The aeromedical retrieval of acute psychiatric patients is a challenging scenario for the most experienced clinician. This is due to the potential for unpredictable behaviour among these patients, coupled with the inherent dangers of the aviation environment.
Chemical restraint is one of the accepted strategies in this environment to ensure patient and crew safety and to minimise patient distress. Benzodiazepines and antipsychotics have been the most commonly employed drugs for chemical restraint, although they are sometimes limited by adverse reactions and inadequate sedation endangering the safety of patient and health care providers. Consequently, there has been increasing interest in drugs like ketamine and propofol in patients where benzodiazepines and antipsychotics have been inadequate or unsafe. However, their adoption into routine clinical practice has been limited by a lack of good quality data about their safety and effectiveness.
In this study, we will compare the safety and effectiveness of ketamine and propofol in sedating acute psychiatric patients needing aeromedical retrieval. We believe that this is the first trial of its kind which will elucidate the complications, the safety profile and effectiveness of the two drugs in sedating acute psychiatric patients.
The study will be a prospective, open-labelled, randomised controlled trial. Patients will be drawn the Northern Territory and Queensland.
Through this study, we will better inform clinicians in their choice of a suitable sedation agent and potential provide an additional sedation choice in aeromedical and other critical care environments. Furthermore, this research has the potential to establish sedation guidelines in the aeromedical retrieval of acute psychiatric patients for Australia and internationally.