Wound Management in Disaster Settings

• Published in: World journal of surgery 2015-04, Vol.39 (4), p.842-853
• Main Authors: Wuthisuthimethawee, Prasit, Lindquist, Samuel J., Sandler, Nicola, Clavisi, Ornella, Korin, Stephanie, Watters, David, Gruen, Russell L.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Antibiotic Prophylaxis; Bandages; Cardiac Surgery; Consensus Development Conferences as Topic; Crush Syndrome - therapy; Debridement; Disasters; Documentation; First Aid; General Surgery; Humans; Medicine; Medicine & Public Health; Necrotizing Fasciitis; Practice Guidelines as Topic; Primary Closure; Surgery; Tetanus; Tetanus Toxoid; Therapeutic Irrigation; Thoracic Surgery; Vascular Surgery; Wound Care; Wound Infection - prevention & control; Wounds and Injuries - therapy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-014-2663-3

Background Few guidelines exist for the initial management of wounds in disaster settings. As wounds sustained are often contaminated, there is a high risk of further complications from infection, both local and systemic. Healthcare workers with little to no surgical training often provide early wound care, and where resources and facilities are also often limited, and clear appropriate guidance is needed for early wound management. Methods We undertook a systematic review focusing on the nature of wounds in disaster situations, and the outcomes of wound management in recent disasters. We then presented the findings to an international consensus panel with a view to formulating a guideline for the initial management of wounds by first responders and subsequent healthcare personnel as they deploy. Results We included 62 studies in the review that described wound care challenges in a diverse range of disasters, and reported high rates of wound infection with multiple causative organisms. The panel defined a guideline in which the emphasis is on not closing wounds primarily but rather directing efforts toward cleaning, debridement, and dressing wounds in preparation for delayed primary closure, or further exploration and management by skilled surgeons. Conclusion Good wound care in disaster settings, as outlined in this article, can be achieved with relatively simple measures, and have important mortality and morbidity benefits.