Ketamine for procedural sedation by a doctor-paramedic prehospital care team

Abstract

Ketamine is a widely used drug that, depending on the dose administered, may be used as an analgesic or as a sedative or anaesthetic agent. A number of features make it attractive for prehospital use. At Essex and Herts Air Ambulance Trust, as with other services and under the guidance of a standard operating procedure, ketamine is used for both procedural sedation and as an anaesthetic agent for rapid sequence intubation. Guidelines exist that define levels of sedation and detail minimum standards of monitoring and personnel required for each level. We conducted a retrospective review from 4 years of our mission database for patients who had received ketamine for procedural sedation from the doctor-paramedic helicopter emergency medical service team. Other data relevant to the patient or the mission were also collected. A total of 212 cases of ketamine used for procedural sedation were identified. In all, 111 (52.4%) were for fracture manipulations and 52 (24.5%) were to facilitate extrication. An overall 12.7% of patients were paediatric (less than 18 years) and 160 (75.5%) were male. The helicopter emergency medical service team was with the patient for a mean of 24.4 min after the 999 call and spent a mean of 44.6 min on scene before departing for the hospital, which, in 75% of cases, was by means of a helicopter. A full set of monitoring was documented as having been used in 59 (27.8%) cases. We describe the use of ketamine over a 4-year period for prehospital procedural sedation. Minimum standards for patient monitoring were documented in only around a quarter of cases.