TRANSFER OF CARE

Downrange surgeons should make every effort to coordinate dressing changes and necessary repeat debridement in anticipation of required patient transport to a higher echelon of care. Given the propensity for wounds to evolve in their acute phase, downrange surgeons must maintain a low threshold to perform additional debridement prior to evacuating the casualty to avoid an unacceptable delay between debridements. Given the unpredictable nature of the air evacuation system and to optimize timing of subsequent serial debridements, the patient should remain NPO for flight so that they are prepared for the next operation. Additionally, since wound healing and nutritional support are a challenge in these casualties, early enteral feeding should occur thought a nasoenteric tube. If the tube is post-pyloric and the casualty has a functioning nasogastric tube, then feeding can occur throughout the continuum of care, as long as strict aspiration precautions are maintained.