Prehospital Ketamine Use for the Combative Patient

The webinar took place November 6, 2020. The national discussion on the use of ketamine for patients suffering from severe agitation is rapidly evolving. Panelists discussed ongoing challenges and controversies with the prehospital use of ketamine for sedation. They also discussed NAEMSP’s new position statement on managing agitated or combative patients by emergency medical services.  Watch the webinar.

Key take-aways:

  • When training on management of combative or violent patients, EMS leaders should ensure our law enforcement colleagues also receive appropriate training to raise awareness that agitation or bizarre behavior may have underlying serious medical reasons that must be evaluated by EMS.
  • The overwhelming majority (> 99%) of patients given sedation are transported to a hospital, not a correctional facility.
  • While ketamine is shown to be a safe and effective medication, it still requires training for potential complications and diligent medical oversight.
  • While males were more likely than females to receive sedation, a national study found no evidence of racial disparity in EMS-administered sedation for patients in police custody; reviews at the individual agency level should be encouraged.
  • Among 1,878 records with available mortality data, there were only six deaths (0.3%) in which ketamine could not be excluded as a possible contributing factor.
  • Patient restraint should be viewed as a broad entity beyond the use of a single medication; the national position statement endorsed by multiple stakeholders includes education, training, QA, CQI, and extensive medical oversight by EMS Physicians as key components of an overall protocol.
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