26: ICRC Style Wound Care

This Clinical Practice Guideline was written by a fellow 18D with input from around the surgical community. It reconciles the differences between wound care done in a role 2 or 3 facility, such as serial debridements, with what is taught in the 18D Special Forces Medical Sergeant Course with regards to delayed primary closure. One way is not “right” while the other wrong, it has more to do with the amount of time and resources available to the medic or other provider. The remainder of the blog post and podcast is meant to be a refresher for those who have already been taught these procedures. It is also meant to be informational for those medical directors who may not be exactly certain of what has been taught as far as wound care and surgery. If you haven’t been trained to do these procedures before going ahead with them, it is very likely that you may do more harm to the patient than good. That being said… The following are recommendations made by the International Committee of the Red Cross (ICRC) concerning the surgical management of war wounds in austere conditions and with limited resources. This is when the provider has some or all of the following considerations which would prohibit him from performing serial (follow-on) debridement with associated post-operative care.

Dirty environment

Limited supplies

Limited manpower

Limited time (mission dictated)

Wounds greater than 24 hours

The considerations above, accompanied with the position that the provider will be managing that patient for more than a couple days or become the definitive provider, should warrant ICRC recommendations for surgical management. For more content, visit www.prolongedfieldcare.org