Risk of complications using a sedation protocol for aeromedical retrieval of acutely unwell mental health patients: a retrospective cohort study in Outback Australia | Emergency Medicine Journal
— Read on emj.bmj.com/content/early/2025/07/15/emermed-2024-214719.long
Editor’s comments : This is a good article comparing standardised protocol approach vs non protocolised approach to aeromedical retrieval of acute mental health patients . The standardised protocol described is very similar to the RFDS Queensland one developed during my aeromedical career in that state. It uses a standardised risk assessment tool and a standardised tiered chemical sedation protocol focussing on oral olanzapine & diazepam initially then escalating to IM/IV droperidol then ketamine . This overall standardised approach is also very similar to the Surviving Sedation guidelines published on this website .
The notable findings of this study are :
1. Midazolam is associated with highest complication rates and cannot be recommended as monotherapy for sedation during aeromedical transfer of this patient group
2. A standardised protocol approach has fewer complications and reduces length of retrieval compared with non protocol management
3. Ketamine sedation appears safer than midazolam in this setting in unintubated patients
4. Intubation carries high rate of severe complications in this patient group and should be considered a high risk intervention
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 