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    A retrospective analysis of ketamine administration by critical care paramedics in a pre-hospital care setting

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    Author
    Cowley, Alan cc
    Williams, Julia
    Westhead, Pete
    Gray, Nick
    Watts, Adam
    Moore, Fionna
    Keyword
    Emergency Medical Services
    Analgesia
    Ketamine
    Emergency Medical Technicians
    Journal title
    British Paramedic Journal
    
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    URI
    http://hdl.handle.net/20.500.12417/188
    DOI
    10.29045/14784726.2018.03.2.4.25
    Abstract
    Abstract published with permission. Objective: This project aims to describe pre-hospital use of ketamine in trauma by South East Coast Ambulance Service critical care paramedics and evaluate the occurrence of any side effects or adverse events. Methods: A retrospective analysis of patients receiving pre-hospital ketamine for trauma between 16 March 2013 and 30 April 2017. Administrations were identified from Advanced Life Saving Interventions and Procedures reports submitted by the clinician and, later, from an electronic database. Each was scrutinised for patient demographics, doses and reports of side effects or adverse events. Results: A total of 510 unique administrations were identified. Following the exclusion of 61 records, 449 (88.0%) administrations remained. The most common indication for administration of ketamine was lower limb injury, with 228 (50.8%) administrations. Ketamine was only administered intravenously, and the median dose of ketamine for all administrations was 30 mg (interquartile range 20‐40 mg). The gender split was dominated by males who accounted for 302 (67.3%) administrations compared to 147 (32.7%) females. The median age of patients was 44 years (interquartile range 28‐58 years), with women on average being older than men. Telephone calls to a consultant were made for 243/449 (54.1%) of the administrations, reflecting a need for sanctioning of the drug, advice on dosages or indications, for example. Conclusions: Critical care paramedics within a well governed system are able to safely administer ketamine within an approved dosing regimen under a Patient Group Direction. Median doses are in keeping with nationally approved guidelines. Reported side effects were within the described frequencies in the British National Formulary. Prospective studies are now needed in order to confirm the safety and efficacy of ketamine administration among the advanced paramedic population.
    ae974a485f413a2113503eed53cd6c53
    10.29045/14784726.2018.03.2.4.25
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