Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Was the In-Custody Death of Eric Garner Due to Police and EMS Abuse? Part I


 

In NYC Medics Restricted By FDNY Pending Investigation Into NYPD Custody Death, The Social Medic writes about the death of Eric Garner during an arrest. Death may have many different causes. Is there any one thing that would have resulted in Eric Garner still being alive – if it had not been done (or if it had been done)?

We do not know.

We probably never will know.

Did Eric Garner deserve to die? No.

Was there a valid reason for an arrest? There is nothing in this video to answer that question.

Should the police have tried to take Eric Garner down the way they did?

Is that a real choke hold, or a movie of the week choke hold?

How much choking was going on?

How much resisting was going on?

The videos only show some of what was going on, but it seems like this was not well thought out.

Eric Garner is a big man and should be approached with a well coordinated plan for the safety of everyone – for the safety of Eric Garner, for the safety of the police, and for the safety of the bystanders. Was ESU (Emergency Services Unit) there? Was a Taser available and is Taser use permitted in that jurisdiction?

A Taser might have saved Eric Garner’s life, but Eric Garner still might have died, even if the police had not arrested him. Sudden death happens hundreds of thousands of times a year in America.

When the police initially take him down, they brush up against/bounce off of a window. If it is glass, what would have happened if it broke? If it is glass, what if they had continued through the glass? If it is not glass, how do they know?

The difference between broken glass and a knife (or a sword) is not in the amount of danger they present, since all can kill you very quickly. This difference is in the perception of that danger.
 

In this video, Eric Garner repeatedly states that he cannot breathe, but this is probably not the first time that police have heard similar statements while wrestling someone into custody. EMS was not there, so no treatment was immediately available, if any treatment had been indicated. We cannot tell. His death later is not proof that he was having trouble breathing, but it does suggest that he was not breathing adequately.
 


 

The commentary from the person filming the video is useless. It is just as prejudiced and uninformed as that of any other politically motivated commentary.

All he did was break up a fight?

Unlikely, but how would the person filming this know?

Prejudiced cops on Staten Island, this is what they do?

Does that applied to the non-white cops, too? Or is that just a prejudiced comment? Prejudice does exist. Nobody is immune from it, but what is the critic basing his comments on? He appears to be basing his comments on his prejudice.

Eric Garner was beat up?

He was violently subdued/wrestled to the ground, but I did not see anyone strike him.

Eric Garner was not beat up.

The critic seems to be singing along with the music in the background, which does not really give the impression of someone who thinks he is witnessing someone being killed. He makes a lot of accusations, but his actions do not match his words. If you are singing along with Muzak, you appear to be indicating that there is nothing important distracting you from your singing. Maybe it is someone next to the critic, but that still suggests that there was not a lot of concern among those as close to events as the critic.

Did the police choke Eric Garner into submission or did one officer overestimate the effect he would have on a much larger guy by grabbing him around the neck?

Someone has written, None of the officers knew what to do in this situation on the bottom of the video. What would the film critic like the police to do? Should they put Eric Garner in the back of a police car?

What does the film critic suggest that they do?

They have called for an ambulance and they have Eric Garner in the rescue position.

Did the police use an inappropriate method of arresting Eric Garner?

The prohibition on the use of a choke hold for restraint may have more to do with the way things look to bystanders, than the effect it has on the person being restrained. Choke holds are not prohibited in most combat sport because apparently choke holds can be used safely. Did the choke hold cause death?
 


Image credit – Wikipedia article on choke holds.
 

At about 4:30 of the video, EMS enters.

I have not commented on what The Social Medic wrote about this incident, yet. I will comment on what can be seen of what EMS did (did not do) and whether excited delirium is a part of this in Part II.

.

Would a Taser Have Made a Difference in the Outcome?


Investigators on the scene of a deadly shooting by San Mateo County Sheriff’s deputies. (CBS)
 

What kind of response should EMS have when a person is reported to be acting violently and carrying a knife? We stage around the corner, or a few blocks away.

What about the police? They need to try to disarm the person and control things without anyone getting hurt, but that is not always possible.

According to the various articles in the news, two deputies arrived and confronted Yanira Serrano-Garcia, an 18 year old woman who had not been taking her medication.
 

