EMT-Is and the death penalty...

[Just Plain Ruff]

Yes I agree, I cannot believe that the State of Missouri Bureau of EMS would ever sign off on this. They are the ones who make the rules.

[Asysin2leads]

You know, uglymedic, I'm not for abuse of benzodiazipines, but in your case, I'll make an exception. You know, I was with you up until the raping of the mother thing, but then we just kind of had to agree to disagree, know what I'm saying?

Anyway, just so my point isn't completely lost to history, primum non nocere is something that medical providers, not criminals, swear to, unless of course the medical provider is a criminal, in which case, oh I'm getting confused. Its not something for them to think of or not think of, its for us to think of in all of our actions, and you know why? Because it makes us better people. I mean as medical providers, not as a society, I'm actually in favor of the death penalty. To make one more point, even the executioner shouldn't get any pleasure or thrill out of offing the condemned, except for maybe the satisfaction of seeing justice carried out. Thats what seperates our justice system from a lynch mob.

To really boggle your noodle, here's something to consider. If you get pleasure out of executing the condemned, then doesn't that mean in some little way you have benefited from his heinous crime? If he didn't commit the crime, you wouldn't get what ever pleasure you derive from watching him die, therefore, in someway, you are benefitting from the victim's pain and suffering and death. Life is so complicated sometimes. And yes Ace, the you're right in the case you're thinking of. Happened in an area I cover. Actually, if it was Tuesday, I think I was working the overnight, so that means that while I sat in the ambulance only a couple of blocks away from me there was an 18 year old girl fighting for her life. Not a good feeling.

[Ace844]

That was rough I am sure...I am also sure finding that must have been worse...I'm glad it wasn't me, and I am quite sure Rykers is too nice a place for that trash, especially with his history. I heard a rumor your boys in blue tuned him up... good....

Hope all is well in your neck of the woods, I amy be down in the bronx in a few months.. Hope to run into you and Richard in the city. Also, I agree with your statements above! Be safe,

ACE

[Michael]

To really boggle your noodle, here's something to consider. If you get pleasure out of executing the condemned, then doesn't that mean in some little way you have benefited from his heinous crime? If he didn't commit the crime, you wouldn't get what ever pleasure you derive from watching him die, therefore, in someway, you are benefitting from the victim's pain and suffering and death. Life is so complicated sometimes.

A noodle-boggler with an august pedigree.

[ALERT Medic]

As far as verbal or written directives, it is still outside of scope to administer such things. I guess there's the lengthy argument of what is in and out of scope. Technically, IV Medication administration is within the scope, so it is allowed. Until protocols come up for "Lethal Injection", it shouldn't be done by EMT's. Regardless of what a Doctor orders, we are still limited by protocols.

Actually, it is within most scope of practices. Basically all they do when they perform a lethal injection is the same thing that most services around the states do when they perform RSI. They give a sedative, paralytic agent then the only difference is that they give a large overdose of usually calcium chloride. That's it. Now I know that RSI is in my state scope of practice and we give calcium chloride for hyperkalemia and have standing orders for it. So I ask you, how is it out of a scope of practice?

Either way, just train one of the prison guards to start the line because once the line is running it's all automated...they just push buttons and the drugs are administered.

I'm not going to give my opinion of weather or not ems personnel should be putting people down or not. I think this thread has already sparked some heated debates. I just don't think many people have researched just what goes into a lethal injection. It's not that big of a deal.

[paramedicmike]

Actually, I think the drug most commonly used to actually kill the inmate is Potassium Chloride. And KCl is certainly outside the SOP of any medic out there. I've never heard of CaCl given to kill the inmate.

And no matter how you spin this it is not included in any SOP out there. It can't be compared to an RSI as the drugs most commonly used aren't used in an RSI (with some exceptions for those that use Succs to paralyze) protocol.

What's further is that we can't operate without the authority of a medical command physician. That means until a MCP gives us the authority (and accepts us under his/her license to do such) to start an IV on an inmate for the purpose of a lethal injection we can't do it. (This is why we can't just run around with IV stuff and meds in out POVs.) And it plays into the larger issue here being that they can't get a doc to sign on to do this.

And I'll disagree with the idea that it's not that big a deal. Technically, no. Starting a line and pushing a button is not a big deal. But it's the end result that's important. Most of us can start lines with our eyes closed in a bouncing truck. But we're not doing it for the purpose of killing a patient.

