Statement from South Metro Fire Rescue

South Metro Fire Rescue

South Metro Fire Rescue Completes Review of Case Involving Ketamine

South Metro Fire Rescue (SMFR) has completed an internal review of an incident from 2019 in Centennial regarding the administration of ketamine on a patient. As a result of the documentation, body camera footage, two internal reviews, as well an external and independent review, SMFR has determined that protocol was followed regarding the administration of ketamine.

SMFR’s conclusion is also supported by an external case review conducted by the Colorado Department of Public Health and Environment (CDPHE), who determined that the SMFR paramedic’s administration of ketamine complied with the applicable department and medical protocols, followed accepted standards of care, and was consistent with medical direction. 

The case was first reviewed by South Metro in the Fall of 2019 and then again in July 2020, when body camera footage – which has not been fully released to the public due to pending criminal proceedings -- was officially made available to South Metro for its internal review. Although some clips of the body camera footage have since been released through the media, it is South Metro’s practice to not speak publicly about individual patient care, as well as discuss specific details on cases that are under investigation or in litigation. 

South Metro understands that ketamine is being widely discussed throughout Colorado and the nation and very much appreciate the diligence, dialogue, and careful and thorough review that is being done to ensure the proper use. The district will continue to work closely with policy makers and CDPHE and will remain committed to ensuring the safety and well-being of citizens and emergency care providers in pre-hospital patient care environments.

Background Information on South Metro’s Overall Use, 
Evaluation and Protocols for Ketamine

Ketamine Program in Colorado 

Per the Colorado Department of Public Health and Environment (CDPHE), ketamine can be administered by paramedics if their Medical Director has a waiver from CDPHE.  As part of the requirements of these waivers, Medical Directors are required to submit records of all waivered ketamine administrations to CDPHE annually.   These reports are then analyzed, and the aggregate statistics are reported on annually. 

South Metro’s Ketamine Waiver Program

South Metro Fire Rescue was first granted a waiver to administer ketamine from CDPHE in 2013.  Every two years, the waiver is reviewed to determine if the district can continue to administer ketamine under the direction of the Medical Director at South Metro.  The waiver was up for renewal in 2020, and South Metro was granted a renewal of the waiver on Aug. 10th, 2020.  

How Ketamine Administration is Evaluated within South Metro

Any call where ketamine is administered by South Metro paramedics is fully evaluated within South Metro’s Quality Management program, which is overseen by the district’s Medical Director. This includes utilizing an independent 3rd party reviewer who is not affiliated with the organization to review 100% of the calls where ketamine was given. 

In addition, all documentation of incidents where ketamine is administered is provided to the CDPHE and the Emergency Medical Practice Advisory Council (EMPAC) for review as these entities govern and grant waivers to pre-hospital emergency care providers for the use of ketamine. 

South Metro Protocols Set in Place for Administering Ketamine 

Administering ketamine and making a differential diagnosis of a patient in the field requires extensive training by South Metro paramedics. Additionally, there are specific and clearly defined protocols that South Metro has in place to ensure the careful and proper use of ketamine, including:

  • Only certified South Metro paramedics can administer ketamine.  These paramedics go through comprehensive training and certifications to be able to do this. 
  • Ketamine can only be administered for two reasons: 1) signs of excited delirium or extreme agitation where the safety of the patient or providers is of substantial concern 2) low doses for analgesia/pain management. 
  • Dosage amounts for agitation are based on a field assessment of the patient’s approximate weight, and ketamine currently has a high margin of safety for dosage amounts. 
  • Repeated doses can be given in certain circumstances. If a second dosage of ketamine is needed to calm a patient, it must be called in directly to a board-certified physician to gain approval before proceeding. 
  • Once ketamine is administered, South Metro paramedics are required to transport these patients to the hospital.   During transport, the paramedics carefully monitor the patient should any significant changes occur and have the ability to care for and intervene accordingly. 

Support by Medical Professionals

The administration of ketamine by emergency medical services has also been supported by various medical directors across the U.S., including Denver Metro EMS Physicians.  In a recent position statement on sedation of prehospital patients made on July 1, 2020, the Denver Metro EMS Physicians state, “We endorse the use of appropriate sedative medications, including ketamine, when administered by well-trained paramedics who are functioning under carefully designed medical care protocols. Patients and EMS workers are safer as a result.”