Special Considerations in Austere Environment

Specific considerations for wound care in the PFC context: although all 10 of the PFC core capabilities should be implemented,1 the following have areas of emphasis specific to longer-term wound care and management.

- Physical examination: Techniques specific to prolonged wound management include inspection of the wound and surrounding skin for evidence of necrosis or infection, passive and active range of motion to assess level of disability, ultrasound to assist in evaluating critical anatomy and/or guide regional anesthesia, distal pulse trending to assess for vascular compromise, and laboratory studies as an adjunct to determine the amount of blood loss or look for evidence of a developing infection.
- Nursing: Scheduled dressing changes are necessary to ensure proper wound healing and infection management. The bandage plan should include scheduled changes, materials to be used, as well as analgesia.
- Surgical intervention: Efforts are most likely geared toward irrigation and debridement. They should be scheduled and planned with evacuation timeline or inability to evacuate taken into consideration.
- Telemedicine: Should be initiated as early as possible so the consultant can properly guide the patient’s management and monitor the patient’s status. Photographs play a vital role in a consultant’s ability to advise the Role 1 provider on wound care, especially in the assessment of viable tissue.