title: A Ketamine Protocol and Intubation Rates for Psychiatric Air Medical Retrieval.
abstract: OBJECTIVE
  The air medical transfer of psychiatric patients with acute agitation is a regular requirement in only a few countries, with ours (Australia) being one of them. The optimal strategy has yet to be well described, ranging from physical restraints to general anesthesia with endotracheal intubation. In an Australian air medical service, Royal Flying Doctor Service (Queensland Section) rates of endotracheal intubation required for patient management were retrospectively compared before and after implementation of a ketamine sedation protocol for this patient population.
  
  
  METHODS
  A systematic retrospective review was performed using 9 years of data included in the Royal Flying Doctor Service (Queensland Section) electronic database (2004-2013). Coding for mental health as the primary diagnosis and intubation were the search criteria.
  
  
  RESULTS
  A total of 1,478 patients were transferred during the study period, with 44 requiring intubation. This equates to intubation rates of 3.5% before protocol use compared with 2.3% after protocol implementation.
  
  
  CONCLUSIONS
  In an Australian air medical service, the implementation of a ketamine sedation protocol for the management of the acutely agitated patient requiring air transfer has reduced the number of intubations in this patient group.
authors.affiliation: Royal Flying Doctor Service, Mount Isa Base, Mount Isa, Queensland, Australia. Electronic address: mlecong@rfdsqld.com.au.
authors.forename: Minh Le
authors.initials: ML
authors.lastname: Cong
authors.affiliation: Cairns Hospital Emergency Department, Cairns, Queensland, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Humble
mesh_terms: D017732:Air Ambulances; D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D002985:Clinical Protocols; D016208:Databases, Factual; D004632:Emergency Medical Services; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007649:Ketamine / Q000627:therapeutic use*; D001523:Mental Disorders / Q000188:drug therapy*; D011595:Psychomotor Agitation / Q000188:drug therapy*; D011793:Queensland; D012189:Retrospective Studies
chemical_list: D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine