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Re: Injectable Morphine

I was surprised to read that the procedure used in the Korean War, for the general issue of medical/medicine paraphernalia (needles, bandages, sulfa, pain meds, etc.) and methods of injecting 1/4 gr. of morphine, have hardly changed in 53 years.  One exception stands out: there are so many conditions, exceptions, and limitations listed below in "today's world" of mass casualties that I wonder how any medics--struggling under Korean battlefield conditions--could ever determine the exact condition of any wounded American in a mass casualty event let alone know whether to give him that second shot of 1/4 grain morphine 4 hours later.  Does anyone know that 1/4 grain of morphine actually dulled the pain sufficiently and long enough during a complex evacuation procedure of severely wounded troops sufficient to really help the casualty or temporarily kill his pain?  The medical procedural list the medic must follow today for mass casualties within the U.S., seems very demanding.  I think wartime is the ultimate test of all systems, and perhaps the Defense Department should re-edit the book, or base it more on the Korean War--where things were rougher and medical treatment harder to get...in time.  
Blake.
rbmooney@bellsouth.net
 

EXAMPLE  OF TODAY'S PROCEDURE:  "ADMINISTERING MORPHINE.  Morphine is the most effective of all available pain-relieving drugs. When administered properly, it can relieve severe pain and prevent shock.

"Experienced medical personnel make the decision to administer this drug. But situations do arise, such as mass casualties, when you may be issued syrettes containing 1/4 grain of morphine (fig. 13-11).

"You may give one syrette of morphine to a casualty suffering severe pain. You may give a second syrette only if a casualty's severe pain persists and at least 4 hours have passed since you administered the first syrette. After this, do not administer any more morphine unless told to do so by a medical or dental officer.

"MORPHINE CANNOT BE GIVEN TO ALL CASUALTIES WHO SUFFER SEVERE PAIN. Administer morphine only if the pain is very severe and only if there is:

No head, neck, or spine injury
No chest injury

Figure 13-11.  Morphine syrette.

  1. No airway obstruction or impairment
  2. No wound of the throat, nasal passages, mouth, or jaws from which blood might flow to obstruct the airway
  3. No evidence of severe or deepening shock
  4. No loss of consciousness

"If you administer morphine in a mass casualty situation, you should:

"1. Select an injection site. The best site is the muscle on the back of the upper arm. If both arms are injured, you may use a thigh or buttock as an injection site.

WARNING

"If a tourniquet has been applied to the arm or the thigh, you must inject the morphine between the tourniquet and the main part of the body, if no other extremity is available.

"2. Disinfect the injection site if you have the time and the materials. Swab the injection site with alcohol or any skin antiseptic. If no antiseptic is available, wash the injection site with soap and water, or with plain tap water.

"3. Remove the plastic hood from the syrette.

"4. Grasp the wire loop at the end of the needle and push down on the loop until it is stopped by the guard. This will pierce the metal seal on the collapsible tube.

"5. Pull on the wire loop and withdraw the wire completely from the needle. Throw the wire away. Do not touch the needle.

"6. Thrust the full length of the needle straight through the skin at the injection site.

"7. Inject the morphine by slowly squeezing the collapsible tube. Start squeezing at the end of the tube and work your way down toward the needle. Once all the morphine has been injected, withdraw the needle and massage the injection site for a few minutes to help circulate the morphine.

"8. Record your treatment. Medical personnel who later provide treatment for the casualty must know when the morphine was administered. Record the treatment on the U.S. Field Medical Card (discussed later), and write the letter "M" and the time of the injection (e.g., M 0830), on the casualty's forehead. Use a skin pencil, or another semipermanent marking for this purpose. You should also attach the empty syrette to the casualty's shirt collar or to some other conspicuous part of the clothing."

----- Original Message -----
Sent: Saturday, October 18, 2003 12:36 PM
Subject: Re: Injectable Morphine

To Don:
 
The packet contained sulfanilamide powder (short name was sulfa). Sulfa was sprinkled into open wounds during WWII as an antibacterial to reduce infection. Although its may have been used early in the Korean War, it was replaced by other antibiotics including penicillin. By 1953, injectable penicillin as well as penicillin tablets were used extensively.
 
Dick   
----- Original Message -----
Sent: Saturday, October 18, 2003 12:03 PM
Subject: Re: Injectable Morphine

In a message dated 10/17/2003 5:01:58 PM Eastern Daylight Time, rtunison@cox.net writes:
Not long ago someone asked about injectable morphine carried by corpsmen or medics. I think this is an accurate answer.
 
"The morphine Syrettes - small tubes with a needle on one end and a dispenser on the other - contained a quarter grain of morphine to be injected into a grievously injured Marine to dull unbearable pain."
 
Flags of Our Fathers by James Bradley, Bantam Books, New York, 2000
 
Dick Tunison
On the day of the Inchon Landing every man in my unit was issued a tube of injectable morphine with strict orders that it was not to use it on anyone else, but yourself. To prevent someone from stealing it we were also warned not to let anyone know where we kept it. Even with the warning it seemed that everyone taped it inside their helmets.  When they passed out of the morphine they also took the package of sulfur powder that was in our personal first-aid kits. They said while the sulfur was effective it caused of too much scar-tissue.  Don Gill