Ketamine Versus Midazolam for Prehospital Agitation

Ketamine Versus Midazolam for Prehospital Agitation

This research study is being done to figure out the best approach to treatment of pre-hospital agitation. It will compare two tiered dosing treatment protocols, one ketamine-based and one midazolam-based. Agitation is a state of extreme emotional disturbance where patients can become physically aggressive or violent, endangering themselves and those who are caring for them. Often chemical substances or severe mental illness are involved in this level of agitation. Specifically, the investigators are interested in studying agitation that is treated in the prehospital setting by paramedics. This study's hypothesis is a ketamine-based protocol will achieve a faster time to adequate sedation than a midazolam-based protocol for treatment of agitation in the prehospital environment. This study will observe the natural history of an emergency medical services standard operating procedure change from a ketamine-based protocol to a midazolam-based protocol.

Inclusion Criteria:

• Age 18 or older
• Severe agitation (AMSS +2 or +3) or profound agitation (AMSS +4) requiring chemical sedation
• Transport to Hennepin County Medical Center

Exclusion Criteria:

• Obviously gravid women
• Patients known or suspected to be less than 18 years of age
• Patients in which stopwatch activation, for safety reasons, is unable to occur