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1. Wound Dressing/Splinting in Preparation for Transport

Dr. Brandon Horne
Dr. Benjamin Kam
I. Stabilize Patient
II. Critical Components of Safe Transport of Extremity Wounds
            A. Cessation of bleeding
            B. Prevention of further injury
                        1. stabilization of fractures
                        2. removal of noxious substances and gross contamination
            C. Monitoring for limb threatening conditions
                        1. further blood loss
                        2. overly compressive dressings/splints
                        3. development of compartment syndrome
            D. Simplicity
                        1. use of external fixators has made transport easier, more comfortable, and safer for extremity injuries
                        2. while possible, transport with skeletal traction or tractions splints not advisable
                                    a. monitoring of position of limbs, traction components, and unpredictable delays or transport times make their use potentially dangerous
                                    b. dark, loud aircraft cargo bay on long transatlantic flight with patient in skeletal traction would be difficult environment to provide constant monitoring or traction
                                    c. undue burden on medical crew when attention may be divided between large number of patients
                        3. soft tissue dressings may include devices
                                    a. newly approved negative pressure bandages may allow exact quantification of drainage
                                    b. require surveillance for mechanical/vacuum failure

III. Medical Considerations/Requirements for Transport

            A. Medical evacuation request includes requirement for surgical equipment and/or providers
            B. Patient is sufficiently stabilized for anticipated mode and duration of travel
            C. Patient’s airway and breathing is adequate for movement
            D. Patient’s IV lines, drainage devices, and tubes are fully secured and patent
            E. Patient at high risk for barotraumas should be considered for prophylactic check tube placement before prolonged aeromedical evacuation
            F. Heimlich valves on chest tubes are functioning
            G. Foley catheters and nasogastric tubes are placed and allowed to drain
            H. Patient is securely covered with both a woolen and aluminized blanket for air transport
            I. 3 litter straps used to secure patient to litter
            J. Personal effects and all medical records accompany patient
Emergency War Surgery, 3rd U.S. revision, Borden Institute, Walter Reed Army Medical Center, 2004, pp. 4.1-4.9.
The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense or the U.S. Government.

Materials and support for The Disaster Preparedness Toolbox is provided by Lt Col. Ky Kobayashi, MD and Col. Benjamin Kam, MD.