Two deputies responded to the Moonridge Housing Complex at Miramontes Point Road, east of Highway 1, where the woman lived, Rosenblatt said. The family told dispatchers the woman was mentally ill and was located down the block with a knife, and that she refused to put the weapon down when asked.[1]

 

However, another article states that the police were provided with different information.
 

The information received by emergency personnel who responded to the incident was that the woman was acting erratically and violently and had a knife. The woman’s family asked her to put the knife down, and when she didn’t comply, family members called the fire department for medical assistance, Rosenblatt said.[2]

 

Another states –
 

The family told dispatchers the woman was mentally ill and was located down the block with a knife, and that she refused to put the weapon down when asked.[3]

 

No recordings of 911 tapes are quoted, but the information that was provided to the responding deputies might change how they approached her.

Should the family have tried to get unarmed EMS to respond to care for a violent armed patient? No.

Were they just trying to protect her? Probably.

What happened?

The two deputies confronted Yanira Serrano-Garcia and shot her at least once. She was pronounced dead on scene.
 

“I don’t know why they couldn’t have done better things instead of getting a bullet through her and trying to shoot her,” said Saul Miramontes, Serrano-Garcia’s cousin. “She was kind of sick — you know, at least they could have Tasered her or at least tackled her.”[1]

 

Tackling someone who has a knife is a very bad idea for everyone. It had Darwin award written all over it.

A Taser may be appropriate, but it should involve at least two armed people, one with the Taser and one backup with a firearm that is drawn and aimed at the person to be taken down. It is not considered appropriate to just drive up and use the Taser without making some attempt to get the person to put down the knife voluntarily.

One problem with the use of the Taser is that if you are close enough to use the Taser, and the person with the knife lunges toward you, you may be stabbed without being able to hit the person with the Taser.
 


 

Did either deputy have a Taser out? We do not know from any of the articles.

Why did only one deputy shoot? It may be that they were not positioned well and when the deputy who did shoot moved, he moved into the line of fire of the other deputy. Maybe the other deputy froze. Maybe the other deputy did not think that a shot was the appropriate response for the circumstances. There can be many other reasons. We do not know.

Was there some other reason that the deputy felt the need to shoot quickly (the shot is reported to have taken place within a minute of arriving on scene)?

There is another bit of information that has not been included in the more recent news reports. This is from a cached copy of one article.
 

Dyanna Ruiz, 12, said she had been walking to a friend’s house when she saw the deputy running away from a woman who had her arm raised and was chasing him with what appeared to be a knife.

“I saw the girl running at him with something in her hands,” Dyanna said. “I didn’t know what was happening. I was really scared about what to do.”

The deputy saw Dyanna, stopped and yelled at Serrano-Garcia, the girl said. When Serrano-Garcia kept coming at him, the deputy fired, Dyanna said.[4]

 

The deputies may have had a plan for controlling the situation that may have seemed reasonable with just the two of them and the person with the knife at risk. With a child/adolescent also at risk, the plan may fall apart. That is pure speculation on my part, but I have a lot of experience with plans falling apart, as does anyone who deals with emergencies.

Why was the statement of this witness removed from more recent versions of the article? I do not know.

Will a Taser always work? No. Sometimes, in spite of reasonable attempts to do everything right and protect lives, bad outcomes still happen.

Footnotes:

[1] Half Moon Bay woman, 18, fatally shot by deputy after lunging at him with knife, authorities say
By Erin Ivie eivie@mercurynews.com
Posted: 06/04/2014 05:56:45 AM PD Updated: 6 Days ago
Contra Costa Times News
Article

[2] Officer Who Killed Woman Felt His Life Was in Danger
Joan Dentler (BCN)
Friday June 06, 2014 – 09:51:00 AM
Page One
The Berkely Daily Planet
Article

[3] Half Moon Bay woman, 18, fatally shot by deputy after lunging at him with knife, authorities say
By Erin Ivie
eivie@mercurynews.com
Posted: 06/04/2014 05:56:22 AM PDT Updated: 6 Days ago
San Jose Mercury News
Article

[4] Woman, 18, shot dead by San Mateo sheriff’s deputy
Henry K. Lee and Kurtis Alexander
Updated 5:07 pm, Wednesday, June 4, 2014
SFGate.com
Cached version of the article. It is a snapshot of the page as it appeared on Jun 5, 2014 00:40:18 GMT.

Woman, 18, wielding knife shot dead by San Mateo deputy
Henry K. Lee and Kurtis Alexander
Updated 8:46 pm, Friday, June 6, 2014
Article at the same link, but when I last checked at 18:00 6/10/2014, the part I quoted was not in the article.

