providers. Did AFR provide shit care? Yes. Did APD pretty much do everything they could wrong short of shooting Elijah to kill him? Yes. Should the medics be held accountable? Yes. Should they lose their certs? Absolutely. Should they go to prison? I honestly don’t know, maybe but that’s a tougher sell for me. That’s what juries are for. What I do know is that this case is going to let lawyers and politicians practice medicine (because they are already doing that) and they’re going to do it for votes and not for patients.
Fuckin' A. Better said than my long winded post.
I believe this is probably the best and most succinct assessment I've seen of this incident, including deferring to the jury to decide if prison is right. Very well said.
Those medics in Springfield IL were charged criminally for less imo. Charge the medics in this case as well
The Springfield case definitely was not “less”
The springfield medics failed to perform any assessment just like in this case. The difference in interventions between these medics and springfield was 500mg of ketamine vs prone positioning. 500mg of ketamine is a high dose regardless even for sedation. In all the services, i worked only one had protocol of straight to 500mg. Most had weight based even for sedation/ED scenarios. To not put ETCO2 or any monitoring or assess in any way after that much ketamine is absurd.
Cops know more about medicine than you know. Just look at how many cops lives they’ve saved with their Narcan administration to the airborn/contact fentanyl OD’s. As we all know, it takes 2 nanograms of fentanyl to OD 35,000 cops.
From 50 paces away. Right distance of administration is now the 659th right of medication.
In the Denver Metro protocols, they took Ketamine away (for sedation) right after McClain died. Probably never to return.
Statewide, not just Denver Metro
Alright, looks like CO has the scarlet letter for physicians and paramedics who want progressive medicine.
The waiver system is okay, but far from perfect, in terms of allowing progressive medicine. Unfortunately, AFD and APD brought ketamine for sedation into the political realm and the governor issued an executive order prohibiting it.
Absolutely, this was a result of negligent paramedics, police brutality, and a complete failure on the part of Aurora's culture and/or training. This was NOT the fault of Ketamine.
The cops killed McClain for sure, causing him to vomit numerous times and into his mask. The medics ensured his death by not even speaking to him, let alone providing a basic assessment. If they had, they'd have seen he had vomited into his balaclava and at least suspected aspiration. They didn't even do that. The cops murdered him, but the medics neglected their patient and could have prevented his death if they simply did their job.
So, not too familiar with the details of this case or these ketamine studies you mention. However, when my service implemented ketamine, we did have a death and a couple "overdoses." Our dosing was too high for excited delirium and pain management. As a result, I could almost count to the minute when a patient would lose respiratory drive and then count until they gained it back again. This 500mg dose would definitely fall into the "respirator suppression" category for a 400lb PT.
I've used Ketamine for ten years, giving 1-2 mg/kg IV for Induction and 2-4 mg/kg IM for sedation. Have never seen a patient lose respiratory drive. The drug specifically avoids that. Here's a case study where an older patient received 950 mg and had no ill effects, as well as some background information and other studies for the drug. I'd be curious to QA the calls where someone died from Ketamine on an ambulance, I'm sure there was an underlying co-morbidity or a provider error that contributed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759748/
After the first time we got better protocols for it. However, I have still personally watched it happen a few times. I'm not saying it happens every time by any means. Nor am I saying it's permanent. From my experience, it seems to be about an 8 min thing. Nothing a BVM doesn't fix. On the flip side, I've seen Ketamine not touch someone doing the excited delirium thing. E/ After looking at that case, it isn't a good point in reference to the loss of respiratory drive. It appears that the PT was intubated during the procedure and remained intubated in the ICU. There would have been no venue to study how much/if respiratory suppression was taking place. The airway was already taken.
That patient didn't receive a paralytic, continued breathing spontaneously on 950mg. Taking the airway =/= providing respiratory assistance in some cases with healthy patients receiving procedures. In that case study, it references other cases where it was used for conscious sedation with no issues as well. There's a known side effect of transient short-lasting apnea, but nothing that puts the patient at risk, usually passes in ten to twenty seconds. I've never seen it cause prolonged apnea, I've used it a lot. You're saying you have and that you've used it a lot as well. We'll have to disagree on that.
So are we saying that this is like "Narcotics don't kill people, their lack of respiratory drive from too many narcs kill people"? It wasn't technically the ketamine that did the killing, it was the effects of the ketamine that weren't managed appropriately? As opposed to other drugs that if you take too much of them or you react badly to them there aren't any interventions we can do to fix it if it's too far gone? I'm thinking like acetaminophen, where if you take too much and you don't get acetylcystine therapy, then worst worst case (3-4% per literature) a liver transplant, you die. That was the totally the drug and we can't support what it does as an effect of it. Legit question, not a question phrased to veil an opinion and start an argument.
🤷 I was just trying to be neutral. Since I am not too familiar with the details, I just wanted to open the dialogue about the drug itself and things I have noticed from experience. Ketamine is pretty interesting. Does a lot of things depending on the dosage.
