Mrs. Michelle Thomson1, Mrs. Cathy Wright1, Ms. Stacey Solomou1, Mr. Jordan Pring1, Mr. Scott Wheaton1, A/Professor Amy Keir1
1South Australia Ambulance Service, Adelaide, Australia
Biography:
Biography to come.
Abstract:
Background: Moderate-to-severe pain is prevalent in prehospital settings. A 2022 review by SAAS found that 52% of patients rarely experience a clinically significant reduction (≥ 2-point reduction) in their pain score and highlighted limited pain relief options in regional and remote areas.
Sublingual ketamine, recognised for sustained pain relief and safety in analgesic doses, was selected for evaluation.
Methods: A pilot of sublingual ketamine was conducted to assess the effectiveness, safety and useability within a multimodal pain management strategy. Interventions included, (1) updating pain management guidelines, including education, and (2) the pilot focusing on regional areas served by volunteer AOs.
The pilot included (1) a standing drug order, (2) presentations at volunteer training nights (3) development of an eLearning package. (3) Paramedics undertaking mandatory eLearning with (4) volunteer AOs opting in.
Results: The pilot ran from October 2022 to January 2024, with interim evaluation in April 2023 prompting adjustments and expansion.
The findings were as follows: 354 patients received sublingual ketamine, with 3 dysphoric episodes identified. Among the patients who received sublingual ketamine, 91% received opioids, 70% received paracetamol, and 66% received methoxyflurane concurrently. A total of 47 cases were administered by AOs.
Out of the 354 patients, 315 (88%) reported experiencing some pain relief. Among these cases, 237 (75%) required between 25-50 mg of sublingual ketamine to achieve a reduction in pain.
Conclusion: Sublingual ketamine within SAAS is safe and effective when integrated into a multimodal strategy for severe pain. Further research is needed to understand the patient’s experience.