Prehospital pain medication use by U.S. Forces in Afghanistan.
Military Medicine · 2015-03-01 · Implementation & quality improvement
Abstract
We report the results of a process improvement initiative to examine the current use and safety of prehospital pain medications by U.S. Forces in Afghanistan. Prehospital pain medication data were prospectively collected on 309 casualties evacuated from point of injury (POI) to surgical hospitals from October 2012 to March 2013. Vital signs obtained from POI and flight medics and on arrival to surgical hospitals were compared using one-way analysis of variance test. 119 casualties (39%) received pain medication during POI care and 283 (92%) received pain medication during tactical evacuation (TACEVAC). Morphine and oral transmucosal fentanyl citrate were the most commonly used pain medications during POI care, whereas ketamine and fentanyl predominated during TACEVAC. Ketamine was associated with increase in systolic blood pressure compared to morphine (+7 ± 17 versus -3 ± 14 mm Hg, p = 0.04). There was no difference in vital signs on arrival to the hospital between casualties who received no pain medication, morphine, fentanyl, or ketamine during TACEVAC. In this convenience sample, fentanyl and ketamine were as safe as morphine for prehospital use within the dose ranges administered. Future efforts to improve battlefield pain control should focus on improved delivery of pain control at POI and the role of combination therapies.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Helicopter & air ambulance · Anaesthetics · Analgesics · Fentanyl · Implementation · Ketamine · Military & tactical · Morphine
Related articles
- Trends in prehospital pain management following the introduction of new clinical practice guidelines. (J Trauma Acute Care Surg, 2021)
- En Route Use of Analgesics in Nonintubated, Critically Ill Patients Transported by U.S. Air Force Critical Care Air Transport Teams. (Mil Med, 2016)
- Is Prehospital Ketamine Associated With a Change in the Prognosis of PTSD? (Mil Med, 2023)
- Prehospital Analgesia for Pediatric Trauma Patients in Iraq and Afghanistan. (Prehosp Emerg Care, 2018)
- Battlefield pain management: A view of 17 years in Israel Defense Forces. (J Trauma Acute Care Surg, 2017)
- Multicenter, Prospective Study of Prehospital Administration of Analgesia in the U.S. Combat Theater of Afghanistan. (Prehosp Emerg Care, 2017)