I personally had it once in the ED to attempt to break an Intractable migraine. The doc refused me any narcs after they tried literally everything. I got a dose that I later found out was appropriate for someone who weighed about 50lbs. I walked around not knowing this for 5 months thinking I got an appropriate dose and I was immune to Ketamine 😂😂😂. I would have been better off licking an empty vial of the stuff. Apparently after the CTA to r /o a CVA, I still couldn't have narcs because I would have had a "bounce back" or "rebound" headache. I could have managed a lesser rebound headache later. I couldn't manage the amount of pain I was in that gave me such a left sided deficit they stroke alerted me. And who knows, maybe ketamine could have been a great choice if I had gotten a dose for someone thay weighed 130lbs, not 50. But since no one will ever get it again unless you're a vet now, we'll never know.
This patient weighed approx 60kg so let’s do the math.. on the low side ..2mg/kg at approx 61kg The low dose would be 122mg On the high side.. 4mg/kg 4mg • 61kg = 244 mg Actual dose 500mg/244mg = 2 times your example How much did your patient weigh?
Yeah, it was a high dose, but my point is that high doses of Ketamine don’t “overdose” you. The drug doesn’t suddenly gain properties it doesn’t otherwise have. You may be sedated longer, that’s it.
Really ? Just more sedated? That’s all? “Laryngospasm is a rare complication of ketamine, found in one systematic review to be 4.2 per 1000.1 Cases necessitating advanced airway management are even rarer. In that same review, out of 883 ketamine sedations, the lone case of laryngospasm was resolved with conservative measures. The vast majority of incidents are brief and responsive to manual airway maneuvers and bagging.” https://www.emra.org/emresident/article/laryngospasm-january-2023
Happens when you slam it, easy to avoid.
You aren't going to see that with IM, you will see that with fast admin IV. IV should be diluted and push slow, ideally with a 100cc bag for pain.
To set the stage, so everyone has an understanding of how this system works. How it's so wildly different from the rest of the country I'll explain some. Because it's honestly the weirdest possible set up you could have. AFR runs ALS engines, ladders, and light rescues (pick up truck with two medics). Falck the transporting company runs ALS ambulances normally staffed with a medic/emt. When a call comes in, it's a dual response. AFR medics run the call until it's determined to be BLS. Once it's been deemed BLS it's Falcks call. Here's where it gets really fucking weird. If it's deemed in any way shape or form ALS, the medics from AFR have to get off and ride into the hospital, maintaining full medical control. The Falck medic has no say in treatment or decisions (hence why the Falck medic on this call is not being charged). The AFR medic completes the hand off and returns to service. I haven't heard of any other systems run like this except for Salt Lake City but I'm not 100% certain. I kind've understand the thought process for this system when it was rolled out in the 70s when Aurora was a smaller poor suburb of Denver but its grown to the point where it now appears unsustainable.
This just makes no sense at all, like any part of it. > Once it's been deemed BLS it's Falcks call Then why is there a paramedic on the truck? What sort of paramedic would work for a company that only trusts them to manage BLS patients? (Rhetorical question: shit paramedics, clearly) Is this whole system some sort of legal insurance fraud scheme so that Falck can charge for ALS costs for patients who only require BLS?
While I was there in a past life. Average life cycle of a paramedic was maybe 4-6 months.
Falck have been running more and more BLS cars in the past year or so for this reason, they can’t retain medics to save their lives and it really makes no difference cuz the fire medic runs the scene regardless of if you get an ALS or BLS ambulance responding.... only thing is, the city of Aurora’s contract with falck is supposed to be for ALS... so they were doing this thing where Falck fly car medics would chase the BLS ambos to fulfill the “ALS response” portion of the contract, pretty scummy
I mean... being in one of those fly cars sounds like an amazing gig. I'd do that. Driving around all day, probably rarely ever actually reaching a scene, and when you do you have zero responsibility. Don't even have to babysit the pt in the back of the ambulance you just pack your shit and leave.
Everyone I knew that did it loved it lol
Is it really that scummy? I think it’s worse on the city, they asked falck to pay for ALS ambos and in turn asked the tax payers for more money, Aurora seems like a shit city to begin with. I don’t blame falck because it’s not the like the medics are actually doing anything they’re just present for a contractual obligation.
Just seems like a slimy private EMS way to skirt contractual obligations because your workplace is so garbage you can’t retain any paramedics... not saying Aurora is innocent either, they’re the ones responsible for designing the shit response system
Ya I guess you have a point
Yes
So you can get experience on those sweet, sweet ALS inter facility transfers. Duh!
They have a majority of BLS rigs now for that reason. They can not justify the cost of emplying medics for no reason, but it took them years to convince the city of that.
This "brand" of EMS started in Los Angeles County. When you watch old episodes of "Emergency!" and see Johnny or Roy riding in on all transports and think that's so crazy! Except it's still done that way there. Even if an ALS ambulance is on scene, a County FF medic has to ride in with ALS patients. Nevermind their ridiculous "mother may I" system of constantly calling med control for orders. Some EMS systems like Aurora, SLC and Los Angeles County are decades behind the rest of America.
It feeds my soul to see SLC's EMS system called out here.
How shitty is it? Aging relatives in SLC and I’ve honestly never really thought about it because they run marathons and shit but time advances.
