Prehospital pain medication use by U.S. Forces in Afghanistan.
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.
Center for the Sustainment of Trauma and Readiness Skills, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201.
Stacy A
SA
Shackelford
Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Marcie
M
Fowler
81 Medical Operations Squadron, Keesler AFB, MS 39534.
Keith
K
Schultz
212 Combat Support Hospital, Miesau AD, Germany.
Angela
A
Summers
Department of Anesthesiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201.
Samuel M
SM
Galvagno
Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Kirby R
KR
Gross
Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Robert L
RL
Mabry
Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Jeffrey A
JA
Bailey
Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Russ S
RS
Kotwal
Joint Trauma System, US Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Frank K
FK
Butler
D000328:Adult; D055826:Afghan Campaign 2001-; D000700:Analgesics / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008889:Military Personnel; D009020:Morphine / Q000008:administration & dosage; D060051:Occupational Injuries / Q000188:drug therapy; D059408:Pain Management / Q000379:methods*; D011446:Prospective Studies; D014481:United States; D000067398:War-Related Injuries / Q000188:drug therapy*
D000700:Analgesics; D007649:Ketamine; D009020:Morphine; D005283:Fentanyl