Wounds are potentially dangerous now and certainly would be much more so in the event of collapse of our current grid and medical system of constant overuse and instant access. First off, what is a wound? Any disruption in the normal function and protective barrier of the skin is defined as a wound. So, a simple rash would NOT be a wound but a blister would be, especially when it “pops” and is open to the elements. Acute wounds are just that, acute. They would be expected to heal and go through the normal stages of the healing process. A chronic wound is one in which the healing is impaired in some way. Normal wounds (acute) have good circulation, free of debri or dead tissue, clear of infection and moist at the bed of the wound. The size of the wound in no way predicts the acute versus chronic nature. Large wounds that are acute undergo granulation in which the tissue will “bubble up” from the healthy base and even though may be scarred, will heal normally with time and continued health of the patient. When dressings are used for wounds, they should eliminate dead space, control pus, control fluid losses, be anti-bacterial or at least prevent new growth of bacteria, be cost-effective and available, and MOST IMPORTANTLY have to be manageable for the patient or the caregiver of that wound. Throwing up into a wound is really bad for it, so the person or patient needs to be able to handle it. There are many topical “helpers” of varying cost and effectiveness, and those will be discussed in further detail below as they are usually only helpful in very specific situations.
Wound care in general follows the same basic principles of baby delivery: keep things clean and let God do the hard work! Luckily for us, the design of both mothers and bodies facilitate normal, healthy outcomes in most deliveries and most wounds–even in a complete collapse scenario. The use of antibiotics in wound healing is NOT indicated for most wounds, and should be used in specific “high risk” wounds and in any wounds that show signs of infection. There is no study that shows that antibiotics are helpful for wounds that do not show signs of infection. Interesting, eh? So, what are the signs of infection in a wound? Local signs of infection are cellulitis, pus, odor, gangrene, streaking of the lymph drainage, or exposed bone. There are systemic signs of infection too; those would include fevers, chills, sweats, nausea or vomiting, low blood pressure, confusion and low blood pressure. High blood sugars are also a sign of infection, but this may be difficult or impossible to monitor without battery supplies and a very well-stocked medical kit. Most folks would not have access to this in a collapse environment, but if you do you could check a blood sugar if there were any other systemic or local signs to help convince you to use valuable stockpiles of medications–again if available. Diabetics will certainly be rare in a complete TEOTWAWKI picture, but obviously they are at much higher risk of chronic wounds and more likely to have infections due to impaired healing caused by high blood sugar levels. The best possible approach for a survivalist diabetic will be prevention of wounds–supervisory positions rather than front line preppers.
Any material that contaminates a wound impedes its ability to heal. Dirt, dust, grease, oil, pus, stool or other bodily fluids, foreign bodies, and dead tissue all decrease the chance for normal healing and increase the chances of infection. Obviously, on initial wound care, washing the wound thoroughly with gentle soap and water will be very helpful in removing these potential healing barriers. Irrigation with warm saline, if available, should be a routine part of wound management. If not available, sterilized water would be a second-best choice, and lastly clean water as a last resort option. Irrigation helps removal of loose material and bacteria. Adding soaps, iodine, or hydrogen peroxide is generally unnecessary and can in fact impede the healing of wounds. Low pressure has been found to be adequate to help wound healing and using higher pressure (force) may actually damage tissue and cause swelling, thereby decreasing healing. Therefore, only low pressure irrigation is recommended in a TEOTWAWKI situation unless the medical staff available is highly skilled at wound care and has advanced supplies and training.
Often surgeons or wound care doctors will cut dead tissue out of or away from wounds to help with healing. Wound care clinics utilize enzymes that help with healing also. Maggot therapy is also used in specific situations to help decrease dead tissue and help in wound healing. Growth factors are also used often to help encourage the healthy growth of tissues which then helps with the speed of wound healing and gives the body an advantage with wounds that are higher risk or larger. All of these options will be beyond the scope of 99% of preppers and therefore are mentioned here only in passing.
