Background and Goal of Study: Ukrainian medics have been treating many wounded for about 3
years during the armed conflict in eastern Ukraine, but the problem of acute pain treatment remains
unsolved. The problem is mainly due to significant differences in terms and conditions of care,
differences in the supply of medics. By this time agonist-antagonist of opioid receptors are available
for the solders for severe pain self-treatment, but for the medics (even for physicians) efficient
medication such as ketamine and fentanyl is not yet available at the prehospital stage. The aim of
the study is collection and analysis of information about the severity of pain and efficacy of pain
management in wounded at the prehospital stage.
Materials and Methods: We have interviewed medics (physicians and nurses) who directly
provided care for the wounded battlefield zone. 35 medics, including 15 doctors, anesthesiologists
agreed to complete the questionnaire.
The questions were next: 1) What percentage of wounded had the most severe (unbearable) pain
before injection of analgesics? 2) What was the average level of pain in injured according to 10-
point scale? 3) Do you agree with availability of opioid receptors agonist-antagonist for soldier's
self-care of severe pain in the absence of physician or paramedics?
Results and discussion: The questionnaire respondents estimated that they provided care to
about 2,565 wounded, of whom 852 were severely injured. Unbearable pain occurred in 42 ± 31%
of the wounded. The average level of pain was 5 ± 2 points (of 10-point scale). Assessment of pain
depended neither on education (physician or other medical personnel), or length of service.
Of the surveyed anaesthesiologists 62% voted "FOR" the availability of opioid receptors agonistantagonist
for soldier's self-care of severe pain without a doctor or paramedic paramedics. These
results indicate that the problem of pain relief of the wounded are still far from being resolved. So
decision for reduction in availability of opioid receptors agonist-antagonist for soldier's self-care
should be made only while increasing the availability to combat medics of effective analgesics such
as ketamine and fentanyl, according to NATO standards.
Conclusion: Our preliminary data suggests that many wounded have unbearable pain and their
analgesia is still not sufficient in the prehospital phase. Filling questionnaires is simple and efficient
method to receive reliable information.

Analysis of the severity of pain in the wounded during the conflict in eastern Ukraine and the effectiveness of pain management in the prehospital settings