Primary Care Paramedic-administered Ketamine in British Columbia, Canada: A Patient Safety-focused Observational Study.
Tania Johnston, Christopher Mistiades, Roxane Beaumont-Boileau, Joseph Acker, Alan M Batt
Journal of patient safety July 7, 2025 DOI: 10.1097/PTS.0000000000001390 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective observational study Peer reviewed |
|---|---|
| Sample size | 100 |
| Population | Patients who received intranasal ketamine administered by Primary Care Paramedics for pain in British Columbia |
| Topics | Ketamine Esketamine |
| Keywords | Medication safety Drug safety Patient safety Adverse event prevention Quality assurance Clinical safety Safety profile Prehospital care Emergency medical services Out-of-hospital care Field medicine Ambulance services Ketamine use Ketamine administration Ketamine therapy Analgesia Pain management Drug intervention Expanded paramedic role Advanced paramedic practice Ems paramedic |
| Key findings | Expanding PCP scope to include intranasal ketamine showed an 11.2% dosage error rate and 14 cases of non-compliance with mandatory clinical support, but no adverse patient outcomes were observed. |
Abstract
In Western Canada, British Columbia Emergency Health Services (BCEHS) aimed to enhance prehospital pain management by authorizing Primary Care Paramedics (PCP) to administer intranasal (IN) ketamine. The objective of this study is to describe patient safety implications of expanding PCP scope to include IN ketamine. This retrospective, observational study reviewed patient care records of the first 100 consecutive patient encounters where PCPs administered IN ketamine for pain between December 2020 and September 2021. Data analysis used the Canadian Quality and Patient Safety Institute and Rights of Medication Administration frameworks. Of the 100 patients, 74% met the analgesia clinical practice guideline (CPG) criteria: adult, trauma, and moderate to severe pain. Most injuries (31%) involved extremities or hips/pelvis (18%). With 6 cases missing data, an 11.2% dosage error rate (>5 mg deviation) was identified. In 14 cases, PCPs did not contact mandatory clinical support and administered ketamine outside of the CPG. Documentation errors occurred in 25% of patient encounters, particularly with pain scores (20), patient weight (15), and vital signs (8), possibly indicating incomplete patient assessments. No instances of adverse patient outcomes resulting from dosing errors or missed consultations were observed throughout the study. This study highlights the safety implications of PCP-administered ketamine, including concerns about weight-based dosing, CPG compliance, and documentation standards. The key competencies of the Canadian Patient Safety Institute framework offer a foundation for addressing these safety concerns before expanding ketamine administration for broader PCP practice.
Comparable studies
Other observational and cohort studies on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Taming the Ketamine Tiger Volunteers from a prison population | 2010 | Observational study | n = 20 |
| Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans | 2017 | Observational study | |
| Disruption of Frontal–Parietal Communication by Ketamine, Propofol, and Sevoflurane Surgical patients undergoing induction of anesthesia with intravenous ketamine | 2013 | Observational cohort | n = 30 |
| Do the dissociative side effects of ketamine mediate its antidepressant effects? Treatment-resistant inpatients with major depressive disorder or bipolar disorder | 2014 | Observational cohort | n = 108 |
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |