EVACUATION CONSIDERATIONS

It is critical that the down-range surgeon be mindful of timing of D&I with casualty evacuation. To avoid extended periods without wound inspection due to fixed wing flight, a best practice is to anticipate movement and plan debridement within 24 hours of movement. Generally, large acute wounds will need inspection and D&I every 24 hours during the first few days after injury. Ideally, serial D&I should be completed by the same provider, and photo documentation of wounds obtained (in compliance with theater policy); however, the nature of patient evacuation may result in rapid transport from the point of injury to the Role 1, 2 and 3 in a compressed timeline. Most wounds should not be closed prior to arrival at a definitive care location. Providers receiving a patient with a closed wound should have a relatively low threshold to reopen a wound if there are any concerns for contamination or non-viable tissue having been left behind. This compulsive approach to combat soft tissue injuries will decrease the likelihood that a wound will worsen and result in adverse patient outcomes.