Re: Ketamine Use in the Prehospital Environment
EM Rap Video: Ketamine in EMS (an excellent short video from EM RAP summarizing the findings)
A recently published study provides good evidence that ketamine use is safe in the prehospital environment. The study, published in the Annals of Emergency Medicine, looked at 11,291 patients who were administered ketamine between Jan. 1 and Dec. 31, 2019. The primary applications were trauma/pain (49%) and altered mental status/behavioral indications (34%).
Ketamine was found to be very safe overall. Deaths were rare. Only 0.07% of the patients (8 patients) who received ketamine died from a cause where ketamine could not be ruled out as a contributing factor. Even in these 8 patients, the study did NOT conclude that ketamine caused their deaths, only that it could not be ruled out as a contributing factor.
There has been controversy surrounding the use of ketamine in the prehospital environment, especially for agitated/combative patients, following the death of Elijah McClain in Aurora Colorado. This study should reassure paramedics, medical directors and state EMS agencies and medical control boards that ketamine, when used properly, is generally safe.
This study does NOT, however, address the larger risks associated with sudden death in agitated patients. I have spent a considerable amount of time studying Elijah McClain’s death and more generally death in custody, and I believe the focus on ketamine misses the point. Situations involving agitated patients in custody are extremely dangerous:
agitated patients in custody are at high risk of sudden death, and we have not provided EMS or law enforcement with the protocols and training to minimize that risk. Death in custody has become an epidemic that was hiding in plain sight.
EMS providers and police officers are at high risk of liability and emotional trauma when these deaths occur.
The conclusion that ketamine is safe in the prehospital environment is welcome, but does nothing to address this larger question. Hopefully now the focus can turn from ketamine to asking what needs to be done to provide adequate protocols and training. I hope that it does not dilute the sense of urgency that needs to be brought to this important issue.
Want to learn more?
Report of the Independent Review Panel that looked into Elijah McClain’s death on behalf of the City of Aurora Colorado.
Attached below is an excerpt from the report containing the conclusions of the ED physician asked to review the actions of EMS