Questions linger about emergency medical responders' independence after ketamine report

A year-old video of a Utah nurse roughly arrested at a Salt Lake City hospital after refusing a police officer's request to draw blood from an unconscious accident victim still inspires outrage.

The incident spotlights another critical issue beyond police misconduct. The nurse wasn't just defending hospital policy. She was standing up for the health care system's historic separate authority in the public domain.

Caregivers are not an arm of the police department. Their mission is each patient's well-being. When health care and law enforcement work together, the relationship must be carefully calibrated to maintain providers' independence — a vital component of the public's trust in these professions and institutions.

Recent Star Tribune stories on the use of a drug called ketamine raise important questions about whether lines of authority have become blurred at calls in Minneapolis served by Hennepin Emergency Medical Services (EMS).

The stories, based on a leaked draft of an internal city investigative report, revealed that investigators found troubling instances where Minneapolis police have urged paramedics to use the sedative as a chemical restraint. The stories also reported that "documented ketamine injections during Minneapolis police calls increased from three in 2012 to 62 last year" and that the drug may have been used on people already physically restrained or may have caused serious adverse reactions.

In April, paramedics complained about police pressure; county officials relayed these concerns to police. Hennepin EMS has also called for an outside review. These are welcome steps. But the county response has been marked by a defensive approach — including a June 20 commentary — and a clinical "we're the experts" tone. What's needed is a "we hear your concerns" approach that acknowledges fears about an unfamiliar drug and mounting tensions over police use of force.

This is a patient education responsibility on which the county-run health care system is falling short. Public outreach needs to involve more than a guest commentary. Yet not even the most basic step has been taken — putting information about ketamine on the Hennepin EMS website or the website for the county-run health care system, Hennepin Healthcare.

The county's medical and political leaders also need to more vocally assure Minnesotans that they take seriously concerns about health care independence and are weighing steps to ensure it, such as including the issue in paramedics' ketamine training.

All that said, satisfactory answers may be available. A physician representing the American College of Emergency Physicians — Dr. Howard Mell of the Chicago area — suggests that ketamine is commonly used by emergency medical personnel in other parts of the country and that 62 uses may be low for a metro area this size. The rise in the number of uses here could reflect responders' growing experience with the drug, an older medication whose versatility and safety has led to its use in far-flung field medical stations.

According to Mell, explanations for using the drug on people already restrained could include the fact that physical restraints also carry risk. And that the drug's benefits address internal symptoms of severe agitation such as hyperthermia and rapid heartbeat.

The responsibility to educate the public and review potential policy changes isn't limited to just the Minneapolis police and City Council. The state's largest county and its leaders must step up and do better.