Some level of pain is present in all combat casualties. While the pain may be initially masked by the intensity of the situation, the combat medic or when the patient reaches the first level of care should assess the level of pain. Seriously injured patients who are not intubated should be assessed every 1-4 hours for the presence of pain. All patients who are intubated need to be continuously monitored for adequate analgesia. Signs of inadequate pain control in the intubated patient include tachycardia, hypertension, and agitation. However – it is imperative that other causes be excluded such as early compartment syndrome, missed injuries, or impending physiologic decline. If the patient is appropriately communicative, then using the DoD/VA Pain Rating Scale (DVPRS) and Supplemental Questions as quantifiers can facilitate evaluation and trends.3,10 All combat casualties will have a pain score recorded on admission to a Level III facility and as part of routine care while in the ICU.