The panel was charged with determining whether CDPHE’s waiver process for ketamine administration for excited delirium and/or extreme or profound agitation provides adequate oversight and training to ensure public health and safety. The panel concludes that the concerns involving the administration of ketamine by prehospital paramedics are not related to the drug ketamine itself; rather, the concerns arise from the administration of medications, including ketamine, to chemically restrain patients in police custody who do not require ketamine as an appropriate medical necessity.
Moreover, the panel rejected the condition or diagnosis of “excited delirium” because it lends itself to discriminatory practices that result in systemic bias against communities of color, and because it lacks a uniform definition and specific, validated medical criteria. Nonetheless, the panel concluded that ketamine is an appropriate medication to manage a scene for the safety of the patient and others. Therefore, the panel recommends that CDPHE may grant waivers for ketamine as a chemical restraint in the prehospital setting when: 1) the paramedic has made a professional judgment that the patient requires immediate evaluation, 2) the patient has not responded to verbal de-escalation or any less restrictive alternative (such as physical restraint), and 3) the patient’s conduct/agitation prevents the paramedic from providing safe assessment, treatment, and transport to the hospital for necessary medical care.
The panel recommends that a standard IM dose of ketamine be used for chemical restraint based upon the patient’s stature. Specifically, a small male individual should receive 300 mg; a medium sized male should receive 400 mg; and a large male patient should receive 500 mg. Small/medium/large females should receive corresponding dosing amounts of 250/350/450 mg. Immediate patient-side cardiopulmonary monitoring should be undertaken to reduce the risk of adverse effects resulting from the medication.
Paramedics and EMS medical directors should receive necessary training on law enforcement hand-offs, verbal de-escalation, explicit/implicit bias and the appropriate use of chemical restraints. Moreover, the panel suggests that CDPHE can support the state’s EMS medical directors and providers by developing and offering training opportunities in these areas.
Finally, the panel concludes that Colorado’s current statutory and regulatory system does not provide unified, effective oversight of the statewide EMS system. A uniform regulatory framework would allow CDPHE to impose consistent regulatory standards, and to exercise predictable oversight, over all system components. The panel believes that such a framework will improve the state’s protection of the public’s health, safety and welfare, specifically for those patients who require emergency medical care and for those who provide that care.