Introduction
Previous studies have demonstrated low rates of prehospital analgesia and adherence to Tactical Combat Casualty Care (TCCC) guidelines in the Joint Theaters combat setting. The reasons for this remain unclear. We seek to expand on previous reports by evaluating a larger prehospital data set and seek associations with various factors associated with analgesia or lack of analgesia administration.
Methods
This was part of an approved quality assurance project to evaluate adherence to TCCC guidelines across multiple modalities. Data were obtained using the Prehospital Trauma Registry (PHTR). The PHTR was in existence from January 2013 through September 2014. This database obtained data from TCCC cards, DD 1380 forms, and after-action reports (AAR) to provide real-time feedback to units on prehospital medical care.
Results
Note that this is a preliminary analysis; full analysis will be available for the conference. During the PHTR’s existence, 705 patient encounters occurred. Those who had an open wound were more likely to receive pain medication vs those who did not have an open wound (46% vs 7%, P < .001) There was a trend toward more pain medications administered to penetrating wounds vs blunt trauma (28% vs 14%, P = .07). If an antibiotic was given, the patient was more likely to receive pain medication (66% vs 19%, P < .001). Patients transported by AIREVAC were more likely to receive pain medication (35% vs 20%, P = .004). If a tourniquet was placed, patients were more likely to receive pain medication (47% vs 32%, P < .001). Medical officers were more likely to administer pain medications (43% vs 17%, P < .001).
Conclusions
There were higher rates of pain medication administration for open wounds vs closed wounds, penetrating trauma vs blunt trauma, co-administration of antibiotics, AIREVAC vs ground evacuation, tourniquet placement, and treatment by a medical officer. A more detailed analysis by analgesia agent and whether the agents were within TCCC guidelines will be performed.