Multicenter, Prospective Study of Prehospital Administration of Analgesia in the U.S. Combat Theater of Afghanistan

Background: Published data on prehospital medical care in combat is limited, likely due to the chaotic and unpredictable nature of care under fire and difficulty in documentation There is limited data on how often analgesic agents are administered, which drug are being used, and whether there is an association with injury patterns. Methods: This study was a prospective, multicenter, observational study to determine which analgesic agents are being used prehospital and whether there is an association with injury patterns. Data was collected and recorded as casualties were brought into combat surgical hospitals in Afghanistan from October 2012 to April 2014. Onsite, trained investigators collected the data as part of a IRB approved protocol. Outcome data to 30 days was obtained from the DoD Trauma Registry (DODTR) within the Joint Trauma System. Results: During the study period 532 patient encounters available for inclusion with 378 receiving an analgesic agent (total of 541 administrations). The average age was 27 (range 21–31), 99% male, 40% were US or coalition forces. Parenteral medications used were ketamine, fentanyl, morphine, hydromorphone and ketorolac. Penetrating injuries were more likely to receive analgesic agent (89% vs 79%, p=0.0057). Blunt trauma was less likely to receive ketamine (p=0.008). Fentanyl was used more for patients with an Injury Severity Score (ISS) >15 (p=0.016). Conclusion: Patients with penetrating trauma are more likely to receive analgesic agents in the combat prehospital setting. The most common analgesic used was ketamine. Patient ISS was not associated with administration of analgesia. Patients receiving analgesia were more likely to still be hospitalized at 30 days. The prospective nature of this study supports feasibility for future, larger, more comprehensive projects.