Ketamine use by paramedics

A poster presentation at the Australasian College of Emergency Medicine’s Annual Scientific Conference in Melbourne in November 2009 reports 100 cases of pre-hospital ketamine use for analgesia by paramedics in New Zealand – reproduced below with permission of the author:

Ketamine is a safe and effective analgesic for pre-hospital paramedic led pain relief
HM Hussey & BC Ellis
Introduction: There have been a number of reports on the use of ketamine by pre-hospital physicians, with many advocating its use as the ideal pre-hospital analgesic and sedative due to its airway and cardiovascular stability. There however is little published on its use by paramedics. This study aims to review its effectiveness and safety when administered pre-hospital by paramedics.

Method: Prospective observational study of 100 consecutive administrations by St Johns ambulance paramedics in 2008–09 using a specifically designed data sheet. Demographic data, adjuvant analgesics used, ketamine dose, pre and post dose pain scores on VNRS and physiological parameters were collected. In addition paramedics and patients completed a satisfaction rating score.

Results: The mean dose of ketamine used was 30.2 mg and the mean improvement in pain was 5.10. Ketamine was used both as a lone agent and with morphine; excellent analgesia was achieved in both groups. The most common reason for use was limb trauma followed by burns and extractions from scene. There were no episodes of hypotension or airway compromise. 15% of patients had an adverse reaction all mild and mostly comprising minor psychotropic effects. The median satisfaction rating for both paramedics and patients was ‘Good’.

Conclusion: These results back the use of Ketamine by St John’s Ambulance paramedics and the authors support its use by other pre-hospital services as a safe and effective analgesic.

Emergency Medicine Australasia 2010;22(S1):A30