This report proposes that battlefield analgesia be achieved using one or more of three options: (1) the meloxicam and Tylenol in the TCCC Combat Pill Pack for casualties with relatively minor pain who are still able to function as effective combatants (2) oral transmucosal fentanyl citrate (OTFC) for casualties who have moderate to severe pain, but who are not in hemorrhagic shock or respiratory distress and are not at significant risk for developing either condition or (3) ketamine for casualties who have moderate to severe pain but who are in hemorrhagic shock or respiratory distress or are at significant risk for developing either condition.
They also reported that ketamine is presently being used as a battlefield analgesic by some medics in theater with good results. Additionally, on a recent assessment of prehospital care in Afghanistan, combat medical personnel noted that Tactical Combat Casualty Care (TCCC) battlefield analgesia recommendations need to be simplified-there are too many options and not enough clear guidance on which medication to use in specific situations. Morphine given intramuscularly has a delayed onset of action and, like all opioids, may worsen hemorrhagic shock. medics carry morphine autoinjectors for prehospital battlefield analgesia. combat forces serving in Afghanistan and Iraq have died from hemorrhagic shock, the majority of U.S. Although the majority of potentially preventable fatalities among U.S.
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