SB 78
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 78 (Senator Waldstreicher)
Judicial Proceedings Judiciary
Maryland Institute for Emergency Medical Services Systems - Administration of
Ketamine - Data Collection
This bill requires the Maryland Institute for Emergency Medical Services Systems
(MIEMSS), by October 1, 2022, and annually through 2024, to collect specified data from
State and local emergency medical services (EMS) providers on the administration of
ketamine by EMS providers in the prior 12-month period. The data collected may not
contain information that reveals the identity of an individual who received a medical
treatment using ketamine. By December 1, 2022, and annually through 2024, the Director
of MIEMSS must report to the General Assembly on the data collected. The bill
terminates December 31, 2024.
Fiscal Summary
State Effect: Maryland Emergency Medical System Operations Fund (MEMSOF)
expenditures increase by $12,500 in FY 2022 for MIEMSS to hire a part-time contractual
data analyst to compile and analyze specified data. Future years reflect annualization and
termination of the position in FY 2025. MIEMSS can report to the General Assembly with
existing budgeted resources. Revenues are not affected.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
SF Expenditure 12,500 9,000 9,300 4,800 0
Net Effect ($12,500) ($9,000) ($9,300) ($4,800) $0
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: None.
 Analysis
Bill Summary: The data collected must include the following about ketamine
administered to an individual by an EMS provider: (1) whether the administration was
directed or requested by a law enforcement officer; (2) the dosage administered; (3) the
height, weight, age, gender, and race of each individual, if known; and (4) the diagnosis.
Current Law: Under the Maryland Controlled Dangerous Substances Act, there are
five schedules for controlled dangerous substances. Schedule III substances have
(1) potential for abuse that is less than that for substances in schedules I or II;
(2) well documented and approved medical use of the substance in the United States; and
(3) evidence that abuse of the substance may lead to moderate or low physical dependence
or high psychological dependence. Ketamine, its salts, isomers, and salts of isomers, are
included on Schedule III.
State Expenditures: MIEMSS advises that the collection of specified data requires the
compilation and analysis of prehospital data. The number of prehospital records to be
reviewed each year is unknown, but based on 2018 and 2019 data, MIEMSS estimates
there will be approximately 1,300 records to review annually.
MEMSOF expenditures increase by $12,486 in fiscal 2022, which accounts for the bill’s
October 1, 2021 effective date. This estimate assumes data from the relevant records is
provided on an ongoing basis throughout the year (rather than provided at one time each
year); thus, it reflects the cost of hiring one part-time contractual data analyst to compile
and analyze the data for the required report. It includes a salary, fringe benefits, one-time
start-up costs, and ongoing operating expenses.
Contractual Position 0.20
Salary and Fringe Benefits $7,298
Operating Expenses 5,188
Total FY 2022 State Expenditures $12,486
Future year expenditures reflect a full salary with annual increases and employee turnover,
ongoing operating expenses, and termination of the contractual position on
December 31, 2024.
This estimate does not include any health insurance costs that could be incurred for
specified contractual employees under the State’s implementation of the federal Patient
Protection and Affordable Care Act.
Additional Comments: MIEMSS advises that the Maryland Medical Protocol lists
four primary indications for EMS administration of ketamine, including moderate to severe
SB 78/ Page 2
pain, CPR-induced awareness/sedation in preparation for intubation, maintenance of
sedation for intubated patients, and excited delirium. MIEMSS further advises that
ketamine may be an effective medication for patients with severe agitation, but it must be
administered with caution. Its use for anxiolysis or sedation should only be considered for
the severely agitated patient who is combative, violent, and represents an immediate danger
to self or others. MIEMSS lays out guidance to supplement the current protocol for the use
of ketamine, including (1) verbal and other de-escalation techniques should always be
attempted before ketamine is administered; (2) known risks must be weighed against
potential benefits; (3) EMS may not accept orders or requests from law enforcement
officers to administer ketamine; and (4) medical direction must be obtained prior to giving
ketamine for severe agitation, unless doing so would present immediate and imminent harm
to the patient or EMS clinician.
Additional Information
Prior Introductions: None.
Designated Cross File: None.
Information Source(s): Maryland Institute for Emergency Medical Services Systems;
Anne Arundel, Baltimore, Garrett, Howard, and Montgomery counties; City of Laurel;
Department of State Police; Maryland Department of Transportation; Department of
Legislative Services
Fiscal Note History: First Reader - January 26, 2021
rh/jc Third Reader - March 31, 2021
Revised - Amendment(s) - March 31, 2021
Revised - Updated Information - March 31, 2021
Analysis by: Amber R. Gundlach Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 78/ Page 3


Statutes affected:
Text - First - Public Safety - Law Enforcement and Emergency Medical Services Providers - Administration of Ketamine: 3-523 Public Safety, 7-404 Public Safety
Text - Third - Maryland Institute for Emergency Medical Services Systems - Administration of Ketamine - Data Collection: 13-516 Public Safety, 21-257 Public Safety, 3-523 Public Safety, 7-404 Public Safety