PACKMaN trial results
PACKMaN: Paramedic Analgesia Comparing Ketamine and MorphiNe in trauma
The PACKMaN trial investigated whether ketamine was better than morphine for providing pain relief in people who had experienced a traumatic injury. The trial successfully completed participant recruitment on 16 May 2023. Participant follow-up was completed on 16 December 2023.
WHY DID WE DO THIS TRIAL?
Pain after an injury is common. The strongest pain killer that UK paramedics are currently allowed to administer is morphine. Unfortunately, morphine can be slow to work and may cause unwanted side effects. Because of this, it may not be the best pain killer for paramedics to use. Ketamine is another option that acts very quickly and may have fewer unwanted side effects. However, we do not know if ketamine is any better than morphine. We did this trial to find out if ketamine was better than morphine.
WHAT DID WE DO?
Paramedics from 2 Ambulance Services recruited patients who had suffered a painful injury. If the patient agreed to take part, then the paramedic administered either ketamine or morphine. Neither the paramedic nor the patient knew which drug they would get. Before and after the drug was given, the paramedics asked the patient to rate their pain on a scale from 0 to 10, where 0 was no pain, and 10 was the worst pain imaginable. We used these pain scores to work out which drug worked best to reduce the patient's pain.
WHAT DID WE FIND?
Ketamine did not work better than morphine. Both drugs reduced pain by roughly the same amount. However, ketamine worked a bit faster than morphine and caused more unusual behavioural reactions than morphine. Morphine lasted for bit longer than ketamine but was more likely to cause a drop in blood pressure and more likely to cause breathing problems.
WHAT DOES IT MEAN?
Ketamine is a suitable alternative to morphine that may be a bit safer to use than morphine, but it is not more effective at reducing pain overall.
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PUBLISHED PAPERS
If you would like to read about the trial results please see the link to the published papers below.
Main results paper publicationLink opens in a new window
Health economics publication coming soon
The RESUS Room
The trial results were discussed during The Resus Room podcast for May 2025 papers.
Click here Link opens in a new windowto listen to the podcast. Time stamp 14:00.
PATIENT EXPERIENCES
This trial would not have been possible without the valuable input from our patients.
Watch the video below to hear Charanpal's experience as a PACKMaN participant (recruited by WMAS):
Watch the video below to hear Mike's experience as a PACKMaN participant (recruited by WMAS):
Watch the video below to hear Stuart's experience as a PACKMaN participant (recruited by WMAS):
Watch the video below to hear Lucy's experience as a PACKMaN participant (recruited by WMAS):
PARAMEDIC EXPERIENCE
The success of PACKMaN relied on the commitment of paramedics from WMAS and YAS to recruit eligible patients into the study.
Watch the video below to hear Josh's experience as a recruiting paramedic for PACKMaN:
Watch the video below to hear Steph's experience as a recruiting paramedic for PACKMaN:
Watch the video below to hear Mike's experience as a recruiting paramedic for PACKMaN:
FEEDBACK ON THE PACKMaN TRIAL PROCESSES
PACKMaN wins West Midlands CRN award
In November 2023, the University of Warwick's PACKMaN trial team in partnership with the West Midlands Ambulance Service’s Research Team won a top award at the Clinical Research Network (CRN) Awards in Wolverhampton.
The team took the top prize in the Innovation of the Year category for the use of electronic consenting.
Image: from left to right, Professor David Loughton (Group Chief Executive of Royal Wolverhampton Trust who host the CRN), Owen Stanley (WMAS research team), Chrissy Evans (WMAS research team), Imogen Gunson (WMAS research team), Zoe Green (WMAS research team), Dr Hannah Noordali (University of Warwick Clinical Trial Manager), Dr Mike Smyth (University of Warwick Co-Chief Investigator) and Carly Craddock (Chief Operating Officer CRN West Midlands).
Participant Research Experience Survey
Every year, the NIHR Clinical Research Network (CRN) asks thousands of participants to share their experiences of taking part in research, through the ‘Participant in Research Experience Survey’ (PRES).
The PACKMaN team were thrilled with the positive response received in 2024 from participants for the trial.
Patients are at the very heart of research delivery so it is important for us to ensure our studies are designed and delivered in a way that is informative, supportive and not burdensome.