Primary Care Paramedic-administered Ketamine in British Columbia, Canada: A Patient Safety-focused Observational Study.
Journal of patient safety July 7, 2025 Tania Johnston, Christopher Mistiades, Roxane Beaumont-Boileau et al.
Expanding the scope of Primary Care Paramedics (PCPs) in British Columbia to administer intranasal ketamine for pain was associated with several safety concerns. A review of the first 100 patient encounters found that 74% met the clinical practice guideline criteria (adult, trauma, moderate-to-severe pain). A dosage error rate of 11.2% (deviation greater than 5 mg) was identified, and in 14 cases paramedics administered ketamine without mandatory clinical support. Documentation errors occurred in 25% of encounters, especially for pain scores, weight, and vital signs, possibly indicating incomplete assessments. No adverse patient outcomes from dosing errors or missed consultations were observed. The findings highlight the need for improved guideline compliance and documentation before broader implementation.