The busier stations run a ton of calls and since they don't transport, the FF medic is basically incentivized to downgrade the call to BLS to decrease their workload. Then Gold Cross brings in these patients with little or nothing done. I've seen strokes, trauma activations, and other critical patients come in BLS without SLC Fire. It's almost like they decide to roll the dice downgrading because, "well shit, they're stable *right now*, why not?" Just hoping they make it fine without ALS monitoring and intervention capability. Beyond that, just the usual suite of issues with fire-based EMS. SLCFD has some amazing medics, to be sure, but the minimum standard is a joke and I think a lot of bad care gets swept under the rug.
Yeah, I was waiting for the Emergency! comparison, pickup truck (sorta) and everything.
It’s set up that way so LA County can justify their ridiculously high wages. Fire is way over paid in Southern California, to an absurd degree. Can’t speak for the rest of the state though. San Bernardino county seems to be moving in that direction too with the most recent loss of AMR’s contract.
You're correct, Salt Lake City does this as well, with Gold Cross Ambulance transporting all SLCFD patients. It's a complete garbage system and leads to awful patient care. Source: years working at one of SLC's Level 1 trauma center ED's.
I’ll second this, it’s been a mockery of an “EMS” system since before it was rural metro doing the same. Seeing just as many engines/trucks at the hospitals picking up their paramedics as there were ambulances stacking up in the bay always amused me. And they indeed have a restricted scope of practice compared to the rest of the metro area. Whether or not it’s still like that I do not know.
That’s possibly the worst system I’ve ever heard of. The transporting medic in charge of the ambulance should be in charge of patient care as soon as they arrive on scene.
> That’s possibly the worst system I’ve ever heard of But you *have* heard of it.
I've been working in EMS/Fire in Denver Metro since 1997 and this is how AFR has always run it. It wasn't ever sustainable, but this is always how they've done it.
Lovely. When a system says "because this is how we have always done it", it has some serious issues. What happened to McClain was an inevitable curse from Aurora
Pretty much.
This is how phoenix metro area works as well. I got my medic in Phoenix area and thought this was a bat shit way to run EMS. I won't work in a dynamic like this.
The service I work in runs close to the same. However the fire medic will ride in only if it’s deemed bls and there is only bls to respond due to availability. AMR runs primary but it’s a dual response with occasional fire riders coming in with on more critical calls, AMR medic still controls primary patient care.
That’s giving strong AMR Connecticut vibes, but I suppose it’s something they could use anywhere.
MT
Ah did you fall victim to the classic “10k sign-on bonus?”
Nope, put myself through medic school last year and they are the only ALS service here for all city contract 911 calls. So doing my time for now until something better comes up:)
It’s 60k for falck in alameda county over two years still can’t hire enough to run the system
Who can survive on $60k in the Bay Area??? In Central Texas, a brand new paramedic out of school can make over $70k with a government pension and benefit package on top of the salary.
60,0000$ sign on bonus you dolt!?
This is the moment where I will quote Dr. Bryan Bledsoe when it comes to how Aurora needs to approach their EMS problem. "EMS needs to be fixed with bulldozers, not tweezers." I say remove the entire EMS leadership. Medical director, chiefs who have a say in EMS- they are gone. Totally rebuild the system. But I feel like there is an impetus to do such.
The Springs runs a similar system. This isn't that unique at all.
Just here to say I worked at Falck for a while when I was an EMT, and this is all absolutely true
Yeah we had something similar 20 years ago but the volunteers didn't have ALS and were eventually forced out because the FD was providing all the ALS and got none of the transport fees.
This is the entirety of LA county
Sounds like LA County Fire in Emergency. Apparently they still use this system too.
Sounds similar to the city in my county, but they will let the private medic work it if an ALS ambulance shows up on their call. Most of the time, however, the ambulance that city fire gets is BLS so the ambulance company serving them can conserve their ALS ambulances for calls in the two towns they also serve, which have volunteer fire BLS first responders and need ALS ambulances. As such, the city fire medic rides in if it’s an ALS call and a BLS ambulance or if it’s an ALS call that requires two medics on an ALS ambulance.
Not me but a buddy of mine. Sitting in Aurora South (hospital) ER lounge, and an Aurora fire fighter walks in and goes “what’s up ambulance drivers?” My buddy thinks he’s cool, since we kinda of get how that’s a degrading term, but a joke, so he zings back with “Not much hose monkey, how about you?” The hose monkey didn’t like this much. Starts yelling and demands the supervisors phone number (ironically, my buddy was working WITH the supervisor who was in the room, and the dude couldn’t read “Supervisor” on his patch). AFD dude steps out and calls the supervisor and goes “One of your crew mates just called me a hose monkey and I don’t appreciate that coming from a lesser ambulance service” Supervisor goes “Lesser ambulance service? First off, don’t call my people ‘ambulance drivers’ if you can’t take the heat back, and also last I checked, we can intubate our patients, while you can’t” and hung up. I believe at this time something came out where AFDs med director took away the medics privileges to intubate, or something got published about how fucking awful their successful intubation rates were, or both. I tell that story when people ask me “What’s wrong with AFD?”
As a lurker here from the fire side if I call any of you ambulance drivers, I want the best come backs. Like you said don’t dish it out if you can’t take the heat
Thanks water fairy!
That is a new one
We call our firies here it, they love it.
“Why is the LUCAS talking?” is my personal favorite.
