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The effects of standardized trauma training on prehospital pain control: Have pain medication administration rates increased on the battlefield?

Bowman, W. Joseph DSc, PA-C; Nesbitt, Michael E. DSc, PA-C; Therien, Sean P. DSc, PA-C

Journal of Trauma and Acute Care Surgery: August 2012 - Volume 73 - Issue 2 - p S43–S48
doi: 10.1097/TA.0b013e3182606148
Pre-Hospital Clinical Research

BACKGROUND The US Military has served in some of the most austere locations in the world. In this ever-changing environment, units are organized into smaller elements operating in very remote areas. This often results in longer evacuation times, which can lead to a delay in pain management if treatment is not initiated in the prehospital setting. Early pain control has become an increasingly crucial military prehospital task and must be controlled from the pain-initiating event. The individual services developed their standardized trauma training based on the recommendations by Frank Butler and the Defense Health Board Committee on Tactical Combat Casualty Care. This training stresses evidence-based treatment modalities, including pain control, derived from casualty injury analysis. Inadequate early pain control may lead to multiple acute and potentially chronic effects. These effects encompass a wide range from changes in blood pressure to delayed wound healing and posttraumatic stress disorder. Therefore, it is essential that pain be addressed in the prehospital environment.

METHODS Institutional Review Board approval was obtained to conduct a retrospective Joint Theater Trauma Registry comparative study evaluating whether standardized trauma training increased prehospital pain medication administration between 2007 and 2009. These years were selected on the basis of mandatory training initiation dates and available Joint Theater Trauma Registry records. Records were analyzed for all US prehospital trauma cases with documented pain medication administration from Operations Enduring Freedom and Iraqi Freedom for the specified years.

RESULTS Data analysis revealed 232 patients available for review (102 for 2007 and 130 for 2009). A statistically significant prehospital pain treatment increase was noted, from 3.1% in 2007 to 6.7% in 2009 (p < 0.0005; 95% confidence interval, 2.39–4.93).

CONCLUSION Standardized trauma training has increased the administration of prehospital pain medication and the awareness of the importance of early pain control.

LEVEL OF EVIDENCE Therapeutic study, level IV.

Supplemental digital content is available in the article.

From the Department of Emergency Medicine (W.J.B., M.E.N.), San Antonio Military Medical Center, Fort Sam Houston; and Department of Emergency Medicine (S.P.T.), William Beaumont Army Medical Center, El Paso, Texas.

This article was the basis for a poster presentation at the 2011 Advanced Technology Applications in Combat Casualty Care Conference, Fort Lauderdale, Florida.

The opinions or assertions expressed herein are the private views of the authors andare not to be construed as official or as reflecting the views of the US Department of the Army or the US Department of Defense.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: W. Joseph Bowman, DSc, PA-C, 23 Bassett St, Fort Bragg, NC 28307; email:;

© 2012 Lippincott Williams & Wilkins, Inc.