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Fire and Emergency Services: Ketamine vs. Fentanyl

Carlos Torres, firefighter-paramedic, and Kevin Craven, firefighter-emergency medical technician, both with Fire and Emergency Services, demonstrate the use of a ketamine mixture for pain management on potential patients for an upcoming test trial aboard Marine Corps Logistics Base Barstow, Calif., April 5.

Story by Laurie Pearson 

Marine Corps Logistics Base Barstow

Paramedics with Fire and Emergency Services are conducting a research trial using ketamine for pain relief aboard Marine Corps Logistics Base Barstow, Calif. and surrounding communities starting April 1.
“It will be used for pain control in lieu of our current medication which is Fentanyl. Fentanyl is an opioid-based narcotic, and due to the ongoing opioid crisis nationwide, emergency medical services have been faced with finding alternatives,” said Greg Kunkel, Emergency Medical Services chief with FES.
There are only three counties in California which have been accepted into this trial study: Riverside, Inland Counties Emergency Management Agency, which serves San Bernardino, Inyo and Mono counties, and Mountain Valley Emergency Management System which is in Modesto County. The trial will run for 18 months. It’s being organized by ICEMA for this area. The three agencies have been authorized by the state to conduct this study. In order to be included in the study, counties had to petition the state of California Emergency Medical Services Agency for authorization. Then ICEMA was selected as the administrator. ICEMA then sent requests for interest out to the various advanced life support fire departments for inclusion into the study.
Ketamine doesn’t have the addiction potential that Fentanyl has, which is why emergency medical services has taken a hard look Ketamine and its promising potential for pain control.
According to the Center for Disease Control:
The death rate of synthetic opioids other than methadone, which includes drugs such as
tramadol and fentanyl, increased by 72.2% from 2014 to 2015.1 Synthetic opioid death
rates (other than methadone) increased across all demographics, regions, and numerous
states. These reports indicate that increases in synthetic opioid-involved deaths are being
driven by increases in fentanyl-involved overdose deaths, which are likely due to illicitly-
manufactured fentanyl.
“Fentanyl is 50-100 times more potent than morphine,” said Kunkel. “If it’s a Fentanyl analogue such as Carfentanil, it can be as much as 10,000 times stronger than morphine. This has caused overdoses across the nation to skyrocket.”
Fentanyl is a central nervous system depressant which decreases breathing, heart rate, and level of consciousness to the point of death if not aggressively treated by medical personnel.
Ketamine gets down to the pain receptors and alters pain perception, Kunkel explained. It is also completely synthetic.
“Ketamine also does not create the euphoria you get with Fentanyl, morphine or heroin,” Kunkel said. “Therefore the addiction potential is low.”
We are hoping that, after the study, that ketamine is accepted to replace fentanyl for general pain control, in the pre-hospital environment because it will prove beneficial for the patient as a safer alternative to fentanyl.
Trauma and severe burns are just two examples of when ketamine would be administered.
“They have to be 15 years of age or older,” Kunkel said. “Their pain has to be at a five or greater on a 1-10 pain scale. They may not have taken any other narcotic pain control 6 hours prior to administration of ketamine to ensure clarity for the trial.”
Fire and Emergency Services personnel not only take care of all incidents on base, but supply mutual aid to the surrounding communities, as well. Some examples are motor vehicle accidents on the local highways or broken limbs from a fall, and sports injuries.
“We responded to a motor vehicle accident a couple of days ago on highway 15,” Kunkel said, “where the victim had a broken leg, and could have benefitted from administration of ketamine.”

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