The nurse administering it is most certainly liable for what s/he administers. It is a very big no-no to blindly administer a medication of which you cannot reasonably verify what it is. To push a syringe or start a pump of something that "could be ketamine, or could be NS" is walking an uncomfortable line for your license to practice nursing. Right patient, right medication, right dose, right route, right time. If you as a nurse cannot attest to all of the above when you push something, it is in error to push it.

Not sure what you're talking about. They're are double-blind placebo clinical trials with injectible drugs all the time.

Exactly. The label says something along the lines of "IMP-#####" where "IMP" stands for 'investigational medicinal product' and the number is unique and tracked. Below that will be a dosage statement, a label with the patient's name and patient ID on it, and (in the UK at least) the legally-mandated words "keep out of sight and reach of children".

For orally dosed RCTs, often the pill making process is the way the blinding is done -- i.e. they're either in brightly-coloured gelcaps or a film or sugar coating. If it is a double-blind RCT it must be double blind. All of this will have been explicitly examined in the ethics statement for a trial and very, very prescriptively laid out.

That's interesting. I am only speaking from experience working in the ED as an RN and do not have any experience with studies like this that give medications that are not positively known (by myself). What you (and others say) actually does make sense. Thanks.

>Right patient, right medication, right dose, right route, right time

Can't you achieve all of those by having someone else create the bag and then label it for the patient. The "right medication" is the one they're receiving as part of the study.

It's not like what they need to do is different if it's ketamine or saline.

The parent comment is absolutely correct. This is salt in the medical community by having a nurse that knows exactly what the patient is getting and a different clinician doing the assessment

How does it work in other clinical trials where you take a pill instead of getting an injection? Those are double blind all the time. They watch you take the pill, but they don't know whether it is active or placebo.

For that matter, a quick web search shows that at least some of the (injected) coronavirus vaccine trials were double blind. Seems like enough for someone in the next room to know if the maybe-ketamine injection is placebo, so they can unblind immediately in case of a bad reaction.