World J Surg DOI 10.1007/s00268-014-2842-2
INVITED COMMENTARY
Facilitating Optimal Wound Care Michael Hollands
Ó Socie´te´ Internationale de Chirurgie 2014
In the aftermath of the tsunami in South East Asia in 2004, the President of the Indonesian College of Surgeons, Aryono Posponegro, made a plea for evidence-based management of wounds occurring as a result of natural and man-made disasters. Tragically, earthquakes, tsunamis and landslides occur often around the world, and survivors face the added challenges of destroyed infrastructure, disrupted communications and paralysed transport systems. In the early stages, victims often rely on care from first responders who have little or no training in casualties and wound management. In this edition of the Journal, Wuthisuthimethawee and colleagues highlight the health care burden imposed by contaminated wounds in such disrupted environments [1]. They have reviewed the nature of wounds, and made a case for a generic evidence-based guideline for distribution in local healthcare facilities worldwide based on broad consensus and able to be adapted to suit different local requirements. In the guideline, they emphasise the importance of proper wound assessment, cleaning and debridement and, in general, avoiding wound closure until such time as expert care is available. To practicing surgeons, this guidance is all too familiar and amounts to proper wound management. But the intended audience are not trained surgeons, and the evidence presented reveals all too clearly that poor wound management, in particular wound closure without adequate assessment, cleaning and debridement, is a common cause of preventable morbidity and mortality following such
M. Hollands (&) Department of Surgery, Westmead Hospital, University of Sydney, Western Clinical School, Sydney, Australia e-mail: [email protected]
disasters. The message is simple, but it needs to be enacted in the places and by the people who, at the time, are among the least able to hear it. What can specialist surgical colleges and societies, as experts in wound care, do to facilitate the message getting out? As a participant in the wound management consensus conference, and subsequently as the President of the Royal Australasian College of Surgeons, I found myself well positioned to promote the conference findings. What I discovered was widespread support in the surgical community to develop a poster, suitable for display in small healthcare facilities, simply stating the messages contained in Wuthisuthimethawee and colleagues review. Input was sought from surgical colleges and societies by presenting the poster in draft form at college meetings and other surgical forums. In some developing countries, it was discussed with the Health Department officials. Emphasis was placed on the poster being a free resource for those countries requesting it. Translation would be encouraged and local idiom accepted to simplify the message. The principles espoused by the American College of Surgeons Advanced Trauma Life Support Course (ATLS) provided a common format and language. As a direct result of this consensus meeting, a poster has been developed (Fig. 1) summarising in simple terms the recommendations of this meeting. It was launched at the Annual Scientific Meeting of the Royal Australasian College of Surgeons in Singapore in May of this year. It is laminated and suitable for display on the wall of a healthcare facility providing a rapid reference point for healthcare workers. The poster will be distributed as a pdf file and translation will not be restricted. To date, the poster has been endorsed by over fifteen international surgical colleges and organisations. This in itself is a significant achievement. It is gratifying to see
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World J Surg
Fig.1 Wound care poster
multiple surgical organisations cooperating to provide a free resource for those who need it. Challenges remain. The next step will need to be a targeted project in an appropriate nation to identify the challenges around distribution of the poster, ensuring it is prominently displayed and that healthcare workers understand its content and begin to use it before a natural disaster occurs.
123
References 1. Wuthisuthimethawee P, Lindquist SJ, Sandler N, Clavisi O, Korin S, Watters D, Gruen RL (2014) Wound management in disaster settings. World J Surg. doi:10.1007/s00268-014-2663-3
INVITED COMMENTARY
Facilitating Optimal Wound Care Michael Hollands
Ó Socie´te´ Internationale de Chirurgie 2014
In the aftermath of the tsunami in South East Asia in 2004, the President of the Indonesian College of Surgeons, Aryono Posponegro, made a plea for evidence-based management of wounds occurring as a result of natural and man-made disasters. Tragically, earthquakes, tsunamis and landslides occur often around the world, and survivors face the added challenges of destroyed infrastructure, disrupted communications and paralysed transport systems. In the early stages, victims often rely on care from first responders who have little or no training in casualties and wound management. In this edition of the Journal, Wuthisuthimethawee and colleagues highlight the health care burden imposed by contaminated wounds in such disrupted environments [1]. They have reviewed the nature of wounds, and made a case for a generic evidence-based guideline for distribution in local healthcare facilities worldwide based on broad consensus and able to be adapted to suit different local requirements. In the guideline, they emphasise the importance of proper wound assessment, cleaning and debridement and, in general, avoiding wound closure until such time as expert care is available. To practicing surgeons, this guidance is all too familiar and amounts to proper wound management. But the intended audience are not trained surgeons, and the evidence presented reveals all too clearly that poor wound management, in particular wound closure without adequate assessment, cleaning and debridement, is a common cause of preventable morbidity and mortality following such
M. Hollands (&) Department of Surgery, Westmead Hospital, University of Sydney, Western Clinical School, Sydney, Australia e-mail: [email protected]
disasters. The message is simple, but it needs to be enacted in the places and by the people who, at the time, are among the least able to hear it. What can specialist surgical colleges and societies, as experts in wound care, do to facilitate the message getting out? As a participant in the wound management consensus conference, and subsequently as the President of the Royal Australasian College of Surgeons, I found myself well positioned to promote the conference findings. What I discovered was widespread support in the surgical community to develop a poster, suitable for display in small healthcare facilities, simply stating the messages contained in Wuthisuthimethawee and colleagues review. Input was sought from surgical colleges and societies by presenting the poster in draft form at college meetings and other surgical forums. In some developing countries, it was discussed with the Health Department officials. Emphasis was placed on the poster being a free resource for those countries requesting it. Translation would be encouraged and local idiom accepted to simplify the message. The principles espoused by the American College of Surgeons Advanced Trauma Life Support Course (ATLS) provided a common format and language. As a direct result of this consensus meeting, a poster has been developed (Fig. 1) summarising in simple terms the recommendations of this meeting. It was launched at the Annual Scientific Meeting of the Royal Australasian College of Surgeons in Singapore in May of this year. It is laminated and suitable for display on the wall of a healthcare facility providing a rapid reference point for healthcare workers. The poster will be distributed as a pdf file and translation will not be restricted. To date, the poster has been endorsed by over fifteen international surgical colleges and organisations. This in itself is a significant achievement. It is gratifying to see
123
World J Surg
Fig.1 Wound care poster
multiple surgical organisations cooperating to provide a free resource for those who need it. Challenges remain. The next step will need to be a targeted project in an appropriate nation to identify the challenges around distribution of the poster, ensuring it is prominently displayed and that healthcare workers understand its content and begin to use it before a natural disaster occurs.
123
References 1. Wuthisuthimethawee P, Lindquist SJ, Sandler N, Clavisi O, Korin S, Watters D, Gruen RL (2014) Wound management in disaster settings. World J Surg. doi:10.1007/s00268-014-2663-3
