Prehospital Analgesia INtervention Trial (PAIN)

Inclusion Criteria:

• Transport after injury to a participating PAIN Trauma center

• Patient with compensated shock as defined by Shock Index (SI) ≥0.9

• Intravenous pain medication indicated (CPOT≥2, NRS≥5) prior to arrival at the traumacenter

Exclusion Criteria:

• No IV access

• Age <18 years

• Females <50 years of age

• SBP>180 mmHg at time of enrollment

• Advanced airway management prior to first dose administration

• Known allergy to fentanyl citrate or ketamine hydrochloride

• Known prisoner

• Objection to study voiced by subject or family member at scene

• Pain treatment contraindicated by local protocol

• Wearing a "NO PAIN STUDY" bracelet