This is not an issue or attack on anyone who personally feels or believes that capital punishment is good, warranted and justified. This is an issue of medical ethics. And ethics is why this has become an issue. When we started working in EMS we allowed ourselves to be bound by certain ethical guidelines. We cannot, as a profession, excuse ourselves from that when it serves our personal beliefs. And I'd argue that if you do allow yourself to cloud the line between professional and personal ethics then you shouldn't be working in this industry.

-be safe.

[ALERT Medic]

Thanks for the clarification mike, I couldn't remember with 100% certainty but I thought it was calcium. As far as you disagreeing with my comments on it not being a big deal, I think you misunderstood me. It's not a big deal to teach someone how to start a line and perform whatever procedure goes along with lethal injection as far as the end result goes now that becomes an issue of semantics and I won't discuss that with anyone on this or any other forum. Thanks again for the clarification but the initial procedure is the same as doing RSI and most services do have standing orders to administer those meds.

Take care.

[paramedicmike]

Thanks for the clarification mike, I couldn't remember with 100% certainty but I thought it was calcium.

No worries.

As far as you disagreeing with my comments on it not being a big deal, I think you misunderstood me. It's not a big deal to teach someone how to start a line and perform whatever procedure goes along with lethal injection...

Got it.

... as far as the end result goes now that becomes an issue of semantics and I won't discuss that with anyone on this or any other forum.

Fair enough.

Thanks again for the clarification but the initial procedure is the same as doing RSI and most services do have standing orders to administer those meds.

Well, not really. Sure, if you look at the basic steps of sedate and paralyze then yes, it's similar. But these are the most commonly used meds used in lethal injection and are not available on standing orders to most (if any) services:

Sodium thiopental: to induce a state of unconsciousness intended to last while the other two injections take effect. Not commonly used in prehospital RSI due to the lack of analgesia provided by this med.

Pancuronium: to stop all muscle movement except the heart. This causes muscle paralysis, collapse of the diaphragm, and would eventually cause death by asphyxiation. This isn't used either due to it's long onset and long duration. Perhaps it might be used once tube placement is obtained as a long acting paralytic. But it's generally not the first choice nor am I aware of any service, ground or flight, who uses this medication in the field.

Potassium chloride: to stop the heart from beating, and thus cause death. This is not in any way, shape or form in any paramedic level formulary.

I'll agree to a certain extent that it mimics an RSI procedure in preparation only. I will disagree, and continue to argue, that these meds fall within the SOP of paramedics...certainly they're not part of any standing orders to most services out there.

-be safe.

[uglymedic]

Asy, you must have gotten an A+ in philosophy. I must commend you on that string. It is quite the brain twister. However, I think it would be ethical because the executioner does not make the person commit the crime. Therefore, any "pleasure" (I don't think that word is correct - sounds like a person getting their jollies by doing it) would be in seeing punishment and justice carried out. I can see how my previous messages could make a person think of the word. When I think of innocents like women and children being harmed like that, I believe there should be swift and merciless justice. I know exactly what I would do to someone that hurt or killed my family and close friends. I think there are many people who are against the death penalty simply because they don't like the word "death". Many, but not all of these people, have never had a member of their family fall victim to a rapist, murderer, or child molester. I do not mean to offend any of those who have and are still against the death penalty. They are by far bigger and better than I. Unfortunately, I am not capable of that degree of forgiveness.

There are a great deal of posts that love to throw the word "ethics" into play, and by all means they should. This has a great deal to do with ethics, but I believe on a more personal level. You would be, simply put, following a protocol. Fortunately, or unfortunately in my eyes, my state does not have the death penalty.

In continuing with the ethics debate, let's open another door... What about the "ethical" people in EMS that are guilty of drinking and driving? Spousal/child abuse? Substance abuse? Use of illegal internet porn? I have seen patients die because of incompetency on the part of other medics and nothing done about it. What is done about these people? Where are your ethics now? Are ethics only applicable when death is discussed, or when it's convenient?

Anyway Asy, I am more than happy to agree to disagree with you. This is nothing more than opinions anyway and I take no offense by anyone being for or against it. This is supposed to be a mature discussion about a controversial subject and I find it intellectually stimulating. I'm just trying to point out a different point of view.

Oh, and while the offer of benzo's is nice, I'll just stick to Captain Morgan and Diet Coke. Maybe some Mike's Hard Lemonade for fun and because of the heat.

Peace and love y'all!

ugly

p.s. Huh-huh, I said stimulating!

[uglymedic]

Oh, and if I'm not mistaken, the cocktail is: Versed, Norcuron or Vercuronium, and Potassium Chloride. In that order.

Still more than they deserve. I've never heard of a murderer giving sedatives to their victims to avoid "cruel and unusual punishment".

ug