EMS providers are not authorized to practice medical care independently; they must practice under the authority of a physician medical director’s license. The physician medical director under whose license the EMS provider is practicing establishes protocols for EMS providers that they must follow in the prehospital setting. Protocols set forth factors EMS providers should use to assess a medical condition, as well as the manner in which the provider should respond if a condition is present. The care that EMS providers deliver in the field is protocol-driven; as such, the less precise the protocol, the more varied the interpretations can be and the more varied the service delivery.
The panel’s recommended rejection of the ExDS diagnosis underpins its conclusion that paramedics should not administer ketamine in the prehospital setting based on the presence of disputed, vague, or medically unverifiable clinical indicators. Instead, ketamine use should be strictly limited to situations in which the paramedic can make specific, independent, rapid determinations to establish whether ketamine should be deployed as a last resort to chemically restrain a person for their safe assessment, transport, and medical treatment at the hospital. The recommended indications should be set forth in a protocol format to define the required factors the paramedic must satisfy before administering ketamine in the prehospital setting.