Ketamine review committee publishes report with several recommendations

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STATEWIDE (Dec. 1, 2021): The Colorado Department of Public Health and Environment published a report today from its independent ketamine review committee with several recommendations for administering ketamine in emergency settings. 

Executive Director Jill Hunsaker Ryan asked for a review of the department’s ketamine waiver program and expert recommendations to ensure patient safety. Dr. Eric France, chief medical officer at CDPHE, served as chairperson of the committee.  

“We convened a diverse group of experts to examine the use of ketamine in the field by emergency medical services. We did a thorough review of the latest research and drew on the many years of experience from the committee members,” said Dr. Eric France, chief medical officer, CDPHE. “I’m truly proud of this committee’s work and am committed to determining what recommendations should be adopted by the state.”

The members of the committee are experts in anesthesiology, emergency medical services, addiction and behavioral health, medical toxicology, and emergency medicine and included:

  • Dr. Gene Eby, M.D., emergency medicine physician and serves as an EMS Medical Director for several hospitals and fire departments in the Denver metro area.  

  • Dr. Janetta Iwanicki, M.D., medical toxicologist and emergency medicine physician. 

  • Dr. Luis A. Verduzco, M.D., anesthesiology and critical care. 

  • Dr. Lesley Brooks, M.D., family medicine and addiction medicine physician.  

  • Dr. Christopher T. Stephens, M.D., anesthesiologist, former paramedic, and serves as a EMS Medical Director for a volunteer fire department in Houston. 

  • Dr. Scott Bourn, RN, MSN, PhD in Health and Behavioral Sciences, EMS educator. 

  • Dr. Jamira T. Jones, M.D., MPH, emergency medicine physician. 

The recommendations in the report include: 

  • Specifying when the use of ketamine may be needed in emergency settings. 

  • Rejecting excited delirium syndrome as an acceptable diagnosis. 

  • Basing the standard dose on body stature (small/average/large), 300/400/500 mg for males and 250/350/450 mg for females. 

  • Monitoring of a patient who has received ketamine closely. All ambulances should contain a checklist of actions for appropriate dosing and monitoring.  

  • Augmenting paramedic educational curriculum to add modalities in patient handoff from law enforcement, racial equity and implicit bias training, verbal de-escalation techniques, and a stronger focus on patient monitoring practices with sedation. 

  • Creating more consistent practices among all emergency medical services and ground ambulances through statewide oversight. 

Read a more detailed brief on all the recommendations. 

“The department will take the panel's recommendations seriously to determine how to best protect the health and safety of Colorado residents," said Jill Hunsaker Ryan, executive director, CDPHE. “I commend Dr. Eric France for convening and facilitating such a well-rounded group of experts. The recommendations are thoughtful and will add to the body of knowledge regarding ketamine administration in the pre-hospital setting.”   

In July, the state notified Medical Directors of Emergency Medical Services of the suspension of ketamine for excited delirium and agitation in the prehospital setting. The report does not change the state’s current suspension of the use of ketamine in emergency settings.