.

‘Hog-tying’ death report faults Fla. medics

An internal investigation by Broward County’s Fire Rescue division concluded that errors by emergency personnel may have caused the death of a Lauderhill man who suffocated after being “hog-tied” by Broward Sheriff’s Office deputies and county paramedics.[1]

This death is from October 15, 2001, so it has been over a decade and everyone in EMS should be refusing to allow patients to be placed in the prone position following restraint. Hog tying should never even be considered.

The responsible way to manage someone who is combative is to chemically restrain the patient. Physical restraint is for the purpose of being able to inject the patient with the chemical restraint.

Should the medics have known better? Yes, but it was a decade ago and there are still EMS agencies that are not aggressive with chemical restraints.

This is the responsibility of the medical director. We are supposed to be trained and equipped to not make things worse. Clearly, we can make things much worse, if we do not have the right education and medication and protocols.

We should not be treating our excited delirium patients like animals in a rodeo. As medical people, we are supposed to be smarter than the patient with the malfunctioning brain.

Diabetes, head injury, stroke, hypoxia, hyperthermia, drugs, psych, et cetera. There are many possible reasons for this behavior. Our job is to sedate the patient with the least harm to everyone involved, including the patient.


Image credit.

Tasers protect everyone, including the patient,[2] so it is safer for everyone if police use a Taser and then EMS sedates the patient. This is not likely to be effective unless aggressive doses of sedative are given.

Given the irrational and potentially violent, dangerous, and lethal behavior of an ExDS subject, any LEO interaction with a person in this situation risks significant injury or death to either the LEO or the ExDS subject who has a potentially lethal medical syndrome.[3]

They point out that a perfect outcome is expected every time.

A perfect outcome is not possible every time.

One of the problems in dealing with excited delirium is that it looks easy, but only when it is done right.

Making the treatment of unstable patients look no more eventful than the treatment of stable patients is what good EMS is all about.

When we make it look easy, some people will claim that we over-reacted. We cannot go back and handle things differently, but we should not want to. Some conditions need to be approached as if they arfe life-threatening. Excited delirium is one of them.

Why?

Because it is life-threatening.

Our job is to try to prevent death, not to cause death. If we do not protect our excited delirium patients by aggressively sedating them, we will kill some of our patients.

Footnotes:

[1] ‘Hog-tying’ death report faults Fla. medics
Report cites 9 ‘failures’ that it says cumulatively may have led to man’s death
By Elgin Jones
South Florida Times
April 19, 2012
Article Reprinted at EMS1.com

[2] Joe Lex: Electrical Misadventures – Microwaves, Cords, Plugs, TASERs, and Lightning
Published: August 30, 2010
Free Emergency Medicine Talks
Page with mp3 link to download

Dr. Joe Lex is one of the most sought after emergency medicine lecturers in the world. Listen to this and to the rest of his talks that are at Free Emergency Medicine Talks.

[3] White Paper Report on Excited Delirium Syndrome
ACEP Excited Delirium Task Force
Vilke GM, Debard ML, Chan TC, Ho JD, Dawes DM, Hall C, Curtis MD, Costello MW, Mash DC, Coffman SR, McMullen MJ, Metzger JC, Roberts JR, Sztajnkrcer MD, Henderson SO, Adler J, Czarnecki F, Heck J, Bozeman WP.
September 10, 2009
Free Full Text PDF

.

Another Excited Delirium vs. Taser Death – Part I

It is the consensus of the Task Force that ExDS is a unique syndrome which may be identified by the presence of a distinctive group of clinical and behavioral characteristics that can be recognized in the pre-mortem state. ExDS, while potentially fatal, may be amenable to early therapeutic intervention in some cases.[1]

If not treated aggressively, excited delirium may progress to cardiac arrest, which generally does not respond to treatment, even though it occurs in the presence of EMS.

While not universally fatal, it is clear that a proportion of patients with ExDS progress to cardiac arrest and death. It is impossible at present to know how many patients receive a therapeutic intervention that stops the terminal progression of this syndrome. While many of the current deaths from ExDS are likely not preventable, there may be an unidentified subset in whom death could be averted with early directed therapeutic intervention.[1]

Still, many in EMS are hesitant to use large doses any doses at all of sedative medication that might prevent cardiac arrest.

