Ketamine administration by HART paramedics: a clinical audit review

Abstract

Hazardous Area Response Team (HART) paramedics from a single ambulance service Trust were trained to administer ketamine up to 0.5 mg/kg for analgesia in the pre-hospital environment. The Trust's special operations department felt that, in doing so, patient care could be improved in both hazardous areas and regular pre-hospital clinical situations. After completing a written examination and scenario training on the relevant Trust patient group directive (PGD), HART paramedics were authorised from 4 July 2016 to administer ketamine autonomously. HART paramedics then retrospectively self-reported on the details of administration using a computerised auditing application called iAuditor. Data from 1 year of usage were then collated and analysed using Microsoft Excel with the aim of identifying current practice and developing recommendations for the future. Despite encountering complications, safe independent use of ketamine was demonstrated and was shown to be an effective analgesic agent in the majority of incidents. Suggested methods for developing and improving ketamine use by paramedics are discussed. Furthermore, a number of recommendations for optimising the Trust's ketamine PGD and the iAuditor template were identified. This work has provided the foundations for future audit and research.