AURORA | Officials with Aurora Fire Rescue will not renew the department’s state waiver to use the powerful sedative ketamine after it expires next month, authorities said Thursday.
Fire Commander Rod Weber told a panel of Aurora City Council members that officials will not seek permission from the Colorado Department of Public Health and Environment to use the hallucinogenic tranquilizer after the city’s current allowance is up at the end of May. State health officials have been granting dozens of health agencies waivers to use ketamine since 2013, though Aurora Fire didn’t begin using the substance until January 2019.
First responders’ use of ketamine in Colorado has been the subject of increased scrutiny following the death of Elijah McClain, the 23-year-old Black man who was injected with the drug in north Aurora after a passerby described him as “sketchy” in August of 2019.
Fire crews in Aurora have been barred from using the drug since city council members unanimously passed a moratorium on its use last September. Fire officials administered ketamine 18 times in 2019 and twice in the first six months of 2020, though it’s unclear how many times it was used between July 1 and 8 a.m. on Sept. 15, 2020, which is when the moratorium officially went into effect.
The local ban on the dug’s usage was slated to run, at a minimum, for one month after a consultant tasked with evaluating the city’s response to McClain’s death briefed council members on his findings on Feb. 22. The city has no plans to use ketamine in the coming weeks, despite the end of that window following Smith’s investigatory findings, Aurora Fire officials confirmed.
“Ketamine is not available for field use in Aurora at this time, and there is no timeline for reimplementation,” a spokesperson for Aurora Fire Rescue wrote in an email earlier this month. “The medical direction team will continue to evaluate and review the protocols/trainings to determine the best approach for our patients.”
Council member Curtis Gardner said fire officials have agreed to alert council members assigned to the city’s public safety policy committee if they plan to administer ketamine in the future.
In his report, Smith and other consultants urged city officials to incorporate forthcoming federal guidelines on ketamine use into any future protocols. They also encouraged paramedics to use smaller doses of the drug.
“Should the city ultimately allow Aurora Fire to resume its use of pre-hospital ketamine, we recommend reducing the weight-based dose and maximum dose of ketamine,” consultants wrote. “Dosing guidelines from multiple sources in emergency medicine and EMS offer a typical range of three to five milligrams per kilogram for intramuscular administration of ketamine for sedation. Using the low end of the range will help preserve a large safety margin in the setting of weight estimation without significantly increasing the risk of undersedation.”
Aurora Fire paramedics overestimated McClain’s weight by nearly 80 pounds and injected him with 500 milligrams of the sedative after officers had placed him in a now-banned chokehold. The 23-year-old massage therapist died several days later.
Fire officials determined paramedics followed departmental protocols after reviewing McClain’s death. No public safety officials have been criminally charged in connection with the incident, though a state grand jury probe is pending.
Fire Chief Fernando Grey on Thursday outlined how fire officials will incorporate Smith’s recommendations into departmental guidelines. At the top of the list of new protocols is smoothing the transfer of authority form Aurora Police to Aurora Fire, a practice that was condemned as ambiguous and ineffective in Smith’s report.
Officials will also retool the “culture of patient care” within Aurora Fire, another area that was criticized in the recent report.
“We want this to be a full cultural shift within our organization,” Deputy Fire Chief Cynthia Andersen said Thursday.
A memo detailing new Aurora Fire training is scheduled to be released early next month, according to city documents. In-person trainings on the relevant topics are expected to begin in October.
Without ketamine aboard local fire rigs, paramedics will be forced to use alternative sedatives that studies suggest take longer to take effect and result in a lower level of sedation, according to the consultants’ findings.
“This moratorium also means that Aurora Fire paramedics must rely on medications demonstrated to be less effective in patients with significant agitation,” the report reads.
A doctor who participated in Smith’s probe pointed to studies that indicate ketamine remains an appropriate drug to sedate “agitated” people who come into contact with first responders.
The departmental changes discussed Thursday come as state legislation and investigations related to ketamine use in Colorado continue to wind forward.
A state bill recently introduced by a pair of metro area Democrats seeks to tighten restrictions on the use of restraints like ketamine. The proposal is scheduled to be heard in the House Judiciary Committee on April 21.
An Aurora City Council committee that keeps tabs on state legislation adopted an “amend” position on the current measure April 14, suggesting officials would favor changes to the introduced language.
And a state investigation into the use of ketamine led by the state health department remains underway, with several additional months of work ahead, a spokesperson for CDPHE confirmed.
A panel of unidentified experts has been meeting periodically since last summer as part of the ongoing probe, according to departmental spokesperson Peter Myers. The group’s findings are expected to be made public in the coming months.
“We have empaneled a group of experts to examine if the department’s existing ketamine waiver process provides adequate oversight and training to ensure public health and safety,” Myers wrote in an email. “Since its formation, the panel has met several times and will continue its work over the next several months. As it does with all investigative reviews of this type, CDPHE is limiting the release of information about both the panel members and the process to protect the integrity of the work. While we are not disclosing the panel members’ identities during the investigative review, the members are medical professionals with relevant expertise to conduct this work. The panel members’ expertise includes Anesthesiology, EMS Medical Direction, Emergency Medicine, Behavioral Health, Nursing, Toxicology, Public Health, and EMS practice, with several panel members having multiple certifications or areas of expertise. Additionally, subject matter experts from other professions are participating as needed.”
Aurora City Council members took no formal action on the forthcoming changes within the local fire department discussed Thursday.