A Descriptive Assessment of Prehospital Ketamine Administration Using a Statewide Data Repository 

Introduction: Ketamine is a powerful analgesic with a favorable risk profile. Few studies have described patients who received prehospital ketamine. 

Objective: Describe patients who received prehospital ketamine in West Virginia. 

Methods: This retrospective observational study included all West Virginia 9-1-1 patients who received prehospital ketamine from Jan. 1–Dec. 31, 2019. Data were obtained from the West Virginia EMS data repository. West Virginia protocols allow ketamine administration for pain and excited delirium. EMS provider impressions were categorized as pain/injury, altered mental status (AMS)/behavioral, and other. Patient primary symptom, demographics, and community size were evaluated. Descriptive statistics were reported. 

Results: In 2019 there were 154,906 West Virginia 9-1-1 patients, and 173 (0.1%) received prehospital ketamine. Among all prehospital patients given ketamine, most were male (63%, 106), white (93%, 135), and in urban areas (50%, 76). Median age was 41 (IQR: 29–59). In all, 62% (74) of patients with pain/injury impressions, 33% (40) with AMS/behavioral, and 6% (7) with other received ketamine. Among patient with pain/injury impressions, 71% (48) had a primary symptom of unspecified pain, 21% (14) had hemorrhage/bleeding, 3% (2) had slowness/poor responsiveness, and one each had the following: abdominal tenderness, abnormal involuntary movements, dyspnea, and nausea. Most of these were male (65%, 46), white (95%, 60), and in rural areas (64%, 44). Median age was 45.5 (IQR: 29–60). Among patients with AMS/behavioral impressions, 46% (12) had a primary symptom of strange/inexplicable behavior, 31% (8) slowness/poor responsiveness, 8% (2) AMS, 8% (2) combative/violent behavior, 4% (1) restlessness/agitation, and 4% (1) suicidal ideations. Most of these were male (54%, 21), white (90%, 26), and in urban areas (75%, 24). Median age was 35 (IQR: 28–62). Among patients with other impressions, the only primary symptom reported was unspecified pain: 71% (5) were male, 83% (5) white, and 86% (6) in urban areas. Median age was 72 (IQR: 41–76). 

Conclusion: More West Virginia 9-1-1 patients received prehospital ketamine for pain/injury than for AMS/behavioral impressions. Ketamine for pain/injury was administered more often in rural areas, while ketamine for AMS/behavioral impressions was more frequent in urban areas. Those with pain/injury were older than those with AMS/behavioral impressions. Future research should evaluate the effectiveness of ketamine for pain/injury and AMS/behavioral impressions.