A Ketamine Protocol and Intubation Rates for Psychiatric Air Medical Retrieval

Area of Science:

• Emergency Medicine
• Psychiatric Care
• Aeromedical Services

Background:

• Air medical transfer of acutely agitated psychiatric patients presents unique management challenges.
• Optimal sedation strategies, including physical restraints and endotracheal intubation, are not universally defined.
• The Royal Flying Doctor Service (Queensland Section) sought to optimize patient management during air transfers.

Purpose of the Study:

• To evaluate the impact of a ketamine sedation protocol on endotracheal intubation rates.
• To compare intubation rates before and after protocol implementation in an Australian air medical service.
• To assess the effectiveness of ketamine sedation for managing agitated psychiatric patients during aeromedical transport.

Main Methods:

• A systematic retrospective review of 9 years of data (2004-2013) from the Royal Flying Doctor Service (Queensland Section) electronic database.
• Data analysis focused on patients with mental health as the primary diagnosis requiring air transfer.
• Intubation rates were compared for periods before and after the implementation of the ketamine sedation protocol.

Main Results:

• A total of 1,478 patients were transferred during the study period.
• 44 patients required intubation, representing an overall intubation rate.
• Intubation rates decreased from 3.5% before protocol implementation to 2.3% after implementation.

Conclusions:

• The implementation of a ketamine sedation protocol effectively reduced endotracheal intubation rates in acutely agitated psychiatric patients undergoing air medical transfer.
• Ketamine sedation offers a viable and potentially safer alternative to intubation for managing these patients in aeromedical settings.
• This study provides evidence supporting the adoption of sedation protocols to improve patient outcomes in specialized air medical services.