A time I was playing in the top left box was the first time I had to use ketamine to sedate a combative patient with a serious head injury that resulted from falling off a hover board while intoxicated. He had a blown pupil, was posturing, abnormal breathing, and combative. We were trying to maintain his airway and also get him sedated. The use of Ketamine was newly added to the GMVEMSC protocol and the crew I was working with at the time, along with myself was unsure of the dose needed in relation to the different methods of administration. The patient was a large male that was very difficult to physically restrain. Careflight was en route to the scene, one of the firefighters was constantly updating me on the status of Careflight, and PD was climbing into the medic to help restrain our patient. While all of this was going on some of the crew members were shouting out what they though was the correct dose/route which only added to the confusion because all the doses were different. Needless to say, it was a chaotic scene in the back of the medic.
I finally found a moment to get the protocol book open and double check the dose needed. One crew member was able to obtain IV access, so we drew up the IV dose. Just prior to administering it the patient was able to pull his arm away and the IV came out. Ultimately this patient ended up getting two IM doses of Ketamine before Careflight arrived on scene and used their medications to sedate him since the patient was still being combative.
Something we could have done differently was to review the new protocol a little more thoroughly when it first came out. It is not a good time to try and look up drug doses in the protocol book when trying to restrain someone. There was a lot going on at the same time on this call which only added to the confusion and hectic atmosphere. As the PMIC, I should have taken more control of the scene.
What have I learned...When you find yourself unsure and falling behind, stop and take a time out. Reassess the situation and see what you have in front of you. Make sure everyone has clear defined roles and make sure everyone knows the protocol. Although we always learn as we go, the best time to learn is before the call, not during it.