Medical professionals like doctors, nurses, and paramedics and
the high-tech equipment they work with are the heart of advanced medical care.
When highly-trained personnel are unavailable, it becomes the responsibility of
the average citizen to obtain medical education and supplies. Lack of knowledge
and materials will cost lives in any situation where modern care is not an
Knowing how to stop hemorrhage is very important, but the
medic in austere settings will be required to do much more with an open wound.
Indeed, they will be responsible for it from the time it was inflicted to full
recovery. A good start is knowing “prehospital care”. Few of us, however (including most medical
professionals), are prepared to handle the complexities of the entire healing
process when there is no hospital.
In today’s medicine, few providers care for every medical issue experienced by a patient. Even generalists send their patients to specialists for specific problems. In a survival setting, this is no longer possible. Therefore, it’s imperative to understand wound healing and the procedures that help a victim make a full recovery. One of these procedures is debridement.
Debridement is the removal of devitalized (“necrotic”) tissue and foreign objects from a wound. Most minor acute wounds heal just fine with cleaning and regular evaluation, but more severe wounds, burns, and bedsores may require intervention. Debridement is a way to eliminate obstacles to good healing.
Debridement speeds the healing process in various ways. Dead
tissue inhibits the development of healthy new cells and makes the area
susceptible to infection. It can also hide the signs of bacterial invasion.
Debridement is rarely taught in standard first aid courses. Even municipal courses meant to deal with emergency trauma can get your victim to the hospital, but little is taught for the days or weeks down the road.
A variety of techniques are used to accomplish debridement and more than one type may be used on the same patient. They follow the acronym “BEAMS” and include:
B for Biological debridement. This involved the removal of dead tissue with special sterile medical maggots. Maggots are the larvae of flies, in this case the Green Bottle Fly (Lucilia sericata); they debride by preferentially liquefying and digesting nonviable areas. They also ingest bacteria in the wound, removing barriers to healing.
E for Enzymatic debridement. Special enzymes known as collagenases are applied to the wound on a daily basis. These chemicals loosen connective tissue that holds dead tissue from the bottom up. The lack of availability of these enzymes in austere settings probably limits their usefulness.
A for Autolytic Debridement. The slowest but least invasive type of debridement. In autolytic debridement, a wet-to-moist dressing is used to help the body’s own enzymes to break down devitalized tissue. This works better for smaller wounds with less necrosis.
M for Mechanical debridement. In mechanical debridement, some type of force is applied to separate nonviable tissue from the wound bed. This is more aggressive than some other methods and may be associated with some discomfort Different methods include irrigation with syringes followed by gentle “scrubbing”. Wet-to-dry dressings are another option. In this case, a damp (not soaking wet) gauze is packed into the wound and removed when it dries, taking dead tissue and debris with it. The best material to use is cotton gauze, although “debridement pads” are commercially available. Other methods less likely to be available in austere settings include whirlpool therapy and others. Care must be taken to remove as little viable tissue as possible during the procedure.
S for Sharp or Surgical debridement. By far the fastest method, the conservative approach involves the use of scalpels, scissors, forceps, and other instruments to remove nonviable tissue. This is usually possible to perform at the bedside off-the-grid. Surgical debridement is more aggressive and, today, is done in the operating room. It removes dead material but sometimes viable as well. The removal of devitalized tissue is rarely very painful, but living tissue (without anesthesia) is another matter.
Debridement is a necessary evil, but many wounds will not heal without it. You must take into account a number of factors besides the wound, including the age and physical condition of the victim, chronic illnesses, and more. You must look at the whole patient, not just the hole in the patient.