The Use of Prehospital Ketamine for Control of Agitation in a Metropolitan Firefighter-based EMS System

Abstract

Introduction. Prehospital personnel frequently encounter agitated, combative, and intoxicated patients in the field. In recent years, ketamine has been described as an effective sedative agent to treat such patients; however, a paucity of research exists describing the use of prehospital ketamine. The objective of this study was to provide a descriptive analysis of the Columbus Division of Fire's experience with utilizing ketamine in the prehospital setting. We hypothesized that ketamine administration improves patient condition, is effective at sedating patients, and does not result in endotracheal intubation in the prehospital setting or in the emergency department (ED). Methods. We conducted a retrospective cohort chart review of Columbus Division of Fire patient care reports and hospital records from destination hospitals in the central Ohio region between October 2010 and October 2012. All patients receiving ketamine administered by Columbus Division of Fire personnel for sedation were included. Patients 17 years and younger were excluded. The primary outcome was the percentage of patients noted to have an “improved” condition recorded in the data field of the patient care report. The secondary outcomes were the effectiveness of sedation and the performance of endotracheal intubation. Results. A total of 36 patients met inclusion criteria over the study period. Data were available on 35 patients for analysis. The mean IV dose of ketamine was 138 mg (SD = 59.5, 100–200). The mean IM dose of ketamine was 324 mg (SD = 120, 100–500). Prehospital records noted an improvement in patient condition after ketamine administration in 32 cases (91%, 95% CI 77–98%). Six patients required sedation post-ketamine administration either by EMS (2) or in the ED (4) (17%, 95% CI 6.5–34%). Endotracheal intubation was performed in eight (23%, 95% CI 10–40%) patients post-ketamine administration. Conclusion. We found that in a cohort of patients administered ketamine, paramedics reported a subjective improvement in patient condition. Endotracheal intubation was performed in 8 patients.

Key words:

• prehospital
• agitation
• ketamine