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