Efficacy and safety of ketamine for pain in prehospital adult trauma: a review

The treatment of pain in the prehospital setting is suboptimal. The scope of paramedic practice is broadening, with more medicines becoming available to these professionals, including ketamine for pain management. A systematic literature review was carried out to examine the safety and efficacy of ketamine for adult trauma in a prehospital setting and its suitability for paramedics working outside an enhanced care scope of practice. Ketamine is effective in hypovolaemic patients and a preferred option for critically ill and hypotensive patients; it is particularly effective in alleviating trauma-based pain when used with opiates such as morphine or fentanyl. Side effects are rare and easily managed. Ketamine is a safe and effective addition to prehospital analgesia for adult trauma patients and safe for paramedics working outside an enhanced care scope of practice to administer. Advancing paramedics' understanding of the co-administration of ketamine and morphine versus ketamine alone would support decision-making in trauma-based patient.