Research Paper Title
Buddy-aid battlefield pain management
As members of the French Military Medical Service currently involved in the management of combat casualties in austere settings, the researchers read with great interest the study by Benov et al reviewing all cases of point of injury (POI) pain treatment documented in the Israeli Defense Force Trauma Registry in the past 17 years.
In this large retrospective study of 8,576 trauma patients, most casualties at POI did not receive any analgesics while on the battlefield. Indeed, only 12.3% (1,056) of casualties were treated with an analgesic at the prehospital settings. More surprisingly, physicians and/or a paramedic provided the administration of 90.5% of analgesics given to casualties at POI.
In the discussion section, the authors justified this high ratio of pain interventions performed by physicians and paramedics, by the rapid availability of these front-line providers.
The researchers would like to go further into the debate since the French Army has a long experience of buddy-aid battlefield pain management, using a 10-mg morphine autoinjector, also known as the Syrette of morphine. The Syrette is a device for injecting liquid through a needle, almost similar to a syringe, except that it has a closed flexible tube, instead of a rigid tube and piston.
During military operations, not only front-line providers, including physicians, paramedics, and medics, can provide an adequate battlefield pain management. Actually, all soldiers carry a combat first aid kit including a Syrette of morphine. At POI, this individual autoinjector containing 10 mg of morphine is well designed for intramuscular administration of drugs for self-aid or buddy-aid, even before the arrival of front-line providers.
Before deployment in a combat zone, every French soldier undergoes the Forward Combat Casualty Care Level I courses, including the virtual simulation of morphine administration in 3D-SC1. 3D-SC1 is a serious game designed for training of soldiers to lifesaving interventions on the battlefield. Soldiers are trained to use their combat first aid kit, including the Syrette of morphine.
In the French Military Medical Service policy for combat analgesia, and also discussed by the authors, other techniques are encouraged, including titration of intravenous morphine, use of ketamine and fascia-iliaca compartment block for lower-limb injuries.
Finally, the researchers would like to know if the authors could provide more details about the IDF experience in buddy-aid battlefield pain management, and if it was used in the 1,056 casualties who were treated with an analgesic at the pre-hospital settings.
Vertu, N., Nacimento, M. & Pasquier, P. (2017) Buddy-aid battlefield pain management. Journal of Trauma and Acute Care Surgery. 83(5):992, NOV 2017. DOI: 10.1097/TA.0000000000001660.