Two thoughts -
1) In Afghanistan & Iraq we had US and coalition units running around with different meds for use in the field.
Some with morphine autoinjectors, typically 10 mg IM, administered by a medic.
Some with fentanyl lollipops, usually taped to the casualty's hand and self administered. If they got "too much" then the natural flopping/straightening of the arm would pull it out of the casualty's mouth.
And some with ketamine, administered by a medic, either IV or IM.
By far, when it came to receiving these patients in the trauma bays, we preferred receiving the patients who got ketamine, vs the ones who came in with too much or too little opioid.
2) I'm so angry and sick of these ****ing ******ed cowboys (mostly ER clowns) sitting around dreaming their adrenalin and caffeine fueled fantasies about point-of-injury battlefield medicine. I want to kick them in the gonads so hard they taste it for the next month, and to end their genetic lines so whatever's wrong with them can't pollute future generations.
I really have no idea what actual "life-saving interventions" they think are going to happen at the point of injury, and who's going to perform these interventions.
The 3 main causes of preventable battlefield deaths are extremely well understood: extremity hemorrhage, airway obstruction, tension pneumo. These are all well within the capabilities of enlisted medics. If you want to expand on these with more skilled care for more complicated problems, you need to put doctors at the point of injury. For all sorts of practical reasons (relatively few number of doctors available, risk of losing doctors, the logistic footprint to bring the tools doctors need to actually do more than a 19-year-old medic) it's the height of idiocy
What the actual **** do they think the use of this magical DARPAsthetic thing is going to be, without a surgeon to do the damage control surgery?
One of the more recent fantasies these inbred delusional boneheads have been fixating on is REBOAs placed by non-physicians in the field. I've ranted about this before in the milmed forum, but to sum up, I think of all the times I've seen vascular and cardiac surgeons struggle to get femoral access in patients under ideal circumstances, in a well lit OR, with skilled assistant hands, extra supplies, patient on a table at an ergonomic height, ultrasound ....
And those bozos actually thought (think?) that a non-physician in the field is somehow going to
a) get a wire into a vessel in a profoundly hypovolemic patient with clamped down arteries
b) without causing additional bleeding trauma to the femoral vessels
c) while kneeling on the ground
d) with suboptimal lighting
e) and no skilled help
f) using insufficient, incomplete, or otherwise non-optimal supplies
g) THEN get a balloon up into the aorta into proper position and inflate it
Today, right now, listed under "future considerations" the
JTS guideline say:
"Training non-physician caregivers to place REBOAs in the prehospital settings is being investigated."
Idiots. It makes me unreasonably angry.
At least part of DARPA's purpose is to study odd, longshot, sometimes weird future ideas. I can respect pure research done even if there are unrealistic goals, and I am certainly interested to see if any new drugs with new mechanisms and new risk profiles ever emerge. That would be cool. Especially if they come up with a better-and-safer-than-ketamine pain reliever to give to casualties prior or during transport to a medical facility. But even if they're wildly successful - there's no place for a general anesthetic on the battlefield, because there's no place for battlefield surgery in the first place.
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