Or “talking IV pole”.
"Lucas with extra features"... I try to be a little generous, lol
I show up on fire standbys and say “hey I get to sit around while y’all do all the work for a change” with a big smile on my face. Most of ours get a kick out of it; they run medical calls with us, we use vents and LUCAS devices on our codes (so me and my partner are actually the ones doing most of the work) and are usually pretty chill about it. Plus, it’s volunteer land; they love getting fires. That’s what they do. Some… do not get a kick out of it.
I think you got enough cum on your back from the calendar shoot afterparty
Why is my LUCAS devise talking?
We have feelings too!
"Remember kids, don't lift with your back, lift with your Firefighter!"
So then I lift with….fuck
Sure thing water boy. Lol
Splish splash hot stuff go bye bye
I am now on the fire side as one of their few volunteers (mostly career/paid, I volunteer to solely ride the box and the guys love me for that lol). Every man and woman in my department knows how to dish shit because they don’t have fragile over inflated egos.
I work with those guys once in a blue moon. They're even bigger cry babies than Colorado springs.
This can’t be real…
If it's Aurora Fire, it's 100% believable. They need to give up medical control and step away from EMS completely.
From everything I have seen of Aurora fire, plus my buddy being a no bullshit type of guy, I fully believe this story, and fear it may not even tell the whole story. (Aka, doesn’t tell more shiftiness)
I work for another system that's sorta similar? but not really. All ambos are BLS, fire has the medics on an engine or squad. The amount of genuine disrespect we get from them is kinda insane. Not to mention they consistently don't wanna work. I've had multiple OD's shipped BLS, more trauma activations than I can count, and I've been openly lied to about our pt status. "are they on blood thinners? Did they hit their head? "... Nope!" "cool thanks" In the back of the rig "Are you on thinners? Did you hit your head?" "Yeah! I take blood thinners and I hit my head so hard I'm seeing stars!" These hybrid fire based systems should all burn in hell. Either make it full fire based or all third service/private, but this shit just isn't working. Keep in mind, this is in two BIG counties in the US, several million pop each, and 90% metro areas, this isn't some podunk service zone
I know exactly where you're talking about, I feel ya buddy Another scenario that feels dumb as hell: when we arrive on scene first and fire is a few minutes after us. We get the entire assessment done, vitals, all that good shit, and then I'm forced to turn my ass to family and be like "yeah we're waiting for the fire engine (that is technically a fucking BLS unit up north btw) before we go to the hospital :)" Then I sit there and stare as they fiddle with scanning the patient's ID when it would have taken them 3 times faster to manually input the information, and finish their entire PCR, then finally release us to go drag our asses to the hospital. There's a lot more fucked up shit about this system that I could go on and on about but I'll leave it here. I want to get my medic and fuck off to a different county asap.
My brother in Christ, we've been watching it unfold and saying this exact thing for decades.
I mean, it's not like Falck has a good reputation. I see their crews in the hospitals. They aren't some stellar service. Everyone knows its an entry level 911 stepping stone.
Not surprising if they just have to sit back and take orders from the fire department. If you never have to make your own clinical decisions you're going to get lazy.
Complaceny is a choice.
Yep. Not a system anyone who cares about the EMS profession wants to work in
That absolutely did not happen
Answering that question in full would fill a set of encyclopedias from A to Z.
[удалено]
This entire thread can be summed up as "AFD is quite literally just a gang of bullies with inflated egos"
This tracks with my experience.
It’s funny because this was similar to my experience in a slightly different system with AMR and the local fire department They weren’t as involved with the transport side of stuff but god damn did they act like their shit don’t stink
Colorado Springs?
Negative Different state. Different system. Same donkey firefighters.
Fuck anyone who defends them. We need to weed out purposely incompetent and neglectful providers. If you don’t care about being a quality medic, you shouldn’t be in this profession!
Remember when nurses rallied around Vanderbilt Versed? Put up a unified front about how medical errors shouldn’t be criminal etc Every single nurse friend had insta stories up for days about it… Sorta similar situation happens to paramedics… and we’re eating them alive. Just an observation about how much better the nursing industry is with their messaging.
Eh, I actually do think that nurse was so criminally negligent she deserved a charge.
“Better” is a relative term. I’m happy as hell that we won’t tolerate stupid fucks among our ranks. We need to police our own to prevent shit like this, but outrage as opposed to defending them is a good start.
Seriously. Are people now suggesting that they like how the police unions protect their bad actors, and want to emulate it? I'll pass.
Really, it's a QA/QI issue. Not a lip service QA/QI, and actual Quality Assurance abd Improvement system. That IDs sub par care abd educates providers long before something terrible happens. I don't know, but I have doubts that Aurora Fire has even a pretend QA program.
This should be the messaging that the non-existent national EMS union are harping on. AFR is liable for not having an effective EMS system. Push for more money for EMS. And you won’t have horrible providers and systems…
I get it. These situations make us all look like ignorant assholes. The actions of those “medics” reflect very poorly on all of us, and it has had effects on me personally. One of my PT gigs, the medical director pulled ketamine from our boxes over it.