Why?

Ignorance.

Fear.

Anger at the person we are fighting with.

Requirements for on line medical command permission.

Suppose I push a huge dose of midazolam (Versed).

What could happen?

Sedation, vasodilation, and respiratory depression.

I am fighting with a patient who has such an extreme surge of catecholamines in his body that it may kill him, but I am worried about too much sedation?

I am fighting with a patient who has such an extreme surge of catecholamines in his body that it may kill him, but I am worried about too much respiratory depression?

I am fighting with a patient who has such an extreme surge of catecholamines in his body that it may kill him, but I am worried about too much vasodilation?

But I am not worried about the death of the patient from an untreated lethal condition?

I’m sorry, but it is our Standard Of Care to stand by and do nothing while you die. Please cooperate.


Image credit.[2]

Chad Brothers dies and all he gets is this foolish headline.

Does this kind of headline help anyone, except as an irresponsible means to attract readers?

A Taser was used on Chad Brothers several times. According to reports, he was still alive afterward. Later he died.

Did the Taser use have anything to do with the death?

We do not know.

Dr. Bell was the first to describe a clinical condition that took the lives of over 75% of those suffering from it. Based on the clinical features and outcomes of the institutionalized cases from the 1800s when compared to the resently accepted criteria known to accompany ExDS, it is believed that Bell’s Mania may be related to the syndrome of ExDS that we witness today.[1]

If this is the same condition . . .

and

about 75% of people presenting with this have had fatal outcomes . . .

but

only a tiny fraction of Taser use results in death . . .

then

is it likely that the Taser is the cause of death?

If the medical condition appears to be fatal much more often than the use of a Taser appears to be fatal, why do we assume that the deaths are due to the Taser when both conditions are present?

[youtube]bsFBYq_h_J0[/youtube]

There is a big difference between exuberance that is controllable and delirium that is not controllable.

Lattimer is just expressing happiness in his own particular idiom.

It is suggested that the fatalities became much less common in the 1950s with more widespread use of psychiatric medication, resulting in a much lower death rate today.

since ExDS is mainly discussed in the forensic literature and is a diagnosis of exclusion established on autopsy, there is little documentation about survivors of the syndrome. A published observational study suggests that the incidence of death among patients manifesting signs and symptoms consistent with ExDS is 8.3%.[1]

If medication is able to decrease the fatality rate from about 75% to less than 10%, why are we so hesitant to use medication?

Are there any cases of patients being killed by too aggressive dosing of midazolam by EMS?

Any?

There are cases of death due to excited delirium in the presence of EMS.

Why is this such a difficult choice?

For adequate control of ExDS, the above doses are conservative and describe a reasonable starting point. Clinical effect in ExDS may require doses greatly in excess of those for traditional medical use in other conditions.[1]

I will discuss some of that dosing in Part II.

Footnotes:

[1] White Paper Report on Excited Delirium Syndrome
ACEP Excited Delirium Task Force
Vilke GM, Debard ML, Chan TC, Ho JD, Dawes DM, Hall C, Curtis MD, Costello MW, Mash DC, Coffman SR, McMullen MJ, Metzger JC, Roberts JR, Sztajnkrcer MD, Henderson SO, Adler J, Czarnecki F, Heck J, Bozeman WP.
September 10, 2009
Free Full Text PDF

[2] Man Freaks Out In The Gym, Is Tased To Death By Police
by Dan Fogarty
1:50 pm, November 1st, 2011
sportsgrid.com (does that make this a Roid Rag?)
Article

.

Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates – Part III

Continuing from Part I and from Part II.

Griffiths said CMS would not discuss whether hospital security should carry stun guns or other weapons because that is a “law enforcement” issue that falls outside CMS jurisdiction.[1]

The CMS approach is dial 911 and hope that nothing bad happens before the police handle the violence, or dial 911 and hope that nothing bad happens because the police have been called to handle the violence.

Certainly, if a patient can survive the JCAHO/TJC (Joint Commission for Accrediting Healthcare Organizations/The Joint Commission) social services questionnaire, that patient must meet the definition of stable – even if that patient’s violent behavior does not meet any definition of stable.

A patient with a head injury would be better treated by the police, rather than by hospital staff.

A patient with hypoglycemia would be better treated by the police, rather than by hospital staff.

A patient with a brain tumor would be better treated by the police, rather than by hospital staff.

