Management of wound infections in a ruck-truck-house-plane plan : preventing multidrug-resistant bacteria in prolonged field care

Session Description: With delayed and extended medical evacuation times, prolonged field care procedures bring new challenges including those of preventing wound infection. More particularly, recent reports from the war in Ukraine have highlighted the significant problem of wound infections, including a high prevalence of multidrug-resistant bacteria, up to a 48.4% rate of antimicrobial resistance to carbapenems among enterobacteria responsible for healthcare-associated infections. Such infections are associated with further increased mortality rate and highly complex hospital management. Putting in other words, after saving the casualty from hemorrhage, you must save him from a later death, related to multiple organ failure associated with late combat-related infections. Indeed, SOF medical teams can perform important actions from the point of injury to limit the risk of wound infections and prevent the emergence of multidrug-resistant bacteria. Such actions can be addressed in a well-known timeline: ruck-truck-house-plane. They include the management of tourniquet to prevent ischemia-related necrotizing injuries, debridement and irrigation of the wounds, proper administration of antibiotics, and dressings changes, ... The later in-hospital management of casualties presenting with multidrug-resistant bacteria is also challenging, including Isolation, reinforcement of hygiene rules and microbiological monitoring. Finally, the prevention of combat-related wound infection can help to mitigate the risk of antibiotic resistance and so safeguard the efficacy of antibiotics for future generations.