Operational Medicine Medical Education and Training

Non-Operative Field Wound Care

Objectives - At the end of this session the participant will be able to:

Describe the common wounds and wounding mechanisms likely to be incurred during combat

List the critical factors in preventing wound infection

Objectives - At the end of this session the participant will be able to: (cont.)

Describe how the combat environment impacts on wound care

Define an approach to wound care that takes into consideration limited resources and the austere combat/field environment

Non-Operative Field Wound Care

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Exploding 20 mm round at moment of detonation

Four Main Teaching Points

The wound you can see on the outside may be the least severe regardless of how bad it looks. Make sure the patient is evaluated and resuscitated (control all controllable bleeding) before doing wound care.

Irrigation and lots of it!

Debridement ("unbridle" the wound)

NO Primary Closure*

Dulce bellum inexpertis

(War is delightful to those who have no experience of it)

Erasmus

War Wound Distribution

No study is possible on the battlefield, one does simply what one can in order to apply what one knows. Therefore, in order to do even a little, one already has to know a great deal and know it well

Marshall Ferdinand Foch

Two Broad Mechanisms of Combat Wounds

Penetrating/perforating wounds

Low velocity

Mostly fragments

Rarely pistol bullet wounds or "spent" bullets

High velocity

Mostly bullets from assault rifles

Some fragments

Mechanisms of Combat Injury

Explosions/Blast

Penetrating fragment wounds

Primary, secondary, tertiary blast injury

Primary direct tissue injury from blast wave

Secondary from flying objects, ie. glass fragments

Tertiary from translational injury, ie. victim being thrown against a wall

Burns

Mechanisms of Combat Injury

Bullets

High velocity all assault rifles (>2000 feet/sec)

Low velocity all military pistols (<1500 feet/sec)


Continue to the PowerPoint Lecture...

Col. Cliff Cloonan USA MC

 

 

 

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