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Minneapolis Police: Uses dangerous drug to sedate criminals

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Minneapolis has some creative people. Too creative for their own good. Somebody probably saw that the guys who take down large animals with tranquilizer darts use darts filled with ketamine. “Hey, if it will take down those animals, why don’t we use it on the animals our police are fighting?” And an immensely stupid program began. It was also illegal, but if we’re controlling bad guys, who cares?

Time for disclosure. I am a doctor. I do not play one on TV. Not only that, I’m an anesthesiologist and used ketamine in my practice. For certain things, it has no equal. But its proper uses are quite limited.

Ketamine comes from a class of drugs called phencyclidines. The street version is known as Angel Dust, and abusers are Dusters. Because ketamine causes profound analgesia (pain relief), Dusters are known for feats of superhuman strength. Broken handcuffs are just one relatively well-known example. At the same time, Dusters may break their own bones. The analgesic effect of ketamine keeps them from realizing the damage they are doing to themselves.

By now, it should be pretty clear that ketamine is no panacea for the problem of sedating troublesome persons being arrested. At the wrong dose in the wrong person, police can put themselves in worse difficulties than when they started. How do you control someone who feels no pain and wants to cause you harm? Flashback to the villain Renard in The World is Not Enough. He is almost impossible to defeat in a fight because he feels no pain. But I guess the Minneapolis wise guys don’t watch James Bond films.

I have to wonder if the police bothered to look at any references. Even Wikipedia would have been helpful. If they had, they’d discover that there are a lot of other problems with ketamine. The first one should have given them a real headache. The primary reason we don’t use ketamine a lot in anesthesia is that it has a high incidence of emergence delirium. In language even an inattentive civil servant can understand, that means that if you give someone ketamine, they can hallucinate. This happens often enough that we try to avoid ketamine except in those odd cases where its other effects make it the best drug available. Just to make a bad problem worse, there are a lot of times when there isn’t anything you can do to stop the delirium. Welcome to hell.

We’ve only scratched the surface. Since Minneapolis police officers obviously consulted Dr. Conrad Murray, we should expect that they got the same level of advice Michael Jackson got. That means that they missed the fact that ketamine can lead to airway obstruction and death. It releases adrenaline, so it can cause hypertension and tachycardia leading to death. Did I mention that it can kill you? And, unlike opioids, you can give all the naloxone you want and it won’t do a bit of good.

But the Minneapolis police officers are really interested in saving lives, so we can let them use this drug they simply don’t understand on patients who aren’t consenting and may suffer badly from its administration. No problem.

The track record is as bad as I suggested up front. Ketamine administration has led to multiple episodes of cardiac and breathing problems, with many patients requiring emergency intubation. Now for a skilled health care provider, intubation is generally no big deal. But you never deliberately put yourself in a position where you create an uncontrolled need for intubation. The moment you do that, you’ll find yourself looking at the impossible situation. With somewhere around fifty thousand intubations under my belt, the next one can still be the one where I have to call a partner in to give it a try. My practice had over eighty anesthesiologists and two hundred nurse anesthetists, so there was usually another set of hands available. But who is the paramedic in the field going to call? Ghostbusters has an unlisted number.

Let’s get one thing clear. Minneapolis police officers did not have a hand on the syringe. They asked the Hennepin County paramedics to administer ketamine. And if a cop asks, how is a paramedic supposed to refuse? But the paramedics are supposed to operate according to a strict protocol, and only give ketamine when a patient is “profoundly agitated, unable to be restrained, or a danger to themselves or others.” It’s clear that this guideline was violated on multiple occasions.

And this brings us to the nub of the matter. Ketamine is properly used only in the sort of situation described in the protocol. In anesthesia, we will also use it in autistic or severely mentally retarded patients who cannot be managed by breathing them to sleep with gases. In short, we mostly use it in the controlled medical equivalent of the field situation.

It’s likely that Dr. Jeffrey Ho (the director of Hennepin County EMS who happened to graduate from the same medical school I did!) is actually well aware of the proper use of ketamine. He’s a recognized expert in pre-hospital emergency care. And if ketamine is used in the very restricted fashion the policy describes, it’s probably better than most alternatives. But when police decide that they want a set of chemical handcuffs rather than doing their job, we have a problem.

Police work can be difficult and dangerous. But police are not allowed to place people in danger just to make their own life easier. Doing so exceeds the bounds of our social contract with police, and also violates a host of laws. For a paramedic to go along with such an improper request places that paramedic in violation of state laws on the practice of medicine. Their drivers’ license isn’t enough. You follow the protocol or get permission from the supervising ER doc by calling it in.

Hennepin County and the city of Minneapolis have a problem on their hands. Their best bet will be to quietly approach persons who were harmed by this cavalier misuse of ketamine and buy out their legal liability. Then the EMS and police persons involved should be invited to leave. Promptly. Do not pass Go. Do not collect $200.

Ted Noel MD is a Board Certified Anesthesiologist with 36 years of experience. He produces a video blog on current political subjects weekly at www.VidZette.com.

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