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עמוד בית
Thu, 25.07.24

ORIGINAL ARTICLES

IMAJ | volume 24

Journal 9, September 2022
pages: 584-590

Trends in prehospital pain management: two decades of point-of-injury care

1Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel 2Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel Departments of 3Plastic and Reconstructive Surgery and 4General Surgery and Transplantation, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel 5Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel 6Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA 7Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel 8Department of Military Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel 9Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 10Hospital Management, Meir Medical Center, Kfar Saba, Israel 11Department of Internal Medicine E, Sheba Medical Center, Tel Hashomer, Israel 12Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 13Department of Medicine B and 14Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel 15Department of Plastic Surgery, Shamir Medical Center, Zriffin, Israel

Summary

Background:

Pain control in trauma is an integral part of treatment in combat casualty care. More soldiers injured on the battlefield need analgesics for pain than life-saving interventions (LSIs). Early treatment of pain improves outcomes after injury, while inadequate treatment leads to higher rates of post-traumatic stress disorder (PTSD).

Objective:

To describe the experience of the Israel Defense Forces (IDF) Medical Corps with prehospital use of analgesia.

Methods:

All cases documented in the IDF-Trauma Registry between January 1997 and December 2019 were examined. Data collection included analgesia administered, mechanism of injury, wound distribution, and life-saving interventions performed.

Results:

Of 16,117 patients, 1807 (11.2%) had at least one documented analgesia. Demographics included 91.2% male; median age 21 years. Leading mechanism of injury was penetrating (52.9%). Of injured body regions reported, 46.2% were lower extremity wounds. Most common types of analgesics were morphine (57.2%) and fentanyl (27%). Over the two decades of the study period, types of analgesics given by providers at point of injury (POI) had changed. Fentanyl was introduced in 2013, and by 2019 was given to 39% of patients. Another change was an increase of casualties receiving analgesia from 5–10% until 2010 to 34% by 2019. A total of 824 LSIs were performed on 556 patients (30.8%) receiving analgesia and no adverse events were found in any of the casualties.

Conclusions:

Most casualties at POI did not receive any analgesics. The most common analgesics administered were opioids. Over time analgesic administration has gained acceptance and become more commonplace on the battlefield.

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