WOUND CARE

For detailed wound care see Acute Traumatic Wound Management in the Prolonged Field Care Setting . For burn wounds, refer to the Burn Wound Management in Prolonged Field Care.

To prevent infection, it is crucial to prioritize wound care and dressing changes.15

- Pain management is paramount during wound care and dressing changes. Ideally, casualties will be medicated with long-acting analgesia medications at least 60 min by mouth or 15-30 min IV before responders begin any wound care. For Ketamine dosing, procedural (higher) dose may be needed; use 0.5-1mg/kg IV/IO (use lower dosing if using multiple medications) and give 2-3 minutes prior to wound care. Local anesthesia such as injectable lidocaine or bupivacaine may be used if available (inject 10-15 minutes prior to procedure). Reference current JTS CPGs for appropriate Analgesia and Sedation Management During Prolonged Field Care If you are in an austere environment and analgesia medication is limited, distract the casualty and consider taking breaks during wound care.
- Wound type (by exposure). All wounds are considered dirty in the deployed environment.
  - Clean: A simple wound (e.g., cut produced by a blade) in an area of the body with low bacterial count, treated shortly after the wound occurred. This would be the minority of wounds obtained in a field or deployed setting.
  - Dirty: A wound in an area with a high bacterial count (e.g., axilla, groin) or presenting late (>6 hours after wounding) in which case bacterial counts are expected to be at levels that could increase risk of infection.
  - Contaminated: A wound impregnated with organic soil (swamps, jungle), claylike soil, or fecal material, or a wound already infected.

Non-medical Responders and Medical Responders

- Wash smaller wounds with soap and potable water.
- Keep dressings clean and dry. Change soiled dressings as needed.
- Assist medical responder with wound care and dressing changes.
- If packaged medical dressings are not available, a clean piece of cloth may be used. If used as an alternate, the cloth should not be visibly soiled and should be dry. Cloth may be hand-washed with soap and water, rinsed thoroughly, and dried.

Ensure you gather all supplies and administer proper pain medication before conducting wound care.

- Minimum: Wash smaller wounds with soap, if available, and potable water. Irrigate larger wounds with potable water (cooled before use if boiled) and pour across the wound. If unable to irrigate because dressings are limited, leave the original dressing and reinforce/secure it. Ensure dressings are not wrapped too tightly, leading to restricted blood flow.
- Better: Inspect dressing at least every 24 hours and change as needed. Remove and replace soiled dressings at least every 24 hours. Irrigate the wound with potable water using a 10cc syringe and 18-gauge angio-catheter. If available, use a topical antimicrobial dressing for burns and wounds that may be contaminated. If only gauze is available, use that. If dressings are available, replace the old dressings with new at least every 24 hours and as needed.
- Best: As above, using sterile water or normal saline to irrigate the wounds. Change the dressing at least every 24 hours and as needed and examine the wound for any change in color, drainage, pain or odor.

CAUTION: Exposing any wounds to a relatively dirty environment in an austere setting may expose a casualty to further contamination. When possible, move the casualty to a location away from the elements, have the provider wash their hands, and make the environment as clean as possible before starting any wound care and dressing changes.