Enhanced Medicines

Ketamine, midazolam and flumazenil are enhanced medicines that should only be administered by a paramedic as part of the following roles:

• Consultant Paramedic (CP)
• Clinical Support Manager
• Sector Clinical Lead
• Advanced Paramedic Practitioner
• HEMS Critical Care Paramedic (CCP) whilst working within the NWAA (this includes Senior HEMS Paramedic Team Leaders)
• HART Specialist Paramedic and Special Operations Clinical Lead

The medicines need to be administered in line with PGDs. The PGDs have recently been updated and go live 1st April 2025. They can be found here on the Green Room using the links below.

• PGD Ketamine injection – version 5
• PGD Midazolam injection – version 6
• PGD Flumazenil injection – version 6

There are two pieces of learning, follow the links below to access them on ESR, or search using the name below. By the end of each piece of learning and after successful completion of the assessment you will be able to safely administer the medicine in line with the current PGD.

The eLearning modules can be found on ESR, or by following the links below.

• 242 Ketamine
• 242 Midazolam and Flumazenil

When you have completed this learning, you and your Consultant Paramedic must complete the “Authorisation and Record for the Administration and Ordering of Enhanced Medicines” form below. The same form should also be used to:

• Inform a change in practice between supervised and autonomous administration
• Inform a change in job role
• Inform a Trust leaver
• Document outcome of approvals discussed by Consultant Paramedic Group

The form can be found following the link below.

Authorisation Record for the Administration & Ordering of Enhanced Medicines 2025

This information will then be used to populate the central register as a record of your approval to administer enhanced medicines for your Consultant Paramedic and Clinical Support Manager to view. They can view this by following the link below.

Note, this is only viewable by those with permission to access.

Authorisation Record for the Administration & Ordering of Enhanced Medicines 2025.xlsx