Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement

Abstract

The American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP) and the National Association of EMTs (NAEMT) have previously offered varied guidance on the use of ketamine in trauma patients. The following consensus statement represents the collective positions of the ACS-COT, ACEP, NASEMSO, NAEMSP and NAEMT. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, nurses and pharmacists in their treatment of the trauma patient in both the prehospital and hospital setting.

Battlefield pain summit 2022: Expert consensus statements

“…In addition, an operational need for a sedation and amnesia effect has driven many medics to combine high-dose ketamine with benzodiazepines, greatly reducing the safety compared with that of ketamine alone at analgesic doses. Research involving ketamine as an adjunct to other analgesics and the role of ketamine in battlefield sedation is warranted 12,13 …”

“…Research involving ketamine as an adjunct to other analgesics and the role of ketamine in battlefield sedation is warranted. 12,13 Statement #3: Battlefield Pain Research Should Prioritize the Most Common Battlefield Patterns of Injury Extremity fracture and gunshot wounds, amputation of 1 or more extremities, and multiple fragment wounds are common battlefield injuries that result in significant pain and are usually survivable. 14 Torso and head injuries are less common since the advent of highly effective body armor and helmets; when present, these injuries also result in significant pain and are overall less survivable.…”

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

“…This makes ketamine a suitable choice for trauma patients if hemorrhagic shock is suspected. 136 Recommendation: We recommend ketamine for the control of acute severe pain in the austere setting using pain-control doses (0.1-0.5 mg/kg IV, 1-2 mg/kg IM). Providers should be experienced in using the medication and equipped to manage airway complications should they arise (strong recommendation, moderate-quality evidence).…”

Low-dose ketamine in the prehospital setting

“…3 Importantly, a joint position statement supporting the prehospital use of ketamine as an analgesic in acute trauma patients has recently been published by several American organizations, including the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians and the National Association of Emergency Medical Services Physicians. 4 Given the limitations of opioids, nonopioid analgesia is clearly needed in the prehospital environment. Examples include high-acuity trauma patients at risk for (or exhibiting) hemorrhagic shock or respiratory compromise, patients in severe pain with known allergies to morphine and fentanyl, and patients with a history of narcotic use disorder who do not wish to be administered opioids or who are receiving treatment with buprenorphine -naloxone.…”