Emergency Wound Care: Managing Wounds in Disasters

During a disaster, even a small wound can quickly become a serious health threat.

Whether wildfires or hurricanes, disasters can disrupt healthcare systems, strain resources, and complicate wound treatment. For nurses and other clinicians, these events demand adaptability, clinical judgment, and a deep understanding of emergency wound care in evolving conditions.

Myra Varnado, RN

Myra Varnado, BSN, RN, CWON, CFCN, a wound, ostomy, and continence nurse with over 25 years of experience, knows firsthand these challenges.

Reflecting on her experience during Hurricane Katrina in 2005, she shared, “I coordinated wound and ostomy assessments and patient care in south Louisiana….We were set up at an indoor track facility and established a 600-bed mass casualty hospital under the auspices of the U.S. Public Health Service and the Surgeon General’s Office.”

She explained that many patients presented with both chronic and acute wounds, primarily on the lower and upper extremities, and that acquiring necessary supplies to support these patients was a constant challenge.

“Some hospitals in outlying regions assisted in obtaining some wound and ostomy supplies, but they also needed supplies to handle the large number of patients seeking care in their facilities,” she said.

Conditions such as these amplify the risk of wound deterioration and infection, highlighting the need for clinicians to be prepared with both foundational knowledge and flexible, situation-specific protocols. Let’s discuss the complexities of wound care during disasters and consider evidence-based strategies for those on the front lines.

Why is wound care more complex during disasters?

Disasters can result in mass casualties, infrastructure damage, and limited access to medical supplies. Wound management during these events can be challenged by:

• Delayed treatment
• Contaminated environments
• Resource scarcity
• Disrupted healthcare access

These factors require modified approaches to care, tailored to the constraints of the environment.

Varnado explained that adapting wound care protocols begins with understanding what’s available.

“Wound protocols are best managed in disaster settings by identifying a formulary of the wound products available and writing a specific dressing plan based on the features [of each product],” she said.

Disaster-related wounds and treatment approaches

Disaster wounds can vary in type and severity, from minor cuts to serious injuries. Emergency wound care focuses on quick assessment and preventing complications. Here are some wound types seen during disasters:

Wildfire and burn wounds

It’s no secret that wildfires can cause severe burns. However, these events often overwhelm the capacity of hospitals and health systems, making emergency wound care even more challenging.

According to the American Red Cross, burns are classified according to depth:

1. Superficial burns (first-degree): These injuries involve only the epidermis.
2. Partial-thickness burns (second-degree): These wounds involve both the epidermis and the dermis.
3. Full-thickness burns (third-degree): Involving both layers of second-degree burns, these injuries can also extend to the subcutaneous tissue, muscle, and even bone.

Here are some considerations for burn wound management during a disaster:

• Triage: Assess burns by their severity using the Rule of Nines to estimate the total body surface area (TBSA) affected. Prioritize patients with burns greater than 20% TBSA for transfer because they require more specialized care.
• Initial care: Cool burns with clean water (not ice) to halt thermal injury progression. If you don’t have access to clean water, use a clean and cold compress instead, according to the Red Cross. Cover with sterile, nonadhesive dressings, if possible.
• Pain management: Administer pain relievers as they’re available, considering both pharmacologic and non-pharmacologic methods.
• Transport: Coordinate with regional burn centers for patient transfers. When direct transfer is delayed and communication isn’t affected, use telemedicine for remote consultation.

Frostbite and exposure wounds

Cold environments pose risks for frostbite and other exposure-related injuries. The Red Cross defines frostbite as “an injury caused by freezing of the skin and underlying tissues as a result of prolonged exposure to freezing or subfreezing temperatures.”

This condition is assessed in these three stages:

1. Frostnip
2. Superficial frostbite
3. Deep frostbite

During a disaster, effective management of these wounds includes:

• Assessment: Identify the stage based on skin color, sensation, and tissue hardness.
• Rewarming: Depending on the injury’s severity, initiate rapid rewarming in a clean, warm bath from 98.6°F to 102.2°F for 15 to 30 minutes. Be sure to remove all clothing and jewelry (if possible) prior to submerging and avoid dry heat sources to prevent further tissue damage.
• Wound management: If you can, debride clear blisters to reduce infection risk, leaving hemorrhagic blisters intact. Apply topical antibiotics and cover with sterile dressings.
• Monitoring: Assess for signs of infection and tissue necrosis.

Flood-related wounds and infections

Floodwaters often harbor bacteria, chemicals, and debris, increasing infection risks. In one study, it was revealed that the infection rate for typhoon-related wounds was between 44% and 59% due to delayed or inadequate infection control measures.

When caring for wounds involving flood water, strategies include:

• Cleansing: Irrigate wounds with clean, preferably sterile, water. “Tap water, if from an assured municipal source, is an approved option for cleansing,” said Varnado, adding that wound cleansers can also be made using tap water or saline and additives, such as hypochlorite and acetic acid.
• Debridement: Remove devitalized tissue to prevent infection, if possible.
• Antibiotic use: If available, consider certain antibiotics for high-risk wounds, especially those exposed to contaminated water.
• Tetanus: The rate of tetanus in disaster-related wounds is high, so ensure patients’ tetanus immunizations are up to date. If not, tetanus toxoid (vaccine) or immunoglobulin (medication) may be necessary.

Caring for vulnerable patients

Patients with medical devices (e.g., dialysis catheters, ports) are particularly vulnerable during disasters. When caring for these patient populations, consider the following with emergency wound care:

• Infection prevention: Maintain aseptic technique during dressing changes. In the absence of standard supplies, use boiled and cooled water for cleaning and clean cloths as dressings.
• Medication access: Coordinate with pharmacies and relief organizations to secure necessary medications and supplies.
• Patient education: Instruct patients on the signs of device-related infections and when to ask for help.

Varnado also underscored other precautions to take when managing high-risk patients. “Maintain any areas with exposed skin and soft tissue and ensure they’re clean and covered at all times,” she said. “Few, if any, wounds benefit from being left open to air.”

Don’t forget the role of mechanical safety for these devices. “When working with tubes, drains, and ports, stabilization of the tubes is essential to ensure that they don’t become dislodged or that the soft tissue surrounding their site of insertion isn’t damaged,” Varnado said. “Stabilization will also assist in identifying early signs of bleeding or local edema from positional issues when moving the patient.”

Emergency wound care protocols across settings

During disasters, nurses and other healthcare professionals must adapt to various settings. Here are a few examples.

Home care

Educate patients and caregivers on basic wound care principles, including hand hygiene, dressing changes, and infection signs. Provide written instructions when possible.

Mobile units

Equip units with essential supplies and trained personnel. These resources should include cleansers, various dressing types, and personal protective equipment (PPE). Use standardized protocols to ensure consistent care.

Shelters

Implement infection control measures, such as designated areas for wound treatment. Coordinate with public health agencies for support.

Across all care environments, using everyday infection control practices is a must. “Handwashing, wearing disposable gloves, and using other PPE cannot be overemphasized,” said Varnado.

However, remember to prepare in other ways. Varnado suggested:

• Providing patient protection: Ensure that patients have access to their own PPE, such as gloves and masks, to help reduce cross-contamination.
• Being proactive in preparation: Familiarize yourself with the wound care plan in advance to anticipate patient needs.
• Stocking essential materials: Gather and organize enough supplies ahead of time to avoid shortages during care.
• Maintaining a clean environment: Promptly remove soiled dressings and other waste from the bedside and dispose of them properly.

The role of clinicians in disaster response

Wound care clinicians offer specialized skills that directly impact patient outcomes, especially during disasters. According to Varnado, following several basic care elements in a disaster makes a huge impact:

• Educate yourself on the patient’s management plan to allow for reasonable adaptations, such as a change in weather conditions or travel availability.
• Remember to focus on maintaining the skin and keeping wounds and soft tissue as clean, dry, and protected from injury as possible.
• Ensure that stabilization (slings, splints, braces, etc.) of any affected body parts is effective to support the wound and protect it from further injury.
• Ensure all dressings are clean and provide full coverage. Avoid leaving wounds open to the air.

Stay prepared: Managing wounds in crisis

To enhance your knowledge of emergency wound care, join WCEI and the American Red Cross for a free webinar, Rapid Response: Managing Wounds During Disasters, on July 17, 2025 at 2:00 p.m., EST, which provides evidence-based strategies for managing wounds during disasters.

This event covers practical approaches to triage and infection control. Tailored for nurses, emergency responders, and other healthcare personnel, the webinar discusses risk factors, interdisciplinary coordination, and adapting standard protocols to improve outcomes.

Disasters differ in how they unfold and what resources are available, but the need for emergency wound care is constant. Regardless of the setting and background, healthcare professionals step in with adaptable skills and clinical expertise to help bridge gaps in care, demonstrating that even in crisis, quality care is always within reach.