(Me with a poster presentation on ketamine sedation at Rural Doctors Association Queensland meeting, Cairns, 2011)
I am a rural trained general practitioner in Australia. I hold dual Fellowships with the Royal Australian College of General Practitioners and Australian College of Rural and Remote Medicine. Along the way I completed a PostGraduate Diploma in Aeromedical Retrieval and Transport with Otago University, Dunedin and gained a Generalist in Emergency Medicine degree with ACRRM.
I have strong clinical and research interests in emergency airway management, , retrieval medicine and prehospital care. I have published articles on ketamine sedation in aeromedical retrieval and a prehospital emergency airway registry.
The Goals of the Show
The aim of this podcast is to discuss and debate prehospital and retrieval medicine–its current practice and controversies. In many ways the philosophy espoused will be that of prehospital critical care. Whereas EMCrit brings upstairs care, downstairs; I aim to bring it out of the hospital. Many prehospital providers are doing this already.
- What works, what does not?
- What is the evidence base and who cares?
My current working and academic life is devoted to answering these questions and more! Explore the diversity of this discipline around the world and join the discussion. Contribute to the debate as that is how things will improve. Along the way we will discuss frontline tips and tricks of the trade, so that you who work in this demanding field, may benefit from hard-learnt lessons of our colleagues!
My opinions are my own and do not represent any policy of my employer, unless specifically cited with permission. My medical opinion expressed on this blogsite and podcast is my own and must not be used to make decisions about individual health related matters or clinical care as medical details vary from one case to another.
Dr Minh Le Cong
MBBS, FRACGP, FACRRM, FARGP, FACAsM(Assoc), GDRGP, GEM, CertIVTAA, PGDAeroRT.
Disclaimer ( Used with permission from Dr Scott Weingart of emcrit.org site)
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Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
You mention Dr. Stephen J Hyde. Do you have an email for him? I have a question I’d like to ask him:
Would a single sublingual dose of ketamine in the hand of a person with suicidal ideation
have a reasonable potential to arrest that SI long enough (overnight)?
If he recognized enough mitigation of his symptoms he might be inspired to pursue treatment.’
I’d be grateful if you could help me get in touch with him
Hi Mark
I will ask him to respond to this post of yours . Personally I have treated someone with refractory depression & suicidal ideation with sublingual ketamine and it resolved it after a single dose for 24hrs but then it returned . Ongoing ketamine dosing led to complete resolution of the ideation
I’m so grateful for your response!!!
I’m drafting an article describing a proposal that is very outside-the-box. It is to distribute – in an extremely controlled manner – a single dose of ketamine. At first, I thought of sublingual because that’s what I use. Then it occurred to me that a spray bottle might be more effective albeit less convenient than a lozenge. Then it occurred to me that an injectable instrument like an Epipen might be more effective but more expensive.
To whom? I have identified a demographic with a significantly higher propensity to suicide. The number of members is very large. (BIG N) They all patronize a particular type of retail store. That type of store is fully capable of implementing air-tight control over inventory and distribution. All the elements – except the necessary implementing legislation – is readily identifiable.
Pick a proper sub-set of this demographic. E.g., those living in a single state. Or, a few states. Promote and distribute the ketamine through the retail outlets. Get as many members of the demographic to take their ketamine SI Kit home; at least as an expression of solidarity for the program/experiment. Observe for a few years. Does the rate of suicide drop in the experimental population?
Safety and control are easily explained.
The key is to answer the question: Is it likely to work? Would a member of the target demographic really look at his SI Kit from time to time? Then remember he has it in a moment of crisis? Would he use it? And then, if he did use it, would it have a reasonable likelihood of taking the edge off his SI? For just one day. That’s all I would hope for. One day.
If the answer is “Yes”, then the experiment would be worth the effort to mount.
Clearly, ketamine is NOT a one-shot-and-your-done. My hope is that after rescuing himself from his acute incident that he would call his doctor in the morning and ask for a referral to a psychiatrist. And ask that psychiatrist for a trial of ketamine. This is where the big win might be realized.
If the experiment worked it could be expanded beyond the test state(s) to the whole country for the selected demographic. If it works for that selected demographic it could be expanded to the general public.
Does this idea intrigue you? Would it likely intrigue Dr Hayes?
Hi Mark
Minh passed this question on…..
A single dose of ketamine, given sublingually or by other routes, does have the potential to reduce suicidal thinking in the short term. Being provided in the context of a therapeutic relationship, as part of an emergency plan and following the provision of a monitored trial dose, then it would be most likely to provide benefit as well as ensuring that this option is not forgotten.
Hello Minh – many of us miss you on the regular social channels – but your choice to depart is yours. I would like to request you sniff out the new early twitter-like BlueSky.com.
It is a safe space for all users with active moderators, and it’s still in beta. The next invite code I get is yours if it suits you to join.
If not, thank you for your contributions, your insights and your willingness to share knowledge and cafe suggestions at all hours to your crowd of long term followers/friends.
Sincerely
Stefan
Thanks for the kind offer but I must decline , Stefan . All the best