Field Wound Care — Modern Trauma Protocol

Wound care in the field has a strict order of operations: stop the bleeding FIRST, THEN worry about cleaning and covering. Most people get this backward. They see a cut, reach for antiseptic, and ignore that the patient is losing blood pressure.

If blood is visibly pumping or spraying, stop reading and apply pressure. Use both hands. Press hard. Hold for 5-10 minutes minimum without lifting to check. If bleeding soaks through the bandage, add more on top and keep pressing. Do not remove the original dressing.

Bleeding control sequence

• ☐ Direct pressure with clean gauze or cloth, both hands, firm. 5-10 minutes minimum.
• ☐ If pressure alone does not work: add more gauze on top (never remove soaked material) and keep pressing.
• ☐ Elevate the wound above the heart if possible (not mandatory, just helpful).
• ☐ For catastrophic extremity bleeding: apply a tourniquet 2-3 inches above the wound, over muscle (not joint).  → Buy
• ☐ For junction wounds (groin, armpit, neck): pack with hemostatic gauze, hold pressure 3+ minutes.  → Buy
• ☐ Israeli pressure bandage for single-handed application  → Buy
• ☐ Mark the time any tourniquet was applied on the patient's forehead or on the tourniquet itself
• ☐ Monitor for shock (pale, cold, confused, rapid pulse, rapid breathing)

The #1 cause of wound infection in the field is inadequate irrigation. Modern wound care protocol (updated in the last 10 years) calls for HIGH-VOLUME, LOW-PRESSURE irrigation with clean water — NOT scrubbing with antiseptic, NOT hydrogen peroxide, NOT iodine directly on the wound.

Hydrogen peroxide, alcohol, and iodine in concentrations high enough to disinfect actually damage healthy tissue and slow healing. The modern protocol is: irrigate with clean water (or saline if available) at high volume, use a mild antiseptic (chlorhexidine or dilute betadine) only on the WOUND EDGES, not the wound itself. Then cover.

Modern wound cleaning protocol

• ☐ Wash your hands first with soap and water (or hand sanitizer if no water)
• ☐ Use clean drinking-quality water — at minimum 500ml per centimeter of wound length
• ☐ Irrigate with pressure — a squeeze bottle, syringe, or pinhole in a water bottle cap
• ☐ Flush until the wound appears clean and debris is gone (may take several minutes)
• ☐ Do NOT pour hydrogen peroxide or alcohol IN the wound — damages tissue, slows healing
• ☐ Apply mild antiseptic (chlorhexidine or 10% povidone-iodine) to the SKIN AROUND the wound only
• ☐ For deep puncture wounds: do NOT pack — seek professional help as soon as possible
• ☐ For embedded objects: do NOT remove — stabilize in place, transport to professional care

Modern wound care is based on "moist wound healing" — the opposite of the old "let it dry out and scab" advice. A moist wound (covered, with a clean dressing, occasionally reapplied) heals 40% faster than a dry scabbed wound with less scarring and lower infection risk.

The right dressing depends on the wound type: simple cuts need a basic sterile gauze pad secured with medical tape or a roller bandage. Deep wounds may need a non-stick pad (Telfa) against the wound and gauze on top. Burns and large surface wounds benefit from hydrogel or hydrocolloid dressings if available.

Dressing protocol

• ☐ Apply thin layer of antibiotic ointment on a small wound (Neosporin, Bacitracin)
• ☐ Cover with sterile gauze pad or non-stick Telfa pad for deeper wounds
• ☐ Secure with medical tape OR self-adherent elastic bandage (coban)  → Buy
• ☐ Dressing should be snug but not tight — you should be able to slip a finger under the edge
• ☐ Check for good circulation past the dressing (capillary refill, pulse, temperature, sensation)
• ☐ Change dressing daily or whenever it gets wet, dirty, or blood-soaked
• ☐ Keep the wound moist, not wet — change if the dressing is saturated
• ☐ For burns: use non-stick pad + dry gauze cover; avoid plastic wrap which traps fluids against skin

Wound infection is the most common wound-care failure. A clean, properly dressed wound can still become infected within 24-72 hours. Left untreated, infection can turn a minor cut into a life-threatening systemic problem (cellulitis, sepsis) or cost you a limb.

The classic signs of infection are the "five Rs": redness expanding past the wound edge, RAdiating warmth, reddening streaks moving toward the heart, rising pain (not decreasing), and rising body temperature (fever). Any ONE of these means the wound needs immediate medical attention — antibiotics, professional cleaning, sometimes surgical drainage.

Infection warning signs

• ☐ Expanding redness around the wound (larger than 24 hours ago)
• ☐ Radiating warmth from the wound site
• ☐ Red streaks moving up the limb toward the body (lymphangitis — emergency)
• ☐ Increasing pain instead of decreasing (pain should fade after 24-48 hrs on simple wounds)
• ☐ Yellow, green, or cloudy pus (some clear drainage is normal; pus is not)
• ☐ Fever above 101°F or general feeling of being systemically sick
• ☐ Swollen lymph nodes near the wound (armpit for arm wounds, groin for leg wounds)
• ☐ Any of these = seek medical care NOW. Oral antibiotics are often effective if started early.

A real wound care kit is simpler than what drugstore first-aid kits contain. Skip the 200-piece "family" kits full of bandaids. Build a focused kit around the real threats: catastrophic bleeding control, clean irrigation, and infection prevention.

Build your wound care kit

• ☐ Pre-built trauma kit (MyMedic MyFAK or equivalent)  → Buy
• ☐ Squeeze bottle or syringe for wound irrigation (60 mL minimum)
• ☐ Chlorhexidine gluconate 2% antiseptic solution  → Buy
• ☐ Sterile saline bottles (for irrigation when no clean water)  → Buy
• ☐ Non-stick Telfa pads for deeper wounds  → Buy
• ☐ Sterile gauze pads in multiple sizes (2x2, 3x3, 4x4)
• ☐ Self-adherent wrap (Coban) for securing dressings  → Buy
• ☐ Medical tape (3M Transpore or paper tape)
• ☐ Triple antibiotic ointment (Neosporin generic is fine)
• ☐ Nitrile gloves — multiple pairs, for you AND the patient
• ☐ Medical-grade manuka honey as backup antiseptic  → Buy
• ☐ Trauma shears for cutting away clothing to access the wound  → Buy