Page 84 - JSOM Fall 2020

and Air Combat Command. Participating units included the US TABLE 1 Injury Demographics
Army’s 75th Ranger Regiment, 160th Special Operations Avi- Injury Type and MOI Number of Injuries Percent of Injuries
ation Regiment, and US Air Force Pararescue. The deidentified Back 4 11.76%
data was collected from After Action Reviews (AARs) in an Airborne Ops 2 5.88%
anonymous manner from training mishaps and injuries. The
AARs were part of ongoing internal Quality Assurance/Quality Other 1 2.94%
Improvement measures. The skill level of the medical providers Unknown 1 2.94%
included special operations combat medic (SOCM) or para- Extremity 23 67.65%
rescueman (PJ), physician assistant, and physician. Descriptive Airborne Ops 3 8.82%
statistics were used to calculate the doses per administration to Penetrating 1 2.94%
include the interquartile range (IQR), standard deviation (SD) Unknown 19 55.88%
and the range of likely doses using a 95% confidence interval Head/neck 1 2.94%
(CI). A Wilcoxon signed-rank test was utilized to compare the Blunt 1 2.94%
mean pre-ketamine pain scores to the mean post-ketamine on Pelvic 3 8.82%
a 0-to-10 pain scale. Unknown 3 8.82%
Polytrauma 3 8.82%
Results Other 1 2.94%
From July 2010 to October 2017, there was a total of 34 Penetrating 1 2.94%
patients in whom ketamine was used for training injuries, Unknown 1 2.94%
all were male. Due to reporting limitations, ages were not Total 34 100.00%
reported in all cases; furthermore, there was some pain data
lacking within the set, therefore this was not reported in the was back injuries sustained by 4 (11.76%), followed by both
final data. The data that was not available for four of the pa- pelvic and polytrauma injuries each having 3 (8.82%) inci-
tients was documentation regarding their level of pain pre and/ dents. There was only 1 (2.94%) head/neck injury sustained.
or post administration of ketamine. The injury patterns for The leading causing MOI were the “unknown” injuries with
training injuries were also reviewed. 24 (70.59%) not being noted in the data. The second leading
MOI was airborne operations with 5 (14.71%) casualties, fol-
The training injuries were delineated by the type of injury and lowed by other and penetrating each with 2 (5.88%) incidents
the mechanism of injury (MOI) based on the documentation and one (2.94%) incident of blunt trauma. Ketamine was used
provided by the units (Table 1). The injury types determined to treat all of these casualties.
in the study included: back, extremity, head/neck, pelvic, and
polytrauma. In the cases for two documented injuries, the po- The mean total dose of all ketamine administration was
tentially most severe injury was used as the primary injury. 90.29mg (95% CI, 70.09–110.49) (Table 2). The mean num-
“Back” injuries were musculoskeletal injuries to the back. ber of ketamine doses via all routes administered to patients
“Extremity” injuries were any injuries to the extremity such as was 1.88 (SD 1.094) (Table 3). The mean initial dose of all ket-
a fracture or gunshot wound. “Head/neck” injuries included amine administration was 47.35mg (95% CI, 38.52–56.18).
musculoskeletal and/or blunt trauma. “Pelvic” injuries were Nineteen (55.9%) of the patients received a second dose of
injuries sustained to pelvis. Last, “Polytrauma” was deter- ketamine. The mean second dose was 62.89mg (SD 60.903;
mined to be three or more documented injuries. The injuries 95% CI, 35.51–90.28). Seven (20.6%) received a third dose,
were categorized into MOI. with a mean of 23.57mg (SD 12.488; 95% CI, 14.32–32.82),
while only 3 (8.8%) patients received a fourth dose of ket-
There were five MOI determined for this study. The MOI in- amine with a mean of 26.67mg (SD 20.817; 95% CI, 3.11–
cluded: airborne operations (airborne ops), blunt, penetrating, 50.23). Only 1 (2.9%) casualty received a total of six doses of
other, and unknown. “Airborne operations” included injuries ketamine, at 10mg for both doses five and six.
sustained during any operations involving exiting an aircraft
while in flight. “Blunt” were simply determined to be an MOI Of the 34 patients, a total of 22 (64.7%) received ketamine
with no penetrating injuries such as a fall; thereby, “penetrat- via intravenous (IV) route (Table 4). Intramuscular (IM) route
ing” MOIs were those that penetrated the patient’s body in of administration was used for a total of 12 (35.3%) patients.
some manner. “Other” indicated MOI that did not fit into the Initially, 10 (29.4%) of the patients received an IM dose and
previously described categories, yet had an outlying MOI in 2 (5.9%) received additional doses via IM route. Intranasal
the documentation by which this was the only MOI of that (IN) doses of ketamine were used for 8 (23.5%) patients for
type in the data, such as “Rappel accident.” Finally, “un- the first dose. Last, none of the training patients were noted to
known” was used to categories injuries where no MOI was have received intraosseous (IO) doses of ketamine, though IO
documented. is a potential route of administration. 4

The most common training injury type appears to be extrem- There were 16 (47.1%) patients who received their first dose
ity injuries with a total of 23 (67.65%) of the casualties sus- of ketamine via IV, the mean dose was 48.44mg (SD 28.967;
taining these injuries. The second most common injury type 95% CI, 34.25–62.63) (Table 5). There were 10 (29.4%)

TABLE 2 Ketamine Dosing (mg) for All Training Casualties
Number of Casualties Mean Dose (SD) 95% CI Range Minimum Dose Maximum Dose IQR
34 90.29 (60.098) 70.09–110.49 310 15 325 83

82 | JSOM Volume 20, Edition 3 / Fall 2020