*The Importance of Minor Wound Care in a Disaster*
By: Mountain Medic
26 August 2013

Last week while I was camping, I met two people who were hiking the 3,100 mile Continental Divide Trail. They had already hiked from Mexico to Montana since beginning about 4 months ago.  One of the hikers, a 43 year old otherwise healthy male, needed a ride to the hospital because of an infection. It started out as a little scratch on his leg. It was nothing that, in my experience as a paramedic, would be serious. The difference is that my experience as a paramedic never involved hiking 30 miles a day and going for days to a week between bathing. His minor scratch got infected and was in danger of killing him. This was in part because he was not able to adequately clean it.

He doesn't know exactly when he got the scratch, but it was at least a week prior to seeking medical care.  It was just one of several minor scratches from walking through brush.  Not serious enough to even stop when it happened.  He thinks he probably wiped it down with a wet-wipe that night.  A few days later he noticed it began to "fester" a little, so he squeezed out the little bit of pus, applied Neosporin and a band-aid, then forgot about it. It seemed to have healed until 3-4 days later he noticed a mass growing on his knee 2 inches away from original wound.  Apparently the infection moved because there were no abrasions over the mass.  The knee began to swell and the next morning, the lower thigh began to swell too.  He could feel a tender streak about 1 inch wide by 6 inches long moving up his thigh. He knew it was serious because his hiking partner had gotten a similar infection a few months ago when her blisters got infected.  Knowing it was serious, he was willing to interrupt his hike and asked  me for a ride to the closest hospital.

As a paramedic, I agree that it was now a serious injury, and without prompt care might have resulted in the loss of his leg or death.   I sometimes had patients with horrible infections when I worked on an ambulance. These were the kind where maggots were going in and out of the persons flesh. These were mostly homeless people that rarely had an opportunity to bathe. I never asked them how the infection started, as it didn't seem too important once maggots were involved. However, I suspect they started as relatively minor wounds too.

I gave the hiker a ride to the hospital, and 24 hours after starting antibiotics the swelling started going down and he resumed hiking.  A few days later, there was no sign of infection; however, the skin was peeling away from where the infection had been.

There are several similarities and lessons to be learned between this hikers experience and what we might experience in a SHTF scenario.

Our bodies will be stressed.  This hiker lost 30 pounds during the last 4 months and was averaging more than 20 miles per day hiking.  In a disaster, we will have to work harder than we are used to, doing the chores required for survival. Plus, we may have to do it on a less optimum diet than we are used to.  This hiker had noticed that through hikers are more prone to infection near the end of their journeys than they are at the beginning.  As a disaster progresses, we may become more prone to infection too.

This hiker did not have access to a daily shower, sometimes having to go up to a week between showers.  In a disaster, finding the time, energy, or even the water to bathe regularly may be a problem.

The hiker had a mission (hiking 20 miles a day to finish his 3,100 mile hike) that kept him from devoting as much attention to his wound as he might have otherwise.  It is easy to imagine that guarding the homestead, planting crops (or any number of other chores), could be deemed more important than cleaning a minor wound in a SHTF situation.

Minor wound care is not part of my professional training, but you don't really need me to tell you what to do to prevent an injury like this from becoming infected.  We all have lots of FNV treating similar wounds that did not become infected. We may use different medicines, solutions, ointments, or poultices, but the common ingredient in all of our care regimens is soap, water, and trying to keep the injury clean. As it turns out, this part that we have in common is what has been proven to work and is what the hospitals do for minor wounds too. Soap is used on the surrounding area and the wound itself is irrigated with clean water. After that, it is covered up to keep everything clean. [Major wounds, like those that require debridement or suturing are a different matter and a subject for a different article.]

If instead of stopping to take care of minor injuries we keep working and exposing our wound to more contamination, we will increase the chances of getting a serious infection. In a disaster, especially if antibiotics are not available, we will have to make efforts to stay clean and clean our wounds. Even if we do have antibiotics, we will probably have more soap and water stored than those and our antibiotics are precious.

Mountain Medic

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