The authors of the reflections on prehospital care article on the use of ketamine should be commended for both their care at the scene and for subjecting their actions to scrutiny.1 However, we are concerned that the published report may be misleading to those less familiar with the use of ketamine for procedural sedation in patients with head injuries.

In our system, procedural sedation is indicated when analgesia alone would be insufficient to facilitate a specific and clearly identifiable clinical procedure (including extrication).2 However, we would not expect to have to administer ketamine for sedation in a patient with a Glasgow coma score of 4. It would seem unnecessarily hazardous to sedate such a deeply unconscious patient who is trapped but is maintaining their airway and …