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British Columbia Emergency Health Service trialled the use of intranasal (IN) ketamine given by Primary Care Paramedics (PCPs). Prior to this practice change, the PCPs had not performed weight-based drug calculations, given medications intranasally, nor been responsible for controlled and targeted substances. This study aimed to use the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domain Framework (TDF) to identify enablers and barriers to implementing IN paramedic administered ketamine analgesia (iPAKA) for PCPs.

This was a parallel convergent mixed methods study with two phases. The quantitative phase consisted of longitudinal staff surveys to assess PCP knowledge and perceptions of ketamine and controlled and targeted substances policies. The qualitative phase involved staff focus groups on programme implementation. Descriptive …