A patient with a psychiatric condition would be better treated by the police, rather than by hospital staff.

Trust CMS. Just seclude patients and call the police. Do not treat!

CMS spokeswoman Ellen Griffiths is making it clear that the approach of CMS is not to consider the ways their rules may affect the overall care of patients. CMS is just a rules organization that does not have to deal with reality.

Lehigh Valley’s actions ran afoul of patient protection rules meant to limit the ways patients can be restrained, said Holli Senior, deputy press secretary for the Pennsylvania Health Department. Weapons should not be used in the context of restraining a patient. If a physical confrontation goes beyond the point at which usual restraints are in order, then local police should be called, Senior said.[1]

This is the problem.

The people making these rules are attempting to limit the ways patients can be restrained.

Perhaps they never heard the saying that when all you have is a hammer, then every problem looks like a nail.

How does the Pennsylvania Health Department come to these conclusions?

How will patients benefit from a rule that makes an arbitrary and binary distinction between patients and criminals?

I’m sorry, at this point you have crossed the line and are no longer a patient. You have been discharged according to Pennsylvania Health Department rules. We are attempting to barricade you away from people we still consider to be patients. We will wait for the police to come and take you away. Maybe the police can mange your blood sugar problems/head injury/psychiatric problems/et cetera better than the doctors and nurses can. All hail the omniscient PHD!

Welcome to the Pennsylvania Health Department. We are here to toggle you.

The health department, which has “deemed status” in Pennsylvania to carry out CMS rules for hospitals governed by Medicare rules, responded to a complaint about a specific incident in which a Lehigh Valley security officer used a stun gun on a patient. The resulting inspection led to a review of patient records, which showed 3 other incidents with stun guns during the previous few years. Lehigh Valley started using stun guns in 2007.[1]

A single incident?

An average of one TASER use per year?

Recklessness!

Abuse!

What if we look at each use of a TASER?

The regulators found fault with Lehigh Valley, according to an October 2010 inspection report, because the stun guns were used without a preceding attempting to restrain or seclude the patients. The incidents involved the following:

•An agitated patient in the ED received multiple doses of Ativan, Haldol, and valium during about 2 hours and was still agitated. Security staff was called and the patient “came at” security, at which point the patient was stunned.

•A patient was asked to sign a transfusion consent and refused, becoming agitated, and began yelling at staff. The patient was using an intravenous pole as a weapon and barricaded himself in the restroom. Security talked to the patient, but he became more agitated and ultimately a stun gun was used. Police were called and took a report.

•An ED patient ran out of an examination room, slamming the door, hitting the wall, and yelling. Medical staff tried to calm the person, and eventually security was called. The patient attempted to punch a security officer, “who intercepted the patient’s punches and took the patient to the ground.” The patient began fighting with both officers, and one used a stun gun to subdue him.

•An upset patient left the ED, and security staff pursued the person for fear he would harm himself or others and called police. The patient pushed a security officer, striking the officer with his fist and grabbing for the officer’s belt containing pepper spray and a stun gun. Another officer warned the patient 3 times and then discharged a stun gun.

In each instance, the health department said, security staff should have followed policy and restrained or secluded the patient or waited for police to arrive.[1]

the stun guns were used without a preceding attempting to restrain or seclude the patients. . . . received multiple doses of Ativan, Haldol, and valium

And we certainly wouldn’t want to consider multiple doses of Ativan, Haldol, and Valium as attempts to restrain (or seclude) the patient, since these are just chemical/medical restraints.

the stun guns were used without a preceding attempting to restrain or seclude the patients. . . . Security talked to the patient, but he became more agitated and ultimately a stun gun was used.

And we certainly wouldn’t want to consider talking with the patient as appropriate, since we only want the patient secluded while we wait for the police to show up to treat the patient..

the stun guns were used without a preceding attempting to restrain or seclude the patients. . . . Medical staff tried to calm the person, and eventually security was called. The patient attempted to punch a security officer, “who intercepted the patient’s punches and took the patient to the ground.”

And we certainly wouldn’t want to consider medical staff trying to calm the patient as attempts to restrain (or seclude) the patient. We also would not want to view security’s attempts to restrain the patient as attempts to restrain the patient.

the stun guns were used without a preceding attempting to restrain or seclude the patients. . . . security staff pursued the person for fear he would harm himself or others and called police. The patient pushed a security officer, striking the officer with his fist and grabbing for the officer’s belt containing pepper spray and a stun gun. Another officer warned the patient 3 times and then discharged a stun gun.

