Introduction: Ketamine is commonly used to treat profound agitation in the prehospital setting. Early in ketamine’s prehospital use, intubation after arrival in the emergency department (ED) was frequent. We sought to measure the frequency of ED intubation at a Midwest academic medical center after prehospital ketamine use for profound agitation, hypothesizing that intubation has become less frequent as prehospital ketamine has become more common and prehospital dosing has improved. Methods: We conducted a retrospective cohort study of adult patients receiving ketamine in the prehospital setting for profound agitation and transported to a midwestern, 60,000-visit, Level 1 trauma center between January 1, 2017–- March 1, 2021. We report descriptive analyses of patient-level prehospital clinical data and ED outcomes. The primary outcome was proportion of patients intubated in the ED. Results: A total of 78 patients received ketamine in the prehospital setting (69% male, mean age 36 years). Of the 42 (54%) admitted patients, 15 (36% of admissions) were admissions to the intensive care unit. Overall, 12% (95% confidence interval [CI]), 4.5-18.6%)] of patients were intubated, and indications included agitation (n = 4), airway protection not otherwise specified (n = 4), and respiratory failure (n = 1). Conclusion: Endotracheal intubation in the ED after prehospital ketamine use for profound agitation in our study sample was found to be less than previously reported.
Study Objectives: Emergency medical services (EMS) are an integral component of the health care system. Interaction with EMS and transition of patient care is a daily occurrence in emergency medicine (EM). EM learners present to residency with diverse levels of prior exposure and familiarity with EMS. Though the American College of Graduate Medical Education (ACGME) requires EM residents to have experience with EMS, emergency preparedness, and disaster management, there is significant variability in EMS curricula and training among residency programs. The goal of the exercise was to determine if a novel interdisciplinary education event, with focus on simulation and demonstration, increased EM resident and student knowledge of EMS systems and equipment as well as confidence interacting with EMS.Methods: A four-hour interactive, multidisciplinary simulation event was developed and held in the summer of 2020. EM residents and medical students rotated through multiple interactive stations that focused on EMS equipment and operations, online medical control, tactical EMS, and firefighting operations. Prior to the event, participants completed a survey to assess prior experiences, familiarity, and comfort with topics presented. An additional survey was provided at the completion of the event. Survey data was compared pre-and post-event to assess for change in responses. Items on the surveys were analyzed independently, and similar items were compared in aggregate. The post-event survey also assessed participants' perceptions of the exercise including organization and relevance.Results: 38 participants completed the pre-event survey; 27 completed the postevent survey with 23 participants identified and matched as answering both surveys. Composite scores showed a statistically significant improvement in learner confidence using the demonstrated EMS equipment and performing online medical control. Comfort with use of EMS equipment improved from an average of 3 to 4.33 (on a 1-5 Likert scale) after demonstration and practice with equipment. (p<0.0001). Average confidence providing online medical control improved from 1.33 to 2.67 (p<0.0001). Respondents indicated the event increased their familiarity with EMS, tactical EMS, and fire department operations. Post-survey perception data revealed that 100% of participants overall reviewed the event as well organized and enjoyable. 96% stated the exercise was relevant to emergency medicine. 93% stated they would use the knowledge gained in the experience in their future medical practice.Conclusion: This novel interdisciplinary educational event utilizing hands-on training and simulation was effective in increasing familiarity and confidence with EMS operations, equipment use and online medical control. Participants found the event to be a positive educational experience which increased their knowledge base and relevant to future medical practice. Further investigation comparing hands-on simulation exercises to classroom-based didactics would be instructive.
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