Is Ketamine a Good Option in Pre-Hospital ED?

Ketamine would definitely be my reach for in this situation I think it would be fair to say what about you Simon? Well yeah pretty boringly I do think ketamine is a good option here but I think having a low threshold for adding in a small amount of medazalan as well if they're not tolerating it very well. One thing that really bugs me is whenever you've got a patient you know you've battled with them in the pre-hospital setting and then you arrive in ED and none of your equipment is compatible with ours. How do we optimize this transition between the two sets of equipment  there are probably a number of different strategies for this.