APPENDIX F: Battlefield Acupuncture (BFA)

BFA requires appropriate training through the Acupuncture and Integrative Medicine Center at Joint Base Andrews or other approved training organization. An exception would be physicians without formal training but the requisite skills that easily translate to this procedure (i.e. surgeons, anesthesia, ER, critical care).

Supplies Needed: 10 Auricular Semi-Permanent (ASP) needles and alcohol pads.

Patients should NOT receive BFA if:

- The patient has an active infection in an ear that is going to be used for BFA (treat only uninfected ear)
- A bleeding disorder is present (relative contraindication)
- The patient is pregnant or might be pregnant
- Current or previous keloid scar formation on either ear

Steps to apply BFA needles:

Read ALL steps before proceeding.

1. Patient Education and Consent – explain the procedure and expected course of having the ASP needle in place for 2-4 days while continuing regular activities.

2. Cleanse area – use alcohol swabs to disinfect both ears.

3. Place ASP needles

- Begin by applying needle at lowest point shown in figure below (the Cingulate Gyrus). Start on the side with most pain, then switch to the opposite side after body movements described in step b. Proceed to the next point and continue alternating sides until pain is resolved (0 or 1 out of 10).
- After each needle application, the patient should walk 10-20 steps unassisted or move their arms/legs for 30-60 seconds if physically unable to walk unassisted.
- If adverse symptoms are noted during the procedure, remove the last needle placed unless doing so is too uncomfortable. Symptoms include lightheadedness, near-fainting, euphoria, or increasing pain level.

4. Post-care

- Recommend patients keep brief written notes of their response to treatment.
- There is a small possibility of drowsiness, lightheadedness, and/or euphoria occurring up to 30 minutes after treatment.
- If effective, additional BFA treatments may be repeated every (5-7 days).

For more information, refer to the BFA Handbook on Deployed Medicine.

- Fox LM, Murakami M, Danesh H, Manini A.Battlefield acupuncture to treat low back pain in the emergency department. Am J Emerg Med. 2018 Jun;36(6):1045-1048.
- Niemtzow. (2010). Battlefield Acupuncture. Journal of the Acupuncture Association of Chartered Physiotherapists, Autumn, 55-59.