Research on racial disparity related to excited delirium and use of ketamine or other sedatives is scant. There is a growing body of knowledge related to EMS administration of ketamine, but most studies were not designed to comment on racial disparities.
A recent published study by Fernandez et al looked at 11,291 consecutive patients from 1,322 EMS agencies who received ketamine in 2019 during their EMS encounter.[22] The study includes this chart, which shows that while Non-Hispanic White patients comprised the majority of the patients who received ketamine, persons of color, particularly African Americans, received disproportionate ketamine administrations in the prehospital setting:
Table 4. National Data on Ketamine Administrations by Race/Ethnicity and Indications[22]
| Race/ Ethnicity | Unique Pt Records | Trauma/ Pain | Altered Mental Status/ Behavioral | Cardiovascular/ Pulmonary | Seizure | Other |
| Unique Pt Records | (N=11,291) | (n=5,575) | (n=3,795) | (n=1,454) | (n=248) | (n=219) |
| White, not Hispanic or Latino | 7,739 (70.5%) | 3,967 (73.3) | 2,386 (64.6) | 1,086 (76.8) |
155 (65.1) | 145 (68.1) |
| Black, not Hispanic or Latino | 1,785 (16.3%) | 681 (12.6) | 824 (22.3) | 200 (14.1) | 52 (21.9) | 28 (13.2) |
| Other Race, not Hispanic or Latino | 266 (2.4%) | 126 (2.3) | 97 (2.6) | 31 (2.2) | 5 (2.1) | 7 (3.3) |
| Hispanic or Latino | 1,182 (10.8%) | 640 (11.8) | 385 (10.4) | 98 (6.9) | 26 (10.9) | 33 (15.5) |
African Americans constitute 16.3% of the unique patient records in the study but represent 22.3% of the population who received ketamine for altered mental status/behavioral symptoms. In contrast, Non-Hispanic Whites, who constitute 70.5% of the unique patient records, represented 64.6% of the population who received ketamine for altered mental status/behavioral symptoms. This suggests bias may play a part in the assessment of an undefined, poorly verifiable syndrome that results in ketamine use; the ensuing disproportionate deployment of ketamine to African Americans can increase and compound the risk of potential harm to marginalized populations.
Another study published as an abstract/academic poster[31] examined potential racial bias in the administration of ketamine by EMS providers. This poster[32] exclusively evaluated EMS responses requested by police in which the patient was in-custody and concludes that, of the 50,542 law enforcement requests for EMS for in-custody patients, there is no statistically significant difference between the rates at which ketamine was administered to different races. This research team used a national data set of prehospital care patient records that have a field associated with the patient’s race. However, that field was not consistently filled in by EMS providers. Consequently, the race data on which the authors based their research might not be a representative sample, and the study’s findings, while compelling, do not allow for definitive conclusions about racial disparities.
The panel was unable to access any studies that conclusively indicate whether there are race disparities in ketamine administration for ExDS or excessive agitation. More research is needed.