OK.
So serious question, do you live in the US? Because fire-based EMS is overwhelmingly the predominant provider of EMS in the largest jurisdictions in the US. We *are* the medical professionals that cover that role for most of the US population.
And yes, ketamine has a well documented history as an fast, effective, and safe emergency sedation agent for people in crisis
when used appropriately. I have found it to work quicker than IM benzodiazepines, especially diazepam, and much faster and more effective than medications like haloperidol (as well as safer in people already at risk of hyperthermia and seizures in excited delirium/extreme agitation.)
The military was also ahead of us for use as a non-opioid analgesic as well, especially in trauma patients as it does not cause a blood pressure drop, nor loss of airway reflexes like morphine/fentanyl do. I have found great success using it for both of those roles while functioning as a paramedic.
Article on ketamine for agitation
Clinical Applications
Severe Agitation/Excited Delirium
The extremely agitated patient with excited delirium represents a wide array of patients who may be affected by drugs of abuse, psychiatric disturbances, and organic causes, and may represent a serious threat to their care providers and themselves. Therefore, an agent is needed to gain rapid control of these patients to eliminate harm to themselves and others. Traditionally, acute agitation in the emergency department (ED) often is treated with antipsychotics, benzodiazepines, or a combination, sometimes with the addition of an anticholinergic such as diphenhydramine. This combination is effective at inducing anxiolysis in an agitated patient; however, they have many undesirable properties, including slow onset, variability in clinical response, and QT prolongation.20,21 In addition, these patients may have other medications or substances in their system that could augment any cardiovascular or respiratory effects of these drugs.
Ketamine is a medication that has been studied recently to treat acute agitated delirium. Characteristics that make it desirable for this patient population are its rapid onset, its ability to be given via several routes, little effect on respiratory drive, and overall low side effect profile, as demonstrated in the sedation literature.22
A prospective, nonrandomized trial by Riddell et al analyzed 106 agitated ED patients who received either ketamine or benzodiazepines and haloperidol, alone or in combination. The researchers found that fewer patients in the ketamine group were agitated at 5, 10, and 15 minutes following medication administration than in the other medication groups.23 This study concluded that in highly agitated and violent ED patients, ketamine is faster at controlling agitation than standard ED medications. However, the dosing in that study was not standardized. A meta-analysis by Sullivan et al
in 2019 evaluating both prehospital and ED use of ketamine for agitation found that more than 85% of agitated patients treated with ketamine achieved appropriate sedation.24
