Ketamine Update

So you may have noticed that ketamine has been in the news quite a bit lately. And we've been using ketamine here for a variety of reasons at Palm Beach County Fire Rescue. And this is a really, really great drug when used under the proper circumstance and the proper parameters. So we've used this as a great pain control method, and we find it's even better than fentanyl for pain. We've just recently found that it's fantastic for status epilepticus. So these are folks that would go on to have BR damage or death, yet ketamine is able to stop their seizure. We use it to safely intubate folks, and we use it for sedation for patients that are violent and a danger to themselves or others. So you may have seen that it's been in the news as, quote, a law enforcement drug. We never use this as a law enforcement drug. We use this for medical reasons only. But because it's been in the news so much and undergoing a lot of scrutiny, now it's time for us to double down on making sure we're following our protocol to the letter. Every single one of these cases will be reviewed. We'll be doing CQI on them. So I'm going to ask you to be very, very diligent about your documentation. We know you're providing good care out there, but now you have to make sure that you're providing really good documentation so we can prove you're doing the good care. Every single case gets monitoring, and I mean every single type of monitoring. End Tidal, CO2, Pulse Ox, EKG, Temperature, Vitals, etc. Every single case gets good documentation of why you had to go to the point of giving somebody ketamine. And just be mindful that there are two doses of ketamine used for sedation. Folks that are older than 65, head trauma, other CNS, depressants or small stature. We obviously go the lower dose, the smaller dose, and then the more moderate dose for younger and larger folks. So please be diligent about your ketamine cases, make sure that you are documenting well, and understand we're going to be very closely monitoring this as this unfolds in the public. And it does take a little while for the public to understand why we do some things. We have found, we've got a lot of experience at Palm Beach County Fire Rescue, that this is an extreme, extremely safe medication, a fantastic tool, and certainly we use it for far more than just patients who are violent or have excited delirium. It's got many, many positive uses, and it's great impact for the health of our citizens. But it's up to us to make sure that we are following all the best practices that are now in your protocol and that we're using this drug in a safe and responsible manner.

I'm using ketamine in children for over 21 years. It's a very safe drug. It has got a very wide therapeutic window. But like Dr. Schepke said, when we're using ketamine in the emergency department, we're monitoring, we're doing all the right things. We're giving IV fluids. Non rebreather masks are available. You have to be sure that whether it's a child or an adult, you're actually, you know, you're checking all the boxes, doing all the right things for the patient. But ketamine, great drug. And I think that we ought to use it, you know, just like the protocol states that we should do.