Ammonia Capsules in EMS

[Guest guest]

Ammonia capsules do not belong in ambulances or anywhere. I thought we had

abandoned the practice until this reporter in Tampa called me Friday. The

article follows:

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Camp's Ammonia Use Unusual, Probe Finds

By ELAINE SILVESTRINI The Tampa Tribune

Published: Mar 17, 2007

TAMPA - After Lee fatally collapsed at a Bay County boot

camp, officials at the facility started calling other boot camps to ask how

they used ammonia capsules, newly released records show.

Officials from at least three different boot camps told the Bay County

officials that only medical personnel used the capsules, also known as

smelling salts.

The use of the capsules at the Bay County camp became a focus of the

criminal investigation that led to manslaughter charges against a nurse and

seven drill instructors.

The Hillsborough County medical examiner ruled in May that , a

14-year-old newly arrived inmate at the boot camp, suffocated when guards

covered his mouth and stuffed his nose with ammonia capsules that produced

irritating fumes.

Then-Gov. Jeb Bush assigned Hillsborough County State Attorney Mark Ober in

February 2006 to investigate 's death, which created a firestorm

that led to the closure of all boot camps in the state.

This week, Ober's office released more than 20,000 pages of records in the

case. Reports show that prosecutors and investigators homed in on the use of

the capsules at the camp, questioning medical experts and camp employees

about them.

The capsules - once a mainstay in funeral homes that kept them to revive

fainting mourners - have fallen out of favor in the emergency medical

community, said an expert who has researched the issue. A legal expert said

the rarity of their use is likely to become an important factor in the

manslaughter case.

collapsed Jan. 5, 2006, and died the next day.

The day died, Bay County Sheriff Mcen called the

Pinellas County boot camp, according to a report contained in the newly

released documents.

The Pinellas commander, Lt. Klein, told investigators that she told

the sheriff her camp had no policy regarding ammonia capsules " because that

would be a procedure for medical staff only, " the report states.

Officials at boot camps in and Manatee counties had similar responses

when contacted by other Bay County camp officials, reports show.

According to records, Bay County drill instructors used the capsules on

three different times for a total of nearly seven minutes, covering

his mouth to force him to breathe in the fumes.

Nurse Schmidt later investigators that she gave instructors at the

camp ammonia capsules that were purchased at a drugstore.

Article Finds Fault With Capsules

Generally, use of the capsules dates back decades and is not supported by

any scientific research, according to Bledsoe, professor of emergency

medicine at Washington University. Bledsoe authored an article

published in the Journal of Emergency Medical Services in 2003 that argued

the capsules should not be used.

" There's absolutely no role for those in modern society, " Bledsoe said.

Bledsoe said the capsules have fallen out of favor in medicine but

occasionally are used by emergency medical technicians and some doctors as

punishment for patients who do not comply with directions.

The ammonia fumes from the capsules displace oxygen and attract water,

Bledsoe said, making it difficult for the patient to breathe. Anyone with a

medical condition that compromises the ability of the blood to take in

oxygen - such as sickle cell trait or asthma - could be particularly

vulnerable when the capsules are used, Bledsoe said.

had sickle cell trait.

The fact that the practice of using the capsules has been discredited and is

unusual likely will play a central role in the manslaughter prosecution,

according to defense lawyer Doherty, who is not involved in the

case.

" The more unusual the practice, the more likely it was not legal, " Doherty

said. " The reason it's unusual is there are certain risks involved. "

The guards, Doherty added, " clearly don't know or don't appreciate the

gravity of what they're doing. Isn't that what someone does who steps into a

car when they're drunk or shooting off guns in crowded places? It's not like

you intentionally killed this person. You just did something so unusual and

so reckless that it ended a person's life. "

A Bay County drill instructor who was not charged in 's death told

investigators that the capsules were carried at the camp by those with the

rank of corporal or above. The instructor, Cpl. Adamczyk, said he had

used the capsules twice.

Typically, he said, a youngster would run a mile and a half and then slow

and complain of being tired and unable to breathe. " We'd walk up, grab him

and put him in the escort position, give him the opportunity to catch his

breath and get going, " Adamczyk said.

" If they feel like, 'Oh, I'm gonna pass out,' we'd pop one and run it under

their nose. They'd wake up. 'You feel better now?' 'Sir, yes, sir.' 'Well,

go, finish your run.' You snap one of those under their nose. It'll fix

'em. "

Adamczyk began working at the camp in 2002. Asked when the ammonia capsule

practice began, he said, " That was in place before I started there. I never

got formal training on it. I just know, I just went from what I seen other

folks using it. "

A Hillsborough County sheriff's investigator reviewed surveillance

videotapes at the camp and found six instances of ammonia capsules used in

2005, according to records. There is no indication in the records whether

any medical problems arose as a result of the use of the capsules.

Commander Reviewed Usage

The boot camp commander, Capt. J. , told investigators he

wanted to know why so much ammonia had been used on . To his

knowledge, the capsules usually were held under the nose for four or five

seconds.

After the incident with , reviewed old intake tapes and saw

that other instructors had held their hands over youths' mouths while

administering ammonia to resuscitate them.

Lt. Helms explained to him that " they put the hand over the mouth

because the child will breathe through their mouth and not through their

nose and not get the effect of the ammonia, " said. Helms is among

the instructors charged with manslaughter.

Ammonia was never approved as a " compliance tool, " said.

It wasn't until the incident with , said, that he learned

ammonia capsules had been distributed to all supervisors at the rank of

sergeant and above " for convenience purposes or time issues " - not

distributed through the nurse as they had been in the past.

Ammonia was used, as far as he knew, only on " intake day, " because that's

when " you find your kids that were in the least physical condition " and

fainting, he said.

On Feb. 6, 2006, responded in writing to questions from the

sheriff. said the camp had no written policy for the use of the

capsules " other than basic first-aid requirements. "

" The technique that Lt. Helms used in this case was of his own decision, "

wrote.

was not charged in connection with 's death.

Editor Altman and reporter Kalfrin contributed to this

report. Reporter Elaine Silvestrini can be reached at

esilvestrini@... or .

[Guest guest]

Ammonia Capsules in EMS

>>>suffocated when guards covered his mouth and stuffed his nose with

ammonia capsules that produced

>>> irritating fumes.

This is a " duh " ...cover the mouth and stuff the nose with ANYTHING

causes suffocation...not rocket science!

Scares ya that people can still buy this stuff off a shelf or out of a

catalog and use it however they decide to!

jules

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[Guest guest]

They don't belong on the boxes, I cannot remember the last service I worked for

that actually carried them either, for just that reason.

Too many variables....

Mike

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

---------- Original Message ----------------------------------

Reply-To: texasems-l

Date: Sun, 18 Mar 2007 12:19:52 -0500

>Ammonia capsules do not belong in ambulances or anywhere. I thought we had

>abandoned the practice until this reporter in Tampa called me Friday. The

>article follows:

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