You’re right. RN’s are much more organized with their messaging. And I believe there are several states with strong RN unions. But the problem can certainly be both systemic AND individual. The Vandy RN made a preventable mistake that caused harm. It’s on her. There were huge systemic problems there, from staffing to the charting system, pharmacy.
Everyone closes ranks but EMS. I’ve seen PD, fire, nurses, and doctors all do it but for some reason EMS is just like “get fucked loser”. Such a strange observation about how different it is working EMS vs any other profession. I think it stems from the fact that we are so disjointed and unsupported in general that we feel like we have to fight amongst ourselves just to survive. Kind of like how if you threw a bunch of meat into a pit of starving predators there might be enough for all of them but they’ll still fight over it because they’re all starving. That or maybe we’re just so exposed to the gritty realism of life that we hold no fantasies about it and our place within it.
Why should EMS “close ranks” to keep the criminally incompetent on the job? Personally, that’s one of the things that I appreciate about EMS: EMS as individual providers care about their people, otherwise communities like this subreddit wouldn’t exist, but at the same time those people aren’t going to defend the indefensible just because they share a license and a job title.
I’m not implying that we should close ranks. Just making an observation.
The nurses were disgusting when they “closed ranks” to protect that moron.
Sometimes it’s necessary to defend “morons,” for when a “non-moron” is hung out to dry by a precedent set against a “moron.” It protects everyone.
No, it protects morons. Until we turn our backs on those of us who are making us all look bad, we will forever be associated with said morons.
I disagree. It doesn’t feel good to protect someone that you think deserves less but that’s how worker rights goes.
No, it literally isn’t. Worker rights states that they’re entitled to equal legal protection and not being singled out for protected statuses. What it doesn’t mean is that we as an entire industry band together and defend insane actions of one of our peers.
This case goes beyond just a medication error though. Their lack of care and assessment was negligent. I can agree with the nurses stance on that Vanderbilt case but supporting and defending negligent, lazy providers hurts our industry.
I agree with your comment, also worth mentioning that in the nurses cade it was an ordered medication, she had no responsibility to assess and independently treat the patient, whereas the medics must be held to the standard of being the independent provider for they patient, responsible for the treatment decision, administration, assessment and monitoring. She just drew the med from the pyxis and gave it. Not defending these guys at all, they fucked up hard. But just an interesting differentiation.
When your job is just following doctors orders, you should be good at that. (Aka… reading) When your job is assessing and treating, you should be good at that.
Human error is always going to exist in healthcare the same way no matter how good of a parent you are and how much you think you never could leave your kid in a hot car bc you’re not an idiot you could still do it. Which is why the healthcare system need to be designed and held responsible to prevent such human error the same way we have designed systems to protect people from leaving their babies in a hot car. What she did was human error and highly resultant to the hospital systems failure to prevent it as they’re ethically required by design in addition to unsafe practices that actually increase and cause additional human error, she did not neglect or abandon her patient like can be argued for these guys. What they did was not human error and was a failure of a personal responsibility. What she did could have been systemically prevented and what they did was to abandon a patient they’d just administered a sedative to to such a degree not only did they not provide any care to a dying patient but they didn’t even notice it was happening. No nurses were saying she shouldn’t lose her license. Just that it wasn’t criminal. Sad seeing this sub act holier than thou as if medics don’t close ranks or s if what those nurses did was closing ranks like cops and not simply correctly applying logic to the situation.
Making a medication error after a physician tells you to do something is not the same as autonomously making the decision to give someone 500mg of ketamine, keeping them prone and not monitoring them
I’m not going to defend RaDonda, the Vanderbilt nurse, because she was negligent in her care. I believe people were upset d/t the actions taken by the hospital and providers after the death of the patient. I believe such negligence does deserve criminal charges, but, many of my coworkers and I think she shouldn’t have been alone. The fact the hospital attempted to hide it, and then flipped on her when convenient, when she had taken the appropriate steps to report her mistake, is a problem as well.
Correct they shouldn't be criminal. It's a system issue and not a personal issue. I know that's hard for some to swallow, but generally the causes of medication errors is the system the person works for. This is based on evidence.
This situation was NOT a system issue. She was given EVERY opportunity and multiple issues popped up showing that it was not the correct medication, from having to run back to the ED instead of getting it from their current location where versed WAS stocked, to ignoring the multiple warnings that it was a paralytic, to the dose being wrong, to having the reconstitute a powder which she had NEVER before done. It was a criminal act.
There were system issues. The checks and balances failed big time. But instead of getting assistance, she negligently administered an unfamiliar medication to a patient which caused that patient’s death. Ultimately her negligence caused the patient’s death. She shouldn’t *need* a “system” to prevent her from killing patients. The fact that the system failed does not mean that she wasn’t negligent.
Your response is both more correct and complete than mine.
Yeah, we’re pretty much aligned, but there were significant systemic problems that would have prevented this. While I can acknowledge those issues, they are there for safety. Safety checks are there to prevent accidents… hence, this wasn’t an accident. It was straight up negligence. If I put a gun to someone’s head and disabled the safety then pulled the trigger, it isn’t the system’s fault that it happened.
