Hennepin Healthcare ketamine probe recommends more training, internal reviews

Hennepin Healthcare System released a review of its use of the sedative ketamine on patients Thursday that included data showing a marked increase in the use of the drug this decade.

In addition, a law firm that conducted the external review offered recommendations to Hennepin Healthcare including the need for more training to support paramedics in the field. The probe also calls for further engagment and education of the public as it relates to waiver of consent to use the drug on patients. 

The probe stemmed from reports that Minneapolis Police urged EMS to respond with ketamine, that in some instances caused heart or breathing failure in patients. The use of ketamine was suspended in June 2018 pending this review.

Hennepin Healthcare CEO John Pryor outlines some of the steps his team will take as a result of the probe. 

Advanced de-escalation techniques for people who have psychosis and also, in the fall, we’re going to work with Web and Associates and we’re developing a training module for them so they can understand about implicit biases and racism. That’s an important part for first responders so hopefully they recognize racism and they recognize some of those tough situations and maybe that will help us decrease the use of sedation even more.

Use of ketamine

Nilan Johnson Lewis is the firm that conducted the external review and its report outlined how and how often Hennepin Healthcare administered ketamine.

Also known as ketalar, ketamine is just one of three sedatives Hennepin Healthcare has used after first introducing it in 2008. Since, use has increased with Minneapolis Police Department detainees.

Use of ketamine has increased nearly tenfold between 2010 and 2017 from six to 62 incidents. In the first four months of 2018, 11 incidents were reported.

The review also outlined why ketamine has been used so often, including its fast onset of sedation and less effect on respiration than other similar medications. Also, ketamine has an “optimal duration of sedation” that allows EMS to examine the patient in a timely manner.

The external review said the following about ketamine’s utility:

The more quickly a severely agitated patient can be sedated, the more quickly paramedics can safely treat and transport the patient. That more rapid onset of sedation in cases of serious agitation may be life-saving. Thus, a question of keen interest to these researchers is which of several medications achieves sedation in the shortest amount of time, with the least amount of risk to patients and providers.

Actions since the review began

According to Nilan Johnson Lewis, Hennepin Healthcare has already taken some steps to change the way they approach the use of ketamine.

For one, Hennepin Healthcare has started reviewing all prehospital sedation cases, instead of a random sampling of them.

Also, the system is partnering with the National Alliance on Mental Illness, or NAMI, to provide mental health training for first responders.

Along with NAMI training, EMS will also undergo implicit bias training so they can “better understand the conditions that have led to fear and a lack of trust of first responders within communities of color.”

Hennepin Healthcare also announced Thursday that it would engage and reach out to the community in an effort to provide more input for researchers.