And we certainly wouldn’t want to consider attempts by security to keep the patient away from other patients as attempts to restrain (or seclude) the patient. We also would not want to view security’s attempts to restrain the patient as attempts to restrain the patient.

Better to let the patient harm himself or others. After all, JCAHO/TJC won’t have any problem with that, as long as the appropriate suicidal questionnaire has been filled out by this oh so cooperative patient.

If the patient does not try to kill himself, but tries to kill someone else, the regulatory agency will not be at fault for creating an environment that makes it likely that the violent patient will be able to harm/kill other patients.

There will probably be a rule created along the lines of permitting law enforcement activity in a hospital, even though the goal should be for the hospital to treat the violent patient.

I also wrote about the problems with violent patients in MedicCast – EMS and Health Care Workplace Violence on Federal Radar. Jamie Davie discussed this in the podcast EMS and Health Care Workplace Violence on Federal Radar.

Footnotes:

[1] Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates
by Jan Greene
Annals of Emergency Medicine
Volume 57, Issue 4 , Pages A20-A23, April 2011

Free Full Text from Annals of Emergency Medicine                 Free PDF from Annals of Emergency Medicine

.

Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates – Part II

Continuing from Part I.

CMS’s actions in Pennsylvania raise a question: Should all hospitals that must comply with CMS regulations stop using stun guns? According to a survey in Campus Safety Magazine, 26% of hospital security officers carry “less-lethal” weapons such as neuromuscular incapacitating devices (stun guns made by Taser International), 7% carry handguns, and 13% carry both.[1]

CMS is the Centers for Medicare & Medicaid Services.

CMS spokeswoman Ellen Griffiths was careful not to extend the Lehigh Valley case into a national mandate for all hospitals. CMS, and any state agencies that act on CMS’s behalf, usually respond to complaints rather than actively inspecting hospitals for compliance with rules. But she did observe, as did a Pennsylvania Health Department spokeswoman, that the CMS rules strongly discourage use of weapons with patients. The rules state:

“CMS does not consider the use of weapons in the application of restraint or seclusion as a safe, appropriate health care intervention. For the purposes of this regulation, the term “weapon” includes, but is not limited to, pepper spray, mace, nightsticks, tazers, cattle prods, stun guns, and pistols. Security staff may carry weapons as allowed by hospital policy, and State and Federal law. However, the use of weapons by security staff is considered a law enforcement action, not a health care intervention. CMS does not support the use of weapons by any hospital staff as a means of subduing a patient in order to place that patient in restraint or seclusion. If a weapon is used by security or law enforcement personnel on a person in a hospital (patient, staff, or visitor) to protect people or hospital property from harm, we would expect the situation to be handled as a criminal activity and the perpetrator be placed in the custody of local law enforcement.”1[1]

Therefore, having a bunch of people wrestle with the patient, raising the heart rate, blood pressure, respiratory rate, intracranial pressure, et cetera even higher than they would be with the use of a TASER, is less harmful to the patient because this more dangerous practice is not classified as using a weapon.

Griffiths said CMS would not discuss whether hospital security should carry stun guns or other weapons because that is a “law enforcement” issue that falls outside CMS jurisdiction.[1]

This is entirely about CMS telling hospitals how to handle violent patients.

Dealing with violent patients is a patient care issue, even when law enforcement are needed to assist with managing the patient.

For the Pennsylvania Health Department to abandon these patients to law enforcement is not fair to those who treat violent patients in Pennsylvania.

For the Pennsylvania Health Department to abandon these patients to law enforcement is not fair to violent patients in Pennsylvania.

This may come as news to CMS spokeswoman Ellen Griffiths but –

Not all violent patients are criminals.

I also wrote about the problems with violent patients in MedicCast – EMS and Health Care Workplace Violence on Federal Radar. Jamie Davie discussed this in the podcast EMS and Health Care Workplace Violence on Federal Radar.

To be continued in Part III.

Footnotes:

[1] Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates
by Jan Greene
Annals of Emergency Medicine
Volume 57, Issue 4 , Pages A20-A23, April 2011

Free Full Text from Annals of Emergency Medicine                 Free PDF from Annals of Emergency Medicine

.

Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates – Part I

There is an interesting article in Annals of Emergency Medicine about contradictory rules from conflicting agencies that affect patient care.

One emergency department (ED) gets cited by a federal agency for using stun guns to subdue violent patients. Another is fined for failing to provide a safe workplace. It is a federal catch-22, leaving ED administrators caught between seemingly contradictory mandates from federal bureaucratic silos.[1]

Different agencies.

Different rules.

No communication.

Faulty logic.

If those of us taking care of patients were guilty of the same errors, we would expect to be fined, or shut down, although probably not for faulty logic.

Yet, when those who regulate us are guilty of these errors, we are expected to satisfy all of their demands and be grateful for the abuse attention.

Dr. Kane has the sense that violence in hospitals is getting worse. Statistics back up her perception. ED visits resulting in violence increased from 16,277 to 21,406 between 2005 and 2008, nearly a one-third increase, according to the federal Substance Abuse and Mental Health Services Administration. Visits to the ED for drug- and alcohol-related incidents increased during that time from 1.6 million to 2 million.[1]

Do the federal, or state, regulatory agencies feel the need to do something to protect those taking care of the patients or to help those taking care of the patients to protect their patients?

No. These regulatory agencies just create more responsibilities for others. These regulatory agencies do not have any responsibility for the damage they cause.

The mayhem is having an influence on hospital staff. More than half of ED nurses are victims of physical or verbal abuse at work in a given week, according to a survey by the Emergency Nurses Association released in September 2010.[1]

CMS’s actions in Pennsylvania raise a question: Should all hospitals that must comply with CMS regulations stop using stun guns? According to a survey in Campus Safety Magazine, 26% of hospital security officers carry “less-lethal” weapons such as neuromuscular incapacitating devices (stun guns made by Taser International), 7% carry handguns, and 13% carry both.[1]

CMS is the Centers for Medicare & Medicaid Services.

In Pennsylvania, the use of TASERs on patients is not considered to be acceptable, because these weapons act by neuromuscular incapacitation. On the other hand, doctors may use paralytics, which are medicines that cause neuromuscular incapacitation, and that neuromuscular incapacitation is considered a treatment, rather than a weapon.

Anything can be a weapon. All that matters is the way that it is used.

Pretty much the same can be said for treatments.

Botulism is extremely poisonous WMD (Weapon of Mass Destruction), but it can be used as a treatment. Ditto radiation.

Just because something is generally perceived as a weapon does not mean that its use is always harmful.

The TASER can be an effective means of protecting patients, but this is something that the regulators do not seem to be capable of understanding in their overly simplistic view of the way the world works.

I also wrote about the problems with violent patients in MedicCast – EMS and Health Care Workplace Violence on Federal Radar. Jamie Davie discussed this in the podcast EMS and Health Care Workplace Violence on Federal Radar.

To be continued in Part II and later in Part III.

Footnotes:

[1] Patient Safety Versus Workplace Safety – Stun Gun Debate Illustrates Dueling Federal Mandates
by Jan Greene
Annals of Emergency Medicine
Volume 57, Issue 4 , Pages A20-A23, April 2011

Free Full Text from Annals of Emergency Medicine                 Free PDF from Annals of Emergency Medicine

.

Oversight – Marin Sheriff with a TASER

The video shown on the news has been criticized by the Marin County Sheriff’s Office. They state –

That reaction can all too often also be influenced by using only small, selected segments of a much lengthier video that better depicts the complexity of the event in question.

That is an excellent point. The full video is 36 minutes 50 seconds of evidence that the Marin County Sheriff’s Office is not providing competent TASER training or oversight. Not only should the Deputy using the TASER be facing criminal investigation by an outside agency, so should the Deputy’s senior partner, and everyone in the Marin County Sheriff’s Office who approved of this flagrant case of abuse. How can anyone competent in law enforcement look at this and claim that it is both appropriate and fall(s) within the guidelines established by law and department policy?

There is language used that may disturb some people, but the language is far from the most disturbing part of the video.

Does the Deputy appear to be using the TASER maliciously?

No, but torture by negligence is not something anyone should condone.

We’re from the government and we’re here to help.

Stop resisting!

Stop resisting!

Stop resisting!

Stop resisting!

Maybe we should have this Deputy provide remedial education to medical directors/medical command physicians, who are hesitant to provide pain medication orders for patients. The result is the same. Torture.

.