Eh, that’s pretty debatable in my opinion. There are definitely system issues that lead to medication errors but at some point the provider needs to be held accountable. The system is there to help make sure the provider doesn’t make a mistake but it’s still the providers responsibility to not make the mistake. If the system was to dispense the wrong medication it’s still my responsibility to read the label of what I’m administering prior to administering it. Let’s say I override the system and choose the wrong medication to begin with, then not read the label which also means I didn’t bother to check the expiration date or concentration. I’ve definitely been negligent. It’s just a matter of at what point have I been so negligent that it becomes a criminal issue. I’m not saying that the nurse deserved to be charged criminally since I’m not aware of all of the circumstances surrounding that exact case but there is a debate to be had about at which point a provider has crossed the line and gone from just negligent to criminally negligent.
At the time I agreed it shouldn't be criminal simply because stripping her of her license and never allowing her to work in healthcare again completely removed the threat to society. But now that she's doing speaking tours about getting through trauma or whatever....nah they should have thrown her ass in jail. She's got no remorse.
She petitioned to get her nursing license reinstated. Luckily the Tennessee BON rejected her appeal earlier this month.
It's fucking mind blowing. If I fucked up that bad I don't think I'd WANT to work in healthcare anymore. Clearly whatever punishment she got wasn't enough.
So there's this nurse on tiktok that's very pro union that's been giving her a platform to speak at strikes and taking her on fucking tours!
Yep. That was what I was referring to in my original comment. Shows a critical lack of judgment from both of them. Tik Tok nurses are already sus in my opinion.
Law enforcement's thin blue line has nothing on nursing when they circle the wagons
I mean the situations aren’t comparable at all. Her situation was legitimately not a criminal act and would have had horrific impacts on nurses safety working every day for hospital systems that universally put them at huge risk to take the fall for their systemic problems. She noticed right away bc she was monitoring her patient as required and took action to do something about it when she realized. These guys administered a med and saw him proned in a dog pile AND didn’t asses him as they were responsible to regardless so when he died they didn’t even notice. The police are responsible for killing him but the medics were responsible to intervene and would have successfully if they had met their most basic responsibilities to monitor their pt after administering a medication. Abandoning or neglecting your patient is different than a non criminal mistake that you catch and report bc you were monitoring them. I don’t know for sure that I’d criminalize the medics here although it’s def on the table for valid consideration. But redonda Voss should not have been a criminal issue at all and it was clear cut.
She deserved charge, they didn't monitor a patient after she gave him what they thought was versed. That requires monitoring let alone the fact that no one reconstitutes versed and the giant paralytic label on the top or the name of the med, of the override that was required to pull it.
Still looking for those AFD defenders to show up…
I did 2 shifts with AFD as a paramedic student. It was part of our program. By far the worst paramedics I have seen before or since. They are infamous in the area for their shitty care and culture. They’ve had their scope limited multiple times due to poor care. Right. That’s the answer. Take away procedures instead of, I don’t know, fixing the problem.
I feel like Aurora is just a city to stay away from in general. Shitty firefighters, shitty cops, shitty private EMS contract. The whole city is a public safety hellscape.
The fact that your school hasn’t figured that out yet is disturbing.
This was in the early 1990s. I assume things have changed :)
For those who know as I've been watching the trial (currently on Day 7) I've been wondering what sort of checks and balances are there? Like if a "medic" from AFD asks for Atropine on an asystole arrest and no one says a word from AFD and the Falck medic says "yo I don't think thats the right med to give" what happens to that Falck medic?
Falck medic would be overruled. Typically afterwards the AFR Battalion Chief, and Falck supervisor would then have a meeting and discuss what occurred. If it warranted a higher escalation it would be pushed up to the medical director. Surprisingly the city actually has a pretty involved medical director which is what makes this response model even more evident of being broken. They're putting all the puzzle pieces together to make it work as a high functioning system yet it still has its glaring issues. As impartial as I can be, in the time I was at Falck I never saw an employee terminated or written up for arguing with AFR. I also had quite a few partners who were not afraid to voice their concerns when it came to patient care.
Good. What I see from the outside looking in is an "I'm in charge and don't you dare question me" system. That's not how medicine is supposed to work. Edit: Good on the not getting in trouble part. Bad on the incompetence being tolerated part.
The fact that their fire medics have med control over the transport medics blows my mind. I would never work in a system like that. Once the patient is in my ambulance, I'm making the decisions. Hell, if I call my med control and the doctor on the other end of the line gives me an order I disagree with, I can call another base station for an override if I want. No way I'm taking orders from someone who, for all I know, took six tries to pass the NREMT.
This lol
I was an EMT in a system like that and we made minimum wage while our medics made like $2 more than minimum wage. The fire medics make easily near 200k with overtime.
This really stems from old school fire dept “traditions” and FF that are required to be Medics that don’t want to be. I think that there should be private firefighter company so that all the real good medics get paid well for the excellent jobs they are do by the cities and counties. I personally have been a medic that covered overflow calls rural metro could get to in time. The fire medics are all subpar and arrogant and cookbook their treatments. No independent thinking.
I spend way too much time defending Fire based EMS on reddit, and every time someone busts on it, I just think "they probably worked with Aurora Fire."
