2205391423_b36fecb946_m.jpgFor at least two years, the Nashville PD have been recklessly endangering citizens by using emergency medical personnel to forcibly inject Versed — a powerful prescription medication with side effects including agitation and confusion — into agitated, confused people. This potentially lethal stupidity is what we can expect when people who go to work with guns on their belt decide to play "doctor".

To compound the dangerous stupid, Versed’s side effects include the same behavior the geniuses in Nashville seek to control.

Reactions such as agitation, involuntary movements, hyperactivity and combativeness have been reported in adult and pediatric patients. Should such reactions occur, caution should be exercised before continuing administration of midazolam.

In addition to making agitated patients more agitated, Versed can (and does) cause respiratory depression. What’s respiratory depression – a case of the sighs? Nope – respiratory depression is the fancy doc talk for what happens when the nerve cells in our lizard brain get so sedated they forget to tell us to breathe – and we suffer severe brain damage, or even die. Because, amazingly enough, our brains require oxygen to survive.

Midazolam is a potent sedative agent that requires slow administration and individualization of dosage. Clinical experience has shown midazolam to be 3 to 4 times as potent per mg as diazepam. BECAUSE SERIOUS AND LIFE-THREATENING CARDIORESPIRATORY ADVERSE EVENTS HAVE BEEN REPORTED, PROVISION FOR MONITORING, DETECTION AND CORRECTION OF THESE REACTIONS MUST BE MADE FOR EVERY PATIENT TO WHOM MIDAZOLAM INJECTION IS ADMINISTERED, REGARDLESS OF AGE OR HEALTH STATUS. Excessive single doses or rapid or intravenous administration may result in respiratory depression, airway obstruction and/or arrest. The potential for these latter effects is increased in debilitated patients, those receiving concomitant medications capable of depressing the CNS, and patients without an endotracheal tube.

These deadly side-efects make Versed a drug that cannot be safely used without full capacity and opportunity to intubate the patient. In many teaching hospitals, use of Versed outside the ICU seting is restricted or prohibited: the risk of iatrogenic (treatment-caused) respiratory depression leading to brain damage or death is judged to be too great.

Of course, this concept may be lost on many whose co-workers insist that choke holds killed black people not because the victims couldn’t breathe, but because of the victims’ ethnicity.

In 1982, Chief Gates provoked an outcry from civil rights advocates when he said that blacks might be more likely to die from choke holds because their arteries do not open as fast as arteries do on "normal people."

The concept also may be lost on many whose co-workers insist that when people are hog-tied and placed face down (thus compressing airways), the resultant deaths have nothing to do with the hog-tying….so they keep using the hog-tying technique known to kill people.

The simple fact of the matter is that even if officers take precautions, hog-tied and prone restraint is inherently risky.

In other words, the concept that our brains actually need oxygen to survive appears to be lost on a significant fraction of those who work in law enforcement.

The Nashville cops try and justify setting themselves to forcibly administer powerful mind-altering drugs without judicial order (much less consent) by trundling out a local Emergency Services doc who tries to excuse away this insane practice by citing a diagnosis that doesn’t even exist: "excited delirium".

…they are assessing the situation and saying, ‘This person is not acting rationally. This is something I’ve been trained to recognize, this seems like excited delirium.’ I don’t view delirium in the field as a police function. It is a medical emergency. We’re giving the drug Versed that’s routinely used in thousands of health care settings across the country in the field by trained paramedics. I view what we’re doing as the best possible medical practice to a medical emergency," Slovis said.

The phrases "excited delirium" and "agitated delirium" were pushed on the world by law enforcement and the people who sell them weapons — like the nice folks from Taser. There is no such medical diagnosis.

The cause of death only appears where police are involved in restraining individuals.[2][3] The term has no formal medical recognition and is not recognized in the Diagnostic and Statistical Manual of Mental Disorders. There may also be a controversial link between "excited delirium" deaths and the use of Tasers to subdue agitated people.[4]

Am I relying on the Wiki? Nope — for years, delirium was a big part of how I made my living. Over years as a consultation-liaison psychiatrist responsible for organ transplant recipients and many oncology patients in a major UC teaching hospital, I diagnosed and treated delirium just about every week, and most days in most weeks. Why? Delirium is very common in patients so severely ill as to require hospitalization in major university teaching hospitals. By some estimates up to one-third of patients in major med centers on any given day will meet diagnostic criteria for delirium. Most will be quiet, so the delirium is often missed. A few will be disinhibited ("agitated") as a symptom of the delirium. "Agitation" is no more a diagnostic category for brain disease than "chest pain" is a diagnostic category for heart disease. Both are symptoms, not diagnoses.

Duh.

Delirium is characterized by a fluctuating (waxing and waning) impairment in orientation (accurate knowledge of self, time, location, and situation). Yep – on any given day, up to one third of acutely ill patients won’t quite know what day it is — and many won’t give an accurate answer about their location and/or situation. Over the course of the day, the level of disorientation waxes and wanes. Who cares? Well, in hospital patients, persistent delirium is one factor predicting an increased risk of death. Yet the delirium is very seldom the factor that causes death.

Delirium is simply an obvious indication of impaired brain function. In medical patients it may reflect other disease states (infection and/or major cardiac, pulmonary, liver, or kidney disease), medication side effects, or even prolonged sleep disturbance. Among these causes, the underlying disease is almost always what causes the delirium-associated deaths.

In people on the street, delirium may sometimes reflect medical illness, but is far more often simply a reflection of acute (and hence self limiting) intoxication with alcohol or other substances. In other words, on the street, delirium fortunately seldom indicates the patient has an acute medical illness — and far more commonly simply indicates acute intoxication.

Who cares? Well, the above facts explain why Dr Slovis’ excuse for forcibly giving Versed to delirious people on the street is bogus

I don’t view delirium in the field as a police function. It is a medical emergency.

Though some acutely intoxicated folks on the street do perish as a result of their confusion, the vast majority don’t. If they did, every Sunday morning college campuses across America would be littered with the bodies of those who got so wasted the night before they couldn’t find their way home.

To justify an insane policy, Nashville’s emergency service doc cites a spurious emergency from a non-existent diagnosis.

Of course, my "colleague" who attempts to defend having Officer Friendly direct EMS personnel to forcibly adminster Versed is the same doc presiding over use of a deadly drug with side effects that look exactly like the "symptoms" the Nashville PD presume to treat in the first place.

Nashville: home of country music and Gulag medicine. No wonder Johnny Cash gave ‘em the finger.

Scotty, if I ever end up drunk in Nashville, beam me outta there. Stat.

[photo: Virany]