The French Syrette of morphine for administration to combat casualties

Dear Editor

As French military physicians currently deployed in Theatre of Operations, we read with great interest the study by Blankenstein et al. determining the opinions of recently deployed British Army personnel with forward medical care experience on the importance of effective battlefield analgesia, the efficacy and shortcomings of current battlefield analgesia and desirable features of the ideal battlefield analgesic.¹ Their results supported existing evidence for the introduction of an adjunct to intramuscular (IM) morphine. Surprisingly, in the introduction section, the authors stated that ‘The British armed forces are unique in supplying parenteral opiates to all deployed soldiers, comprising two 10 mg morphine auto-injectors designed for intramuscular (IM) administration to casualties’. We don’t totally agree with this statement since the French Army has a long experience of battlefield analgesia, using a 10 mg morphine auto-injector, also known as the Syrette of morphine. The Syrette is a device for injecting liquid through a needle, almost similar to a syringe, except that it has a closed flexible tube, instead of a rigid tube and piston. Before deployment in a combat zone, every French soldier undergoes the Forward Combat Casualty Care Level 1-courses and is trained to use his combat first aid kit, including the subcutaneous injection of 10 mg of morphine, using this Syrette.² Finally, in the French Military Health Service policy for combat analgesia, and also suggested by the authors, other techniques are encouraged, including titration of intravenous morphine, use of ketamine and fascia-iliaca compartment block for lower limb injuries.³