Eric Jaeger, JD, NRP

super yikes 😬

{generally healthy person}
+
{cardiopulmonary symptoms a few weeks after knee arthroscopy}
=
PE until proven otherwise

this happens a LOT

Want to learn how to apply these principles in real world scenarios? Join me at EMS World on Oct. 21 for a full day preconference including hands-on simulations:

EMS World Preconference Session Oct. 21 8a-5p
lnkd.in/eAGzSycX

Reach out to me if I can help. More info can be found at TheHardWork.org.

#10 ALWAYS perform a medication cross check.
>>These are HIGH RISK medications.

#9 Select the medication based on the patient’s presentation.
>>But understand its less about which medication and more about how you perform the procedure.
Many deaths have occurred with a single, standard dose of midazolam or droperidol.

#8 A supervisor or independent paramedic improves safety.
>>Remove the emotion & focus on compliance with clinical & procedural safeguards.

#7 Only proceed if patient remains an ACTIVE threat to self or others.
>>De-escalation works; only proceed after multiple attempts.
>>Rule out treatable causes: hypoglycemia, shock, etc.
In many deaths, it’s been unclear whether sedation was justified; often little or no assessment was performed.

#6 All monitoring & resus equipment must be at the patient’s side.
>>The failure to do this is a common thread in many deaths.

#5 Monitoring must begin PRIOR to sedation.
>>Assign a specific team member to monitor the patient’s airway/breathing. Can’t attach monitoring to the patient bcs they’re agitated? “You’re the monitor until the monitor can be applied.”

#4 NEVER sedate a patient in the prone position!
>>This carries a profound risk of death.
>>Sedation can kill a restrained patient who is already dangerously hypoxic or acidotic.
>>“Reposition before you sedate” to ensure the patient can breathe freely.

#3 Sedation is a team sport!
>>Build a shared mental model with the team and assign specific roles.

#2 Anticipate apnea!
>>Apnea is a predictable outcome of sedation, NOT an unforeseeable risk.
>>Especially in patients who are already hypoxic or acidotic.
>>Have multiple backup plans briefed and prepared.

#1 Slow down!
>>Don’t act precipitously.
>>Sedation is a deliberate procedure, akin to RSI or procedural sedation in the ED!
Too often, we’ve seen paramedics proceed precipitously, without the assessment and preparation essential to ensuring safety.

Chemical Sedation: We’re Doing it All Wrong!
Top Ten Principles for Improving Safety

The recent death of Jesus Barcenas in Colorado echoes mistakes made in many other deaths involving prehospital chemical sedation. Here are my top ten principles for improving safety.
www.9news.com/article/news...

Nice!

Handcuffs and Unexpected Deaths — “I Can’t Breathe” as a Medical Emergency | NEJM Cases in which someone in apparently good health is physically restrained by police and has a cardiac arrest represent a failure of the medical profession — not just of law enforcement.

This is why I do the work that I do. We must radically reframe our approach to physical restraint & chemical sedation to enhance safety. This protects patients and reduces liability for EMS providers & police.

Reach out to me if I can help. More information can be found at TheHardWork.org.

5. Behind-the-back-handcuffs should be removed before the patient is placed on the stretcher.
Patients with behind-the-back-handcuffs frequently end up in the prone position.

4. NEVER restrain a patient on the stretcher in the prone position.
It creates a severe risk of death. It’s reported that the paramedic said “Just keep him facedown. I don’t care…I don’t want to move him.” This is deeply troubling.

3. All patient monitoring and resuscitation equipment must be at the patient’s side. Patients who have been chemically sedated must be continuously monitored.
This did not occur. (Post-sedation monitoring is a flawed concept; the correct approach is peri-sedation monitoring.)

Handcuffs and Unexpected Deaths — “I Can’t Breathe” as a Medical Emergency | NEJM Cases in which someone in apparently good health is physically restrained by police and has a cardiac arrest represent a failure of the medical profession — not just of law enforcement.

I wrote about this in NEJM:
“Handcuffs and Unexpected Deaths-“I Can’t Breathe” as a Medical Emergency” www.nejm.org/doi/full/10....

1. NEVER sedate a pt in the prone position.
This carries a high risk of death.

2. Every patient MUST be assessed prior to sedation.
This apparently did not occur.

Mr. Barcenas was restrained prone by police when paramedic McClure injected him with a sedative (droperidol). He was restrained on the stretcher in the prone position with his hands cuffed behind his back. He went into cardiac arrest shortly after the ambulance began transport to the hospital.

Boulder CO Paramedic Faces Manslaughter Charge in In-custody Death

Paramedic Edward McClure has been charged with manslaughter in the death of patient Jesus Lopez Barcenas on Dec. 27, 2024.

I am deeply troubled by every aspect of this patient’s care as reported.

www.9news.com/article/news...

Family of Alabama teen shot by police seeks access to video of shooting Lawyers representing the family of a Black teenager killed by police in an Alabama suburb said the state’s refusal to release body-camera video during an investigation is fueling mistrust.

Lawyers representing the family of a Black teenager killed by police in an Alabama suburb said the state's refusal to release body-camera video during an investigation is fueling mistrust.

A black and white graphic with an image of ACLU Co-Founder Roger Baldwin on the right, and the U.S. Supreme Court building in the background, with a quote from Baldwin in black text on the left: “Silence never won rights. They are not handed down from above—they’re forced from pressures from below.” The ACLU logo is featured in light blue at the bottom.

We will always fight for the country we want to live in.

Push dose epi mixed. Strong consideration for norepi drip up and running at a low dose.

Ketamine over etomidate, but the evidence is mixed on whether it really offers a hemodynamic advantage.

Anticipate hypotension in all patients (regardless of hemodynamic status pre-induction).

but the evidence says boluses of fluid are NOT hemodynamically protective.

Respect the MAP and Shock Index (HR/SBP). Proceed with extreme caution with Shock Index over 0.8.

Recognize that correcting BP is not the same as hemodynamically stable.

Induction of the Hypovolemic Patient

Focusing on prehospital and emergency department:

Some patients need a definitive airway but are too sick to intubate.

Resuscitate before you intubate.

Why hypovolemic? Hemorrhage? Give blood if available. Others? Fluid perhaps…

Dissent is patriotic.

We have a right to disagree and dissent with those in power and demand a better world.

The antivaccine movement threatens health in the US and worldwide Robert F Kennedy Jr and others in the antivaccine movement are using the power of the US government to promote disinformation and flawed science, write Anna Kirkland and Scott Greer With Robert F Ke...

www.bmj.com/content/390/... @casinoshiftmd.bsky.social

George Takei is 88 years old and will never stop fighting for equality | CNN George Takei has a very personal view about current US immigration enforcement efforts.

George Takei has a very personal view about current US immigration enforcement efforts.

Medicaid is the primary health coverage for one in three disabled adults. The "Big, Beautiful Bill" just stripped close to one trillion dollars from federal Medicaid funding across a decade.