• Cathrin S Parsch, Adrianne Boonstra, David Teubner, Wade Emmerton, Brian McKenny, and Daniel Y Ellis.
• Emergency Medical Retrieval Service, SAAS MedSTAR, Adelaide, South Australia, Australia.
• Emerg Med Australas. 2017 Jun 1; 29 (3): 291-296.

ObjectivesThe aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline.MethodsThis is a a retrospective cohort study of mental health patients with acute behavioural disturbance, transported between January 2010 and December 2015.ResultsA total of 78 patients were transported in the study period, 50 before and 28 after implementation of the ketamine guideline in June 2013. The introduction of the ketamine guideline was associated with a significant reduction in intubation for transport (36.00 vs 7.14%) (odds ratio 0.14, 95% confidence interval 0.02-0.71, P < 0.01). The likelihood of utilising ketamine for non-intubated patients (n = 58) was higher in the period after implementation (37.50 vs 84.62%, odds ratio 9.17, 95% confidence interval 2.54-33.08, P < 0.005). The incidence of complications in our series was low.ConclusionsThe implementation of a ketamine clinical practice guideline for agitated mental health patients was associated with an increase in the number of patients receiving ketamine as part of their sedation regime and a reduction in the number of patients requiring intubation for transport. Appropriately trained critical care retrieval teams should consider ketamine as part of the sedation regime for agitated mental health patients.© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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