title: The effects of standardized trauma training on prehospital pain control: have pain medication administration rates increased on the battlefield?
abstract: BACKGROUND
  The US Military has served in some of the most austere locations in the world. In this ever-changing environment, units are organized into smaller elements operating in very remote areas. This often results in longer evacuation times, which can lead to a delay in pain management if treatment is not initiated in the prehospital setting. Early pain control has become an increasingly crucial military prehospital task and must be controlled from the pain-initiating event. The individual services developed their standardized trauma training based on the recommendations by Frank Butler and the Defense Health Board Committee on Tactical Combat Casualty Care. This training stresses evidence-based treatment modalities, including pain control, derived from casualty injury analysis. Inadequate early pain control may lead to multiple acute and potentially chronic effects. These effects encompass a wide range from changes in blood pressure to delayed wound healing and posttraumatic stress disorder. Therefore, it is essential that pain be addressed in the prehospital environment.
  
  
  METHODS
  Institutional Review Board approval was obtained to conduct a retrospective Joint Theater Trauma Registry comparative study evaluating whether standardized trauma training increased prehospital pain medication administration between 2007 and 2009. These years were selected on the basis of mandatory training initiation dates and available Joint Theater Trauma Registry records. Records were analyzed for all US prehospital trauma cases with documented pain medication administration from Operations Enduring Freedom and Iraqi Freedom for the specified years.
  
  
  RESULTS
  Data analysis revealed 232 patients available for review (102 for 2007 and 130 for 2009). A statistically significant prehospital pain treatment increase was noted, from 3.1% in 2007 to 6.7% in 2009 (p < 0.0005; 95% confidence interval, 2.39-4.93).
  
  
  CONCLUSIONS
  Standardized trauma training has increased the administration of prehospital pain medication and the awareness of the importance of early pain control.
authors: Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA. w.joseph.bowman@mail.us.army.mil
authors: W Joseph
authors: WJ
authors: Bowman
authors: Michael E
authors: ME
authors: Nesbitt
authors: Sean P
authors: SP
authors: Therien
mesh_terms: D055826:Afghan Campaign 2001-; D000700:Analgesics / Q000008:administration & dosage*; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000193:education / Q000379:methods / Q000706:statistics & numerical data*; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000700:Analgesics