Ask Spitfire – September 2024 – Dirty – Clean – Sterile 

Dirty – Clean – Sterile 

Question: 

I took the 100 class yesterday at the Roanoke Valley Harley Davidson. It was an amazing class and I appreciate everything y’all do. I do have a question however. I am a firefighter/EMT: I checked with one of our FTO master paramedics, his wife who is an ER Trauma attending at Carillon Hospital, and a friend who is a Wilderness Medicine Fellow at Carillon… All of these professionals agree that if in a situation where a patient has an evisceration and no sterile water is available, use your drinking water to dampen whatever you use to cover the injury. If it’s wet, keep it wet. They all agree that the patient will need surgery and will be given massive doses of antibiotics so sterile water isn’t needed – if it’s clean enough to drink, it’s clean enough to rinse wounds and to dampen gauze before covering eviscerations. All of the professionals stated that covering wet organs with dry materials will cause more damage in the long run than using unsterile water. Please follow up with me on your opinion on this as well. Again, I really do appreciate what y’all do, I just want to know the best practices for giving patients the best chances of survival. 

Answer: 

I discussed your question with several medical professionals on our team to be sure this was not just my personal thoughts on the matter as a registered nurse and the author of the program. Our program also has medical oversight with an emergency room physician, a trauma nurse, and a paramedic. 

We all agreed that telling people to use water from a bottle can lead to unwanted contamination—especially in the situation of abdominal evisceration. To rinse road rash is one thing, but the greatest risk of death in an abdominal evisceration is sepsis. A person can live without some of their bowels if they get dried out and cannot be saved, but sepsis can kill them. Additionally, rinsing the wound pours dirt and debris into the belly, increasing the chance of sepsis & reduces body temperature, which increases the risk of hypothermia. Using a new bottle of water and moistening the dressing may have some benefits, but rinsing the wound is not recommended. Your actions as a bystander are simply to cover the wound to protect it from dirt and debris until a higher level of help arrives. Big, bulky, absorbent dressings are unnecessary since they further dry the wound, which is often wet from blood. After lightly covering it with sterile gauze to keep it as clean as possible, cover the wound with an occlusive dressing such as a plastic zip lock bag to keep heat and moisture in. Bend the legs at the knee and cover the injured person with a blanket, or other cover, to keep them warm.