This CPG provides an evidenced based framework for the management of PAD in injured combat casualties. It is a moral, medical, and operational imperative to provide state of the art pain services to combat casualties, in so forth reducing the incidence of chronic pain syndromes, PTSD, and long- term narcotic dependency. This process begins at the point of injury and Role 1 facility. As the casualty moves along the care continuum, pain and anxiety must continue to be addressed with the increasing capabilities inherent to the military Medical Treatment Facility (MTF). In this CPG, emphasis is placed on Role 3 care, as this is the first MTF that typically is equipped with robust treatment options. Optimal analgesia is a team effort and should be coordinated by the trauma surgeon, the APMS consultant, and the critical care consultant in conjunction with the bedside nurse who ultimately delivers therapy and monitors the adequacy of it. This CPG will address the need for an APMS at Role 3 care.1-3 The APMS will be introduced as a necessary adjunct to the Trauma Team. This multidisciplinary collaboration will assess analgesia needs throughout Role 3 care based on injury complexity, trauma burden, risks for coagulopathy / thromboembolic events, anticipated number of surgical procedures, evacuation plan, logistical constraints, and practitioner expertise. It is also important to recognize that pain control should be optimized as a priority over sedation and that the principle of “analgosedation” (i.e. analgesia-based sedation) is a viable solution for critically injured casualties.4

This CPG will also delineate specific treatment guidelines between Role 1, Role 2, Role 3, and higher echelons of care. Role 1 care guidelines are incorporated from the JTS Committee on Tactical Combat Casualty Care recommendations.