In defense of #HCMC ‘s Ketamine study and possibly protocol for potentially violent and violent patients…
IMPORTANT DISCLAIMERS: My normal disclaimers do NOT apply as far as my NOT being a clinically trained medical and mental health professional or NOT being trained in law enforcement and/or public safety, as this blog addresses the safety threats to first responders and healthcare professionals locally, but this is a dialogue that above study in first link, that addresses on a national level, the threat that healthcare workers are up against with patients who are ALREADY in an acute facility for evaluation and treatment when in mental and/or medical crisis or combination there of or that first responders are potentially in danger, when responding to a crisis call.
I have in NUMEROUS blogs, advocated for patients rights, in this case though, as in a few other blogs that I’ve written, the patients that I’m advocating for ARE the first responders and healthcare providers that are in danger when verbal de-escalation techniques may not be the most effective, which can not only jeopardize a patient in who is in medical and mental health crisis, but the first responders and healthcare providers who are trying to stabilize them.
There are already local and national activists who advocate for verbal de-escalation, I don’t agree and I think someone who isn’t a peer as a first responder or healthcare worker needs to advocate for safety of people who work in these professions.
If this is a topic as a patient, that could be triggering, please do not read.
About 8 months ago, I blogged about a less than ideal encounter at Hennepin Healthcare’s emergency department, from the perspective of a patient, where I felt that I had been unfairly labeled and was also given prescription high strength ibuprofen that I never filled, as a patient who had a gastrointestinal bleed history and NSAIDs are an AWFUL treatment option for me.
The rare 4 times I’ve been in the emergency department at that facility and ONLY at that facility in the last 5 years in their emergency department as a patient, truthfully before seeing above 2nd link or similar stories last year , when either in the waiting room or when roomed and waiting for care, truthfully, I had wondered why some very aggressive patients wandering around had NOT been sedated.
Not just for patient safety sake, both the patient themselves who were acting out and other potentially non violent sick patients who were being treated but for physicians, nurses, other hospital staff, as well as there is police and/or Hennepin County sheriffs at this facility.
I’ve also blogged several months ago about a nurse who was violently assaulted at Anoka Metro Regional Treatment Center and also when 3 1/2 months ago a man who was under the influence of illegal substances had made a terroristic threat against my apartment building about blowing it up and also mentioned about wanting to kill me when he first saw me.
This is how I personally de-escalate situations when being harassed for money, sex and drugs.
I look the person in the eye, tell them I’m sorry that I can’t help them but that I don’t have any money, that I wish I had drugs but that I’m on probation and get drug tested (not true and all I’ll add to that, is my medication list is up to date at both FUMC and HCMC online resources as well as in my DNR/emergency info in my phone) and depending on how agitated or aggressive they are, I’ll give them a cigarette and wish them well and go on my way.
OBVIOUSLY, clearly that’s a technique that NO first responder or any physician or nurse working with an unstable patient can actually do.
I’m not the medical or mental whisperer, I realize that part of the reason, even dealing with extremely unstable people with a propensity to be violent, on a regular basis, is largely due to luck.
The big deal with Ketamine issue at HCMC was informed consent and some of the consequences with some of the patients needing to be intubated, afterwards.
The problem is that no one could say with absolute certainty that the patient would’ve been better off, the patients around them, the hospital staff and the first responders had they not been given Ketamine.
I clearly have a bias…
But the thing is, it’s not the hospital staff that if I have a patient encounter that I am not thrilled with the evaluation and treatment that scares me.
It’s the patients who are aggressive and agitated who pose a threat to staff and patients who aren’t sedated who scare me at HCMC, which I live 2 blocks away from and truthfully at any hospital.
And those potential patients who are roaming in Minneapolis and St. Paul who are in crisis of some sort, who also I find terrifying.
I really have to wonder if those advocating on non medication interventions have ever been a patient, visitor or volunteer at HCMC’s emergency department.
And in my case, I can just choose not to get treatment there, any longer, now that I have a DNR and just wait for my biannual medical visits with my longterm PCP of over 20 years in Princeton, a much smaller town, outside of the Twin Cities.
However HCMC’s first responders, entire hospital staff and patients in medical crisis who don’t have a predisposition to ever be violent and either need a level 1 trauma center or hospital closest to them, don’t have that as an option, to opt out.
This is a topic that needs more discussion, when patients in crisis, who are potentially a threat to themselves, really can’t give informed consent and are potentially a threat to first responders, healthcare workers and innocent others, and the injury risks and rates HAVE to be reduced, if they can’t be eliminated, for healthcare workers.
Note: Again, I welcome respectful differences of opinion, even if they are opposing. Anything that threatens the welfare of myself or any of my readers will be reported to the proper authorities.