Prehospital Analgesia and Sedation: a Perspective from the Battlefield
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THE MILITARY PERSPECTIVE (M MARTIN AND M TADLOCK, SECTION EDITORS)
Prehospital Analgesia and Sedation: a Perspective from the Battlefield Andrew D. Fisher 1,2
&
Taylor T. DesRosiers 3 & Brendon G. Drew 4
Accepted: 15 October 2020 / Published online: 17 November 2020 # This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Abstract Purpose of Review Battlefield medicine is a dynamic and chaotic environment in which to provide care. However, it is critically important for the medical practitioner to provide adequate analgesia for the wounded. Throughout the last two decades of conflict, there have been several changes to how analgesia and sedation are provided in the prehospital setting. Recent Findings Despite the recommendations from the Committee on Tactical Combat Casualty Care (CoTCCC), adherence to the guidelines has been poor to moderate. Additionally, Prolonged Field Care (PFC) guidelines offer additional recommendations, which can differ from CoTCCC guidelines. There are several factors that impact adherence including conflicting references, leadership, and logistical issues. Expanding the current prehospital approach to analgesia and sedation may help increase adherence. Summary The two prominent guidelines for military prehospital care, TCCC and PFC, offer an evidence-based approach to providing analgesia and sedation on the battlefield that should help increased optimal battlefield analgesia. Keywords Analgesia . Ketamine . Sedation . Combat . Prehospital
Introduction Pain management is an important aspect of battlefield care and has been a part of military medicine for thousands of years. The Romans used a variety of pain management, including ice This article is part of the Topical Collection on The Military Perspective This manuscript contains discussion and information that is being utilized for the proposed change document in Analgesia and Sedation for Tactical Combat Casualty Care. * Andrew D. Fisher [email protected] Taylor T. DesRosiers [email protected] Brendon G. Drew [email protected] 1
Department of Surgery, University of New Mexico School of Medicine, MSC10 5610, Albuquerque, NM 87131-0001, USA
2
Medical Command, Texas Army National Guard, Austin, TX, USA
3
Division of Critical Care, Walter Reed National Military Medical Center, Bethesda, MD, USA
4
1st Marine Division, Marine Corps Base Camp Pendleton, Oceanside, CA, USA
and cold water to decrease swelling, as well as draught of mandrake and draught of opium for moderate to severe pain [1]. While during the Revolutionary War there was little pain management [2], after morphine was discovered in 1804 [3], it became more practical to provide analgesia in the prehospital setting. In the Civil War, morphine was the drug of choice for analgesia at the Regimental Aid Stations, though alcohol was also used [4]. Morphine remained standard of prehospital analgesia through the early years of the conflicts in Afghanistan and Iraq/Syria.
Tactical Combat Casua
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