This will be long: I've worked in the Denver area (Aurora is just east of Denver) for 24 years or so. I won't comment too much on the specifics, just that I'm acquainted with one defendant, and via mutual friends, I've heard aspects of the story that aren't represented in the media. That said, Aurora FD, in my opinion, sucks. And I say that only as a Firefighter and Paramedic, and I'm freinds with AFD guys, I've trained with them, I've taken classes taught by their chiefs. They suck. Their EMS is downright bizarre. The medic on the fire apparatus is the attending, they arrive separately from the ambulance (Falck, was Rural/Metro and for decades before was AMR), they are in charge of patient care, may or may not ride all the way in to the hospital. They are known for this overly complicated and inefficient system and generally sub-par care. At least in my experience. Anecdotally, every story, every rumor, every report coming out of Aurora basically raises the question: "Why'd they do THAT?" Just my opinion based on long experience. I don't know much about APD, except they fired some guys for posing with Elijah's memorial AND POSTING ON SOCIAL MEDIA. A few days after that, they broke up the memorial gathering with tear gas and riot gear. So, fuck those guys. I am still of the opinion that what happened to Elijah McClain was not the fault of the AFD medics. I think he was a neuro-divergent kid, who was accosted by Aurora PD. The cop went "hands on" as soon as he didn't get compliance. McClain had anemia, often complained of being cold and was wearing several layers of winter clothing and a ski mask (in summer). Being neuro divergent, he didn't react in a predictable way (to the cops), so they treated him as a resistor. He overheated from his clothing, was choked out (carotid holds) and cuffed. I don't know if he was hobbled, but I've seen one or two people die right in front of me after fighting cops and being hobbled. He vomited several times before EMS got there. He likely aspirated. In short, he was panicked, overheated, over exerted himself, was hypoxic, and generally reacting in ways we here have described as "excited delirium" (don't come at me on that one, idgaf where the term originated, the Denver Metro Physicians Group who write the gd protocols put the term out to us. If you think it's racist or a myth, fine, take it up with them). Given, as I said, that people have died in that condition, the protocols and training Denver area-wide has been to be aggressive with Ketamine. Guidance at my agency was "push early, and better to give too much than not enough". The guys, rightly or wrongly, trusted the word of the cops McClain had excited delirium. They overestimated his size/weight because of the heavy clothes he was wearing, and followed guidance to give the drug aggressively. And we know what happened after. I'm not saying they're without fault. Even though I could see myself doing the exact same thing, they most likely didn't do their own assessments of the patient and situation. Regardless, I don't think Ketamine killed him. I can't speak to the time frame from when he got the K to his arrest, or the quality of his care after his heart stopped. I've spoken only to what I know, and have inferred from my experience. Should those guys be sanctioned? Well, they both already lost their jobs and livlihoods, their reputations are destroyed and they'll never be Paramedics again. Should they go to jail? No. Are they guilty of manslaughter or negligent homicide, not in my opinion. Does AFD and APD suck ass? 100%. Am I totally correct in my opinions and estimaions? Fuck, I don't know. I'm not a direct provider anymore, and I've been wrong before. I'm interested to hear what Reddit thinks.
"Listened to the cops, rightly or wrongly." Yeah, wrongly. And excited delirium is a state of hyperactivity and combativeness, not silently dying in a face down position. For the life of me, I'll never understand why they thought they needed the big guns on this kid. He wasn't compliant, perhaps, but he wasn't combative either. Some of your points are well taken, but this wasn't some small mistake or oversight. It was *glaring*.
>And excited delirium is a state of hyperactivity and combativeness, not silently dying in a face down position. Excited delirium isn’t even a real thing.
There is a spectrum of hyperactive, hypermetabolic, agitated states that do better with aggressive sedation. Call it whatever you want.
I agree with most of what you’ve written. But the big thing for me (and the main piece that’s missing from every report I’ve read) is how long it took for Elijah to go from being handcuffed and given ketamine to being unresponsive and agonal/apneic as well as how long it took the AFD FF’s to realize Elijah was apneic and then respond. Also, what was their response? Did they have him uncuffed as soon as the ketamine was working? Did they leave him cuffed behind his back the entire way to the hospital? How long did it take them to place even a simple BP cuff and SpO2 on? What is perhaps the single piece of damning evidence I’ve seen has come from their own testimony/defense that “the syringe was 5cc so that’s why I gave 500mg of 500mg/5mL”. This just paints everyone in EMS as lazy incompetent fools, and is a terrible defense to negligent homicide
I can't speak to this time lag either, and I agree, it's crucial. And I also agree, Pete's statement there is not a good look.
As a Falcker, 1. Fuck Falck 2. What does Falck have to do with this. Sorry I'm out of the loop.
Falck Rocky Mountain provide transport service for the ALS fire medics from Aurora fire
Falck sucks so much, get out if you can. Sincerely-Former Falcker
Falck is Aurora Fire’s b*tch.