Almost all topical antiseptic and antimicrobial products available both over the counter (OTC) and prescription are irritating to wounds and can delay or prevent healing rather than aid it. There are two products that do have well-supported research that they actually do have some role in wound healing: Iodosorb and Silvadene. Silvadene is only available with a prescription and also both creams and ointments do not have a great shelf-life. Iodosorb does show reduction in bacterial growth and stimulation of healing by providing a moist wound environment. Silvadene is toxic to bacteria and therefore can often decrease bacterial growth in large wounds and burns. Again, both the cream and the ointment would have a shelf life of perhaps 2-5 years in ideal conditions, so for longer-term disasters these products would be unavailable even if stored by well-intended preppers.
Wound dressings often can have great effect in speeding wound healing, strength of the recovery skin, and cosmetics. Moisturizing the wound may seem like a bad idea because it would encourage bacterial growth and infection, but wounds heal much better if they are able to be moist during the healing phase. Scarring is often reduced also. Perfect dressings have the following abilities: absorbing excess drainage but keep the wound moist, protecting the wound from damage, bacteria, and pain, eliminates dead space, debrides necrotic tissues, minimizes swelling, does not contaminate the wound, minimizes changes, costs little to nothing, has a long shelf life, and is transparent. Such a dressing does not exist, but attempting to hit as many of these ideals as possible is the goal. Most post collapse wound dressings will be simple gauze pads moistened with sterile saline or water. This type of dressing has major drawbacks: it is too wet on the edges, bulky, and needs to be changed often. But, they have served the purpose of wound dressings since guaze was invented, so it is a viable use of guaze in the larger wound healing challenge of TEOTWAWKI. There are many other types of fancier dressings available currently for wound care at clinics and hospitals throughout the world, but they are expensive and will be unavailable to all but the Richiest of Riches after a collapse of importance.
Wound packing is a subject near and dear to my heart as an Urgent Care doctor. Smaller wounds are often created by us for drainage of abscesses. These wounds have been studied countless times and there is debate within medicine about the use of packing for I&Ds (incision and drainage). The latest and greatest word is that these types of abscesses, boils, pimples, (there are many names for them) do NOT need to be packed in order to heal if the wound is allowed to continue to drain. This type of wound will be BY FAR the most common wound necessary WTSHTF, and early drainage is superior to “waiting it out”. Packing these wounds has proven in the studies to cause more pain and shows no benefit in healing. Larger wounds are not so easy to comment on. If a wound is big and has a lot of “dead space” then packing is the current standard of care. The dressing is removed before it completely dries out, which is often 2 or 3 times a day for wounds with standard guaze packing. As soon as the wound appears to be granulated and the necrotic tissues have been removed, the packing can be stopped. If there is a wound big enough for more than a few 4X4 guaze pads to fill, that is a very bad sign for long-term survival at TEOTWAWKI.
Closing wounds in a post-collapse world is basically done at the time of the wound only and then not at all. Follow the 12 hour rule. If you can get it closed within 12 hours of it happening, then it is needing to heal with a bigger scar. Only minor lacerations will really be eligible for this type of closure. Bigger wounds will require specialty skills that will largely be unavailable to most after TEOTWAWKI. If your group is lucky enough to have a surgeon or doctor with skills, supplies, and space for repairs–you will be among the truly blessed. For the rest of us (including me) it will be staplers for skin and when the supplies run out then duct tape. If you do resort to duct tape or other “less desirable” options, remember to NEVER completely seal a wound with tape. Always leave room for drainage and the ability to see the wound for signs of infection. Small strips beats an entire roll any day. Lacerations should be washed and irrigated with sterile saline or water if at all possible before any closure. Larger lacerations that cannot be closed and bigger open wounds should also be washed and irrigated if possible, even if closure is not.
Wound care is a difficult and challenging profession WITH all the help of supplies, medications, hyperbaric chambers, hospitals, skilled nurses, surgeons, operating rooms, computers and electricity. Without those things, we go right back to the Civil War pictures in you head with the buckets on the floor and the blood-soaked rags hanging off everyone. Prevention of injury and wounds is of course the best practice, and all efforts should be taken to do so. But, with activity comes injury and wounds are inevitable. Make sure you have supplies of both sterile and non-sterile gauze. If you have access to more specialized supplies and someone has the skill to use them, stock up now. Make sure you have saline and/or sterile water available. Sutures, staples, glues and steri-stips do you no good whatsoever if you don’t have the knowledge to use them appropriately. Make sure someone in your group has that knowledge and get them the supplies they need to be comfortable facing an unpredictable future. As always, stay strong and comment via email anytime! Dr. Bob