Table 1

Details of mechanism of injury, predominant injuries, and drugs administered

Case number	Sex/age	Mechanism of njury	Injuries	Ketamine dose	Midazolam	Comments
1	44	RTA	Pelvis	100 mg	1 mg	Ketamine to facilitate extrication and limb splintage. Blood pressure 90 mm Hg systolic
	M	Driver Entrapment	Ipsilateral right closed femoral and compound ankle fracture dislocation
2	16	Sports injury	Traumatic patella dislocation	50 mg	0.5 mg	Entonox inadequate
	F		Traumatic patella dislocation
3	39	Fall	Posterior right elbow dislocation	100 mg		Alley between houses
	F		Posterior right elbow dislocation
4	23	Fall from 15 feet	Back injury	100 mg		Difficult transportation from building site
	M					Difficult transportation from building site
5	37	RTA	Chest injury	100 mg		Maintained anaesthesia until arrival in A&E
	M	Motorcyclist collision with car	Fractured right humerus	+50 mg		Maintained anaesthesia until arrival in A&E
		Motorcyclist collision with car	Fractured right femur	+50 mg
			Right wrist fracture
6	18	RTA	Ipsilateral left open tibial and closed femoral fractures	50 mg		To facilitate reduction and splintage
	M	Motorcyclist				To facilitate reduction and splintage
		No other vehicle involved
7	65	Home accident.	Head injury	50 mg	0.5 mg	To facilitate management including transport
	F	Fall downstairs	Agitated			To facilitate management including transport
			GCS 11
8	68	Home accident	Known multiple myeloma	25 mg		Relative entrapment
	M	Fall in toilet	Bilateral closed femoral shaft fractures	+25 mg		To facilitate extrication and limb splintage
			Bilateral closed femoral shaft fractures	+25 mg		To facilitate extrication and limb splintage
9	34	RTA	Head injury	50 mg	2 mg	To facilitate management extrication and transportation
	F	Driver	GCS 11	+50 mg		To facilitate management extrication and transportation
		Entrapment	Combative
			Fractured shaft of femur
10	23	RTA	Fractured femur pronounced angulation	50 mg	0.5 mg	To facilitate reduction and splintage
	F	Pedestrian	Fractured femur pronounced angulation			To facilitate reduction and splintage
		Struck by car
11	18	Sports injury	Head injury	50 mg		To facilitate management
	M	Fall from a height	Blunt chest injury	+20 mg
		30ft.	Agitation	+20 mg
		Climbing	Right wrist fracture
12	75	Fall in street	Compound right ankle fracture	50 mg		To facilitate realignment and splintage of fracture
	M		Compound right ankle fracture			To facilitate realignment and splintage of fracture
13	32	RTA	Pelvic injury	100 mg		2.5 h extrication maintained anaesthesia until hospitalised
	M	Non-restrained front seat passenger	Bilateral ankle fractures	+increments to a total dose 270 mg		2.5 h extrication maintained anaesthesia until hospitalised
		Entrapment
14	47	RTA	Crush injuries to right thigh	50 mg	1 mg	5 h 15 min entrapment
	M	Lorry driver	Crush injuries to right thigh	+increments to a total dose of 450 mg		Compartmental syndrome
		Entrapment		+increments to a total dose of 450 mg		Hypoperfusion to lower leg
15	25 M	Fall from a height into a 25 feet deep trench	Back injury Spinal cord injury	50 mg +20 mg		Extrication using fire service lifting platform
						Horizontal on spinal board
16	32	Foot trapped in street drain	Soft tissue right foot injury	50 mg		To facilitate extrication in combination with the fire service
	F		Soft tissue right foot injury
17	46 M	Industrial accident Hand trapped in machinery	Severe open crush injury of all fingers	50 mg +20 mg	1 mg	In combination with peripheral nerve blocks
			Right hand			Patient maintained in horizontal position
18	37	Fingers trapped in till	Soft tissue crush injury	50 mg	1 mg	Extreme patient distress
	F		Fingers right hand
19	29	RTA	Head injury	100 mg		To facilitate management and limb splintage
	M	Motorcyclist	Chest injury			To facilitate management and limb splintage
		Collision with car	Left femoral fracture
			Compound patella fracture
20	19	RTA	Blunt chest injury	50 mg	0.5 mg	To facilitate extrication using a spinal board
	M	Rear seat occupant	Pelvic fracture	+20 mg		To facilitate extrication using a spinal board
				+20 mg
21	37	RTA	Multiple lower limb fractures	50 mg		To facilitate extrication and limb splintage
	M	Driver	Multiple lower limb fractures	+50 mg		To facilitate extrication and limb splintage
		Collision with central reservation
		Entrapment
22	19	Fall from a horse	Compound right elbow fracture	50 mg	1 mg	To facilitate limb splintage
	F		Compound right elbow fracture	+20 mg
23	87	RTA	Head injury	20 mg		To facilitate extrication spinal boarding and limb splintage
	F	Rear seat car occupant	GCS 15	+20 mg
		Entrapment	Right patella fracture	+10 mg
			Multiple soft tissue injuries
24	37	RTA	Head injury	50 mg		Systolic BP 90 mm Hg
	M	Van driver	GCS 13	+50 mg		To facilitate rapid extrication and patient management
		Head on collision	Abdominal injury	+20 mg		To facilitate rapid extrication and patient management
		Entrapment	Right femoral fracture	+20 mg
			Left ankle fracture
25	17	RTA	Head injury	50 mg	1 mg	To facilitate management and extrication
	M	Car v tree	GCS 13	+20 mg		To facilitate management and extrication
		Entrapment	Agitated
			Fractured right femur
			Fractured both wrists
26	9	Fall from 8 feet	Compound left ankle fracture	25 mg		To facilitate realignment wound dressing and splintage
	F		Compound left ankle fracture			To facilitate realignment wound dressing and splintage
27	47 M	RTA Lorry v tree Severe Entrapment	Head injury GCS 13 Open abdominal injury Severe crush injury right leg	50 mg +incremental ketamine to a total dose of 210 mg		To facilitate on site above knee amputation Subsequent extrication, spinal boarding. and transportation
28	11	Fall in the home	Closed fracture of left femur	25 mg		To facilitate limb splintage
	F	Osteogenesis imperfecta	Closed fracture of left femur
29	84 F	Fall at home	Closed fracture proximal left femur	25 mg +25 mg		To facilitate realignment of fracture and limb splintage
			Leg angulated through 130 degrees
30	32	Jump from 30 feet	Head injury	50 mg	1 mg	To facilitate immobilisation and packaging
	F		GCS 12	+25 mg		To facilitate immobilisation and packaging
			Spinal injury
			Multiple lower limb fractures
31	53	RTA	Blunt chest injury	50 mg		To facilitate extrication and splintage
	M	Driver	Abdominal injury			To facilitate extrication and splintage
		Entrapment	Fractured right femur
32	16	RTA	Head injury	50 mg		To facilitate realignment of fractures, placement on a spinal board, and transportation
	M	Pedestrian	GCS 14	+20 mg
			Bilateral lower limb injuries