Buckland Daniel M, Crowe Remle P, Cash Rebecca E, Gondek Stephen, Maluso Patrick, Sirajuddin Sarah, Smith E Reed, Dangerfield Paul, Shapiro Geoff, Wanka Christopher, Panchal Ashish R, Sarani Babak
1Department of Emergency Medicine,George Washington University,Washington, DCUSA.
2The National Registry of Emergency Medical Technicians,Columbus, OhioUSA.
Prehosp Disaster Med. 2018 Feb;33(1):23-28. doi: 10.1017/S1049023X17007142. Epub 2017 Dec 21.
Use of ketamine in the prehospital setting may be advantageous due to its potent analgesic and sedative properties and favorable risk profile. Use in the military setting has demonstrated both efficacy and safety for pain relief. The purpose of this study was to assess ketamine training, use, and perceptions in the civilian setting among nationally certified paramedics (NRPs) in the United States.
A cross-sectional survey of NRPs was performed. The electronic questionnaire assessed paramedic training, authorization, use, and perceptions of ketamine. Included in the analysis were completed surveys of paramedics who held one or more state paramedic credentials, indicated "patient care provider" as their primary role, and worked in non-military settings. Descriptive statistics were calculated.
A total of 14,739 responses were obtained (response rate=23%), of which 10,737 (73%) met inclusion criteria and constituted the study cohort. Over one-half (53%) of paramedics reported learning about ketamine during their initial paramedic training. Meanwhile, 42% reported seeking ketamine-related education on their own. Of all respondents, only 33% (3,421/10,737) were authorized by protocol to use ketamine. Most commonly authorized uses included pain management (55%), rapid sequence intubation (RSI; 72%), and chemical restraint/sedation (72%). One-third of authorized providers (1,107/3,350) had never administered ketamine, with another 32% (1,070/3,350) having administered ketamine less than five times in their career. Ketamine was perceived to be safe and effective as the vast majority reported that they were comfortable with the use of ketamine (94%) and would, in similar situations (95%), use it again.
This was the first large, national survey to assess ketamine training, use, and perceptions among paramedics in the civilian prehospital setting. While training related to ketamine use was commonly reported among paramedics, few were authorized to administer the drug by their agency's protocols. Of those authorized to use ketamine, most paramedics had limited experience administering the drug. Future research is needed to determine why the prevalence of ketamine use is low and to assess the safety and efficacy of ketamine use in the prehospital setting. Buckland DM , Crowe RP , Cash RE , Gondek S , Maluso P , Sirajuddin S , Smith ER , Dangerfield P , Shapiro G , Wanka C , Panchal AR , Sarani B . Ketamine in the prehospital environment: a national survey of paramedics in the United States. Prehosp Disaster Med. 2018;33(1):23-28.
在院前环境中使用氯胺酮可能具有优势，因为它具有强大的镇痛和镇静特性以及良好的风险特征。在军事环境中的使用已证明其在缓解疼痛方面的有效性和安全性。本研究的目的是评估美国国家认证护理人员（NRP）在民用环境中对氯胺酮的培训、使用情况及看法。
对NRP进行了一项横断面调查。电子问卷评估了护理人员对氯胺酮的培训、授权、使用情况及看法。纳入分析的是那些持有一个或多个州护理人员证书、表明“患者护理提供者”为其主要角色且在非军事环境中工作的护理人员的完整调查问卷。计算了描述性统计数据。
共获得14739份回复（回复率 = 23%），其中10737份（73%）符合纳入标准并构成研究队列。超过一半（53%）的护理人员报告在其初始护理人员培训期间了解到氯胺酮。同时，42%的人报告自行寻求与氯胺酮相关的教育。在所有受访者中，只有33%（3421/10737）被协议授权使用氯胺酮。最常见的授权用途包括疼痛管理（55%）、快速顺序诱导插管（RSI；72%）和化学约束/镇静（72%）。三分之一的授权提供者（1107/3350）从未使用过氯胺酮，另有32%（1070/3350）在其职业生涯中使用氯胺酮的次数少于五次。绝大多数人认为氯胺酮是安全有效的，因为绝大多数人报告他们对使用氯胺酮感到放心（94%），并且在类似情况下（95%）会再次使用。
这是第一项评估民用院前环境中护理人员对氯胺酮的培训、使用情况及看法的大型全国性调查。虽然护理人员中普遍报告了与氯胺酮使用相关的培训，但很少有人被其机构的协议授权使用该药物。在那些被授权使用氯胺酮的人中，大多数护理人员使用该药物的经验有限。需要进一步研究以确定氯胺酮使用普及率低的原因，并评估氯胺酮在院前环境中使用的安全性和有效性。巴克兰德DM，克罗伊RP，卡什RE，贡德克S，马卢索P，西拉朱丁S，史密斯ER，丹杰菲尔德P，夏皮罗G，万卡C，潘查尔AR，萨兰尼B。院前环境中的氯胺酮：美国护理人员的全国性调查。院前灾难医学。2018；33(1)：23 - 28。
