The CWMP is option #1 in the TCCC Guidelines and should be used by all Service members who are still able to fight and have mild to moderate pain. In the ASM and CLS TCCC training, they are taught to take all three pills out of the CWMP; but you are able to determine whether or not the antibiotic should also be administered and so may recommend that only two of the three medications are taken. 

In a study published in the Fall of 2020, only 84 out of 11,665 casualties (<1%) in the DoD trauma registry received the CWMP. The study concluded that the CWMP had very infrequent use among those casualties with injury patterns meeting indications specified in the TCCC Guidelines. So, as you train your Combat Lifesavers and talk with your Service members (combatants or not), it is appropriate to emphasize to them that the CWMP is a useful tool to help them achieve or maintain tactical superiority and accomplish their unit’s mission if they are injured.

Another benefit is that neither medication produces sedation or alters the casualty’s level of consciousness, so they are able to provide analgesia without reducing combat effectiveness. Also, they avoid the logistical difficulties of having to monitor controlled medications.

Both CWMP pain medications should be self-administered by the casualty as soon as feasible after an injury is sustained if the pain is mild to moderate. If you or your Combat Lifesavers come across a casualty who meets the criteria for analgesia with the CWMP and they haven’t already self-administered their dose, remind them to do so. As with all medications, it is important to make sure that the casualty has no allergies to medications prior to administration (either self-administration or assisted administration).

Another important thing you can do for your unit personnel and Combat Lifesavers is to educate them about the risk of using aspirin and other NSAIDs before and during their deployments. These medications decrease platelet function and should not be used at all by troops deployed in support of combat operations since these individuals may be called upon to conduct missions on very short notice; the risk of bleeding can last days or even longer after stopping the medication.