Page 78 - JSOM Fall 2020

Prehospital Combat Wound Medication Pack Administration
in Iraq and Afghanistan

A Department of Defense Trauma Registry Analysis

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Steven G. Schauer, DO, MS *; Jason F. Naylor, PA-C ; Yousef M. Ahmed, MD ;
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Joseph K. Maddry, MD ; Michael D. April, MD, DPhil, MSc 5

ABSTRACT
Background: The United States (US) military utilizes combat and decreased wound infection rates among combat casual-
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wound medication packs (CWMP) to provide analgesia and ties sustaining open wounds in the deployed environment. In
wound prophylaxis in casualties who are still able to fight. response to the need for an easy to administer pill combina-
We compared characteristics of combat casualties receiving tion that addresses both the pain associated with trauma and
CWMP to those not receiving CWMP. We also describe the provision of antibiotic prophylaxis, the US military developed
proportions of casualties with injury patterns consistent with combat wound medication packs (CWMP) that contain ac-
Tactical Combat Casualty Care (TCCC) guideline indications etaminophen, meloxicam and moxifloxacin (National Stock
for CWMP use who received this intervention. Methods: This Number 6505-01-548-5129). Current TCCC guidelines rec-
is a secondary analysis of Department of a Defense Trauma ommend the administration of the CWMP for open wounds
Registry (DODTR) dataset of US military personnel from Jan- and casualties who are in mild to moderate pain and can con-
uary 2007 to August 2016. We searched for all subjects with tinue fighting. 4
documented use of at least one medication from the CWMP
(acetaminophen, meloxicam, moxifloxacin). Results: Within Limited data exist to quantify the use of the CWMP in the
our dataset, 11,665 casualties were US military Servicemem- combat setting. That data which exist specifically examined
bers. Overall, <1% (84) of our study population received the CWMP administration for open wounds among a single unit
CWMP. The median age and mechanism of injuries were sim- with exceptionally high rates of TCCC guideline adherence
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ilar between CWMP nonrecipients versus recipients. Median not likely to be generalizable to all forces. Similarly, lim-
composite injury scores were higher for nonrecipients than re- ited data exist with regard to rates of administration of the
cipients (6 versus 4, P < .001). Proportions of casualties with individual CWMP components to include oral analgesia and
injury patterns meeting TCCC guideline CWMP indications antibiotic administration. That data which exist on analgesia
who received this intervention were low: gunshot wound, administration in the prehospital combat setting focus on par-
<1% (14 of 1805), tourniquet applied, <1% (11 of 1912), ma- enteral medications (namely opioids and ketamine). 7–12
jor amputation, <1% (5 of 803), and open fracture, <1% (10
of 2425). Based on serious injuries by body region, we had The literature would benefit from further investigation into
similar findings for the thorax (<1%; 3 of 1122), abdomen the use of the CWMP among all forces in the deployed envi-
(<1%; 1 of 736), and extremities (<1%; 11 of 2699). Conclu- ronment. It would further benefit from comparisons between
sions: Subjects receiving the CWMP were less severely injured CWMP nonrecipients versus recipients to elucidate reasons for
compared to those who did not receive this intervention. The administration or lack thereof and difference in outcomes.
CWMP had very infrequent use among those casualties with
injury patterns meeting indications specified in the TCCC Goal of This Study
Guidelines for use of this intervention. First, we compare characteristics of combat casualties receiv-
ing CWMP to those not receiving CWMP. Second, we also
Keywords: combat; pill; pack; military; pain; antibiotic describe the proportions of casualties with injury patterns con-
sistent with TCCC guideline indications for CWMP use who
received this intervention.
Introduction
Methods
Combat casualties frequently experience pain and open
wounds. Analgesia is a vital component of prehospital trauma Data Acquisition and Dataset Development
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care as the literature reports an association between lack of We identified subjects as part of a larger descriptive study of
analgesia and subsequent negative outcomes such as post- emergency department (ED) interventions for trauma patients
traumatic stress disorder (PTSD). Additionally, an associa- in Iraq and Afghanistan using predefined search codes within
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tion exists between administration of antibiotic prophylaxis the Department of Defense Trauma Registry (DODTR). This
*Correspondence to Steven.g.schauer.mil@mail.mil
1 MAJ Schauer is affiliated with the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA
Fort Sam Houston, TX; Uniformed Services University of the Health Sciences, Bethesda, MD; and 59th Medical Wing, JBSA Lackland, TX.
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2 LTC Naylor is affiliated with the Madigan Army Medical Center, Joint Base Lewis-McChord, Washington. Dr Ahmed is affiliated with Naval
Special Warfare Group ONE, Coronado, CA. LtCol Maddry is affiliated with the Brooke Army Medical Center, US Army Institute of Surgical
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Research; University of Texas Health San Antonio, TX; and 59th Medical Wing, JBSA Lackland, TX. MAJ April is affiliated with the Brooke
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Army Medical Center.
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