Ketamine Investigatory Review Panel Appendices

The listing below contains, for easy reference, the acronyms used in the executive summary as well as in the findings and recommendations sections of this report.  

• ACEP:  American College of Emergency Physicians
• ACMT:  American College of Medical Toxicologists
• AMA:  American Medical Association 
• APA:  American Psychiatric Association
• BCCTPC:  Board for Critical Care Transport Paramedic Certification - a non-profit organization that develops and administers the Critical Care Paramedic Certification and Flight Paramedic Certification exam.
• CDPHE:  Colorado Department of Public Health and Environment
• Certification/Licensure:  Designation as having met CDPHE’s requirements for EMS providers. The terms certification and licensure are used in this report interchangeably.
• CMB:  Colorado Medical Board 
• CQI:  Continuous Quality Improvement - refers to a program used to objectively, systematically and continuously monitor, assess and improve quality and appropriateness of care. 
• CQM:  Medical Continuous Quality Management Program - another term for a continuing quality improvement program, used in CDPHE ground ambulance agency regulations.
• C.R.S.:  Colorado Revised Statutes
• CSA:  Colorado Society of Anesthesiologists
• CSAPH:  The Council On Science And Public Health Reference Committee, American Medical Association
• DMEMSMD:  Denver Metro EMS Medical Directors
• DORA:  Department of Regulatory Agencies - the state department that regulates professions; includes the Colorado Medical Board
• DSM-5:  Diagnostic and Statistical Manual of Disorders (5th ed.)
• EMPAC:  Emergency Medical Practice Advisory Council- a board that advises CDPHE on matters related to EMS provider scope of practice as well as on the criteria and minimum standards for physicians to serve as medical directors.  
• EMS:  Emergency Medical Services
• EMS Medical Director: a physician licensed in Colorado and in good standing who authorizes and directs EMS agency providers through protocols and standing orders
• EMS Provider: an individual who holds a valid emergency medical service provider certificate or license issued by the Department and includes Emergency Medical Technician, Advanced Emergency Medical Technician, Emergency Medical Technician Intermediate and Paramedic. 
• EMTS: Emergency Medical and Trauma Services
• ePCR:  Electronic patient care report
• ExDS:  Excited Delirium Syndrome. The terms “excited delirium” and “excited delirium syndrome” are used in this report interchangeably.  
• GCS:  Glascow Coma Scale
• CD 10:   International Classification of Diseases, 10th Revision. ICD defines the universe of diseases, disorders, injuries and other related health conditions.  ICD is the foundation for the identification of health trends and statistics globally and the international standard for reporting diseases and health conditions. 
• IM: Intramuscular 
• IN: Intranasal
• IO: Intraosseous
• IV: Intravenous
• KIRP:  Ketamine Investigatory Review Panel (or panel)
• Medical condition:  as used in this report means a physical, traumatic or behavioral condition unless the context dictates otherwise.
• NAEMSP:  National Association of EMS Physicians
• NEMSIS: The National Emergency Medical Services Information System - a national database that stores EMS data from the states and territories.  
• NHTSA:  National Highway Traffic Safety Administration
• Paramedic: a Colorado certified or licensed individual who is authorized to perform advanced acts of emergency medical care.
• P-CC:   Paramedic with a Critical Care Endorsement
• PCR: Patient Care Report
• QA: Quality Assurance
• QI:  Quality Improvement
• RASS:  Richmond Agitation Sedation Scale
• RETAC: Regional Emergency Medical and Trauma Services Advisory Council 
• RSI: Rapid Sequence Induction 
• SEMTAC: State Emergency Medical and Trauma Services Advisory Council - a 32 member board that provides expert advice to CDPHE on all matters related to emergency medical and trauma services.
• Standing Order: written authorization provided in advance by a medical director for the performance of specific acts by EMS providers.
• Verbal Order: authorization is given by physician via direct verbal order or written order received contemporaneously to when patient is receiving treatment.
• Waiver: a CDPHE-approved exception to a rule.
• WHO:  World Health Organization

Data Submission Requirements for Waivered Medications or Acts

The EMS agency report for ketamine use for excited delirium/extreme agitation has the following data elements:  

Source: Ketamine for Excited Delirium Report Form 2020

• date of the incident; 

• patient age; 

• patient weight;

• patient gender; whether or not the patient met protocol; 

• the suspected cause of excited delirium (medical, overdose, psychiatric/behavioral, trauma, unknown); 

• level of ketamine dose in milligrams; 

• the administration route (IV bolus, IV infusion, intramuscular, intranasal; intraosseous;

• additional prehospital interventions (i.e., whether: additional medications were given, the patient was intubated, cricothyrotomy was performed, a cardiac monitor was applied, capnography was initiated, and/or pulse oximetry was initiated);

• complications (apnea, bradycardia, cardiac arrest, hypotension, hypoxia, laryngospasm; medication side effects; other (specify below);

• hospital disposition;

• transport destination (with a listing of licensed hospitals as well as options to select that the destination was a free-standing emergency department, community clinic emergency center, or other facility); 

• whether or not the patient was admitted to the facility;

• if admitted to a hospital:   length of hospital stay and whether the patient was intubated.