Prehospital Analgesia and Sedation: a Perspective from the Battlefield

Abstract

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. 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. 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.