Required Reports for Submission
These data collection forms will be utilized by all EMS Agencies licensed at the Advanced Life Support level when reviewing Ketamine or Etomidate administrations. Remember, even if you do NOT utilize Ketamine or Etomidate you are still required to submit the appropriate paperwork showing no utilization for that quarter.
Sedation Assisted Intubation (Etomidate / Ketamine)
Sedation-assisted intubation may be appropriate for patients with compromised respiratory effort
and partially intact protective airway reflexes. Examples of appropriate criteria for sedation-assisted
intubation include:
1. Hypoxia (pulse oximetry < 90%) despite high flow oxygen by NRB mask or by CPAP.
2. Inability to protect airway.
3. Traumatic injury with GCS < 8 at the time of decision to intubate.
Sedation Assisted Intubation
Ketamine Administrations
Appropriate reasons for Ketamine administrations:
1. Delirium with Agitated Behavior
2. Non-Traumatic Pain Management
3. Musculoskeletal Trauma
Ketamine Administrations


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