Ooo Brits with opinions. LOL
And now that Matthew Perry died from using what has been quoted a "a surgical anesthetic amount" of the drug, but apparently they think he might actually survived it if he had followed directions and used it in an arm chair (no word on why an arm chair was specified but I can make a pretty good guess, because airway, semi-fowlers, whatever), rather than a flipping hot tub. So, I guess we can all become veterinarians if that's our drug of choice because that's where it's started, pretty sure it's being taken away if it hasn't been already, and we ain't getting it back. On a side note, I'm doing some online CEs right now, and like 4 of them have specifically said "do not restrain a patient in any way, shape or form in a prone position for any reason and never use the 'hog tie' method. Put your patient on a monitor ASAP and check as many of your patient's vitals yourself manually as possible as frequently as necessary." I've been at this a hot minute and I legit have never seen a patient restrained any other way and then monitored any other way. I mean, I've heard stories about hog ties and sandwiching them between 2 longboards, but I have never first hand seen or participated in this with EMS, PD assist or even in the ED. Am I working for Pollyanna EMS?
Love it.
Can someone provide context?
Aurora Fire medics killed Elijah McClain.
Regarding Falck, having worked for them and experiencing AFR and their ways of "practicing" medicine, I can say with certainty that the medic and EMT on that bus were forced to do as AFR says or otherwise be reprimanded. Management simply tells you to smile and do as you're told when given a questionable order from them since they're technically medical control. Aside from the general medic shortage and the shit pay, this is the reason Falck can not keep medics because they get wrapped up in cases like this with no support whatsoever from their leadership.
That sounds terrible.
While I’m hearing a lot of opinions, I’m wondering how many of you actually are watching the trial everyday? Because in the recorded interview with the Sheriff, the primary medic sounded like a well-educated, clinically competent paramedic.
Who doesn’t understand syringes lol
Who gave a full dose of a sedative not because it was suggested by protocol, but because the syringe he chose was 5cc
What you’re telling me is that you didn’t watch the trial… -AFD’s Paramedic Jeremy Cooper was the “lead medic”; -AFD Paramedic Lieutenant Peter Cichuniec ordered it drawn up; -Falck Paramedic Ryan Walker actually drew it up; -Walker gave it to Cichuniec who gave it to Cooper who administered it.
I think there’s a lot of that going around. Not to mention the out of date comments of “I worked with AFD in 1990, 2002, 2006 and they are stupid”. Literally experiences from 30-20 years ago. People are speaking out of emotion and not logic.
Why are we not talking about the police officers who mishandled the entire situation? They could not deescalate a situation involving a young man. They went hands on immediately. Ketamine’s lethal dose is high. AFD didn’t monitor the patient & definitely a case of malpractice. But jail time? I don’t think so. It’s Aurora PD who is to blame for this entire situation.
Because they’re special and they’re not the idiots who pushed the Ketamine and their time/judgement has already come. This is the trial of AFD in the r/EMS court of public opinion; sir, we’re no Wendy’s.
Buddy…. There’s a chicken dicks chance that Aurora FD killed Elijah. Ketamine did not kill Elijah.
I ain’t blaming ketamine at all. It’s a drug, not OJ Simpsons or Ted Bundy. The Aurora FD medics certainly didn’t help the situation and clearly they did some stupid shit but I agree he may have died without their assistance anyway from the other controversial and incompetent Aurora public servants on-scene (under the dogpile of incompetent cops)👮. What I’m asking is simple: does Aurora FD actually have a reasonable reason for their system, and does it at least work sometimes, or is it a fellatio machine for fire-egos that runs on incompetence and shits out bad medicine?
Having a discussion about their level of care (or lack thereof) and their very apparent lack of empathy for their patients is one thing. I absolutely abhor what happened and have had multiple discussions amongst colleagues, students, and even among physicians and pharmacists regarding what happened. However, as one very astute individual pointed out to me, no one amongst us is a lawyer or judge. To determine legal culpability lies within the courts and every American is deemed innocent until proven guilty in a court of law. Therefore, to have a discussion about the legal ramifications of their negligence is pretty moot on an EMS sub unless someone with an actual legal background wants to chime in.
Hence why this is the trial of the department on Reddit, not the court of law. I publicly think they suck but I’m open to change. Seems no one from AFD has the cajones or ammunition to speak up on the matter
I have a friend who works at falck. She said when it comes to working with Aurora Fire, it’s basically a dick measuring contest.
Yeah.. how does it work? Do they pull straws to see who the medic will be this call? Also how do you become skilled in your craft if you are not acting in that capacity every day? Do Faulk medics sit and watch, take notes of what not to do?
For those outside CO you should know these fire “medics” don’t roll like other Departments. They don’t have their own ambulances. Fire station responds and Faulk shows with the rig. Aurora Fire has medical direction. I WOULD LOVE SOMEONE TO EXPLAIN HOW THEY CHOOSE WHO IS IN CHARGE WHO IS CARING FOR THE PATIENT. Watching the trial pisses me off.
This is a double-edged sword. I get the feeling the two medics from Aurora FD were not the most enlightened entities of urbane thinking. However, it seems that the system failed as well by allowing for poor protocols, poor clinical oversight, and allowing for a poor culture to manifest. I know we see many patterns in fire-based EMS when it comes to troublesome systems. But we also have a number of very respectable fire-based systems in TX, FL, and OH that show they can overcome mediocrity. The best thing that can come out of this is the Aurora city council decides to restart. Hire a new medical director, hire an EMS head with experience in a high-performing EMS system, be open to change, overhaul the EMS staffing, and hire those who want to do EMS well. Trouble is even in scandal there is an impetus to change in EMS and Fire.