Date of Degree

8-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Education

Advisor

Ashley Love

Advisor

Mary Ann Spott

Advisor

James Simpson

Advisor

Cord Cunningham

Abstract

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty data collection tool. Quantitative study inclusion criteria were adult casualties treated by U.S. military medical professionals with ketamine in a prehospital environment, had documented injury data, and had both pre- and post-ketamine pain scores. Descriptive statistics, followed by inferential statistical analyses using Shapiro-Wilkes, Wilcoxon Signed Rank, Spearman rho, and Kruskal Wallis tests were used. Additionally, phenomenology guided the analysis of two (n = 2) case studies. In vivo coding was used to develop themes and subthemes. Case studies collected from U.S. military medical professionals provided qualitative insight that reinforced the quantitative data and provided clinical validity to the study. Research Results/Findings. The study showed safe, efficacious use of analgesic sub-disociative ketamine use in prehospital trauma casualties relative to the 0–10 NRS for pain. The median reported pre-ketamine pain scale for casualties was 9.0 (IQR 2). The median post-ketamine pain scale was 0.0 (IQR 3). The mean total dosage of ketamine administered was 98.19 mg (SE = 9.545). There were 6 (12.8%) casualties who experienced side effects from ketamine that were neither permanent nor life-threatening. The case studies provided the human aspect of the study, reinforced the quantitative data, and provided clinical validity. Post-ketamine pain scores were better than pre-ketamine pain scores. Higher dosages of ketamine provided greater pain relief. No life threatening nor adverse drug reactions were found in this study. Conclusions From Research. This study demonstrated a safe, efficacious analgesic ketamine use in prehospital trauma casualties used by U.S. military special operations medical professionals relative to the 0–10 NRS for pain. The results of this study may inform medical practitioners and policymakers regarding the efficacy of analgesic ketamine in a prehospital environment, aid in making informed treatment decisions regarding trauma casualties, and provide facts for updating and improving clinical practice guidelines and policies focused on the U.S. military. Advancing the understanding to promote better prehospital pain management guidelines, procedures, and practices is essential. Education efforts will make medical professionals aware of the importance of analgesic ketamine for trauma casualties in a prehospital environment.

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