Wound Care in the Austere Environment for Those Experiencing Homelessness

Abstract

Research Question: In individuals experiencing homelessness in the austere environment, what resources are available for treatment of skin wounds tailored to the person with limited or no access to clean, running water? Would providing instructions to individuals in this population specific to their resource-limited setting improve the treatment outcomes compared to those in the resource-rich environment?

Background, Significance, and Rationale for the Question: Patients who experience homelessness are often undertreated in medical settings as there are limited resources available for medical providers to treat this population of patients. Education directed towards this population could instill more trust in the medical provider, increase likelihood of follow-up and provide the patient with information necessary to improve wound outcome. The education would be as succinct to encourage widespread use of this method.

Materials and Methods: This is primarily a literature review of treatment options with limited resources for patients with healing skin wounds and a proposed study to evaluate outcomes of treatment. The literature review is a comprehensive evaluation of the current literature and standards of care for open skin wound management, which includes both the resource-limited and resource-rich environments. The proposed study to follow would be a prospective study in which patients with open wounds and experiencing homelessness will be identified in the same locations and provided interventional wound aftercare instructions specific to those who have limited or no access to clean water as well as supplies to properly care for their open wounds.

Results: A simple to understand instructional pamphlet was developed which includes instructions for care of simple wounds or wounds that have been assessed and closed by a physician. Included in those instructions is some information on how to collect clean water from plants for those who may be homeless. A low-cost kit was developed for provision to these patients. Finally, a prospective trial to investigate the use of the pamphlet and kit in the community has been designed.

Conclusions and Impact: There is little information available to medical personnel who are not trained in wilderness medicine to instruct those who have limited access to water and supplies on caring for their wounds, therefore we have created this pamphlet with information for patients to obtain clean water to care for wounds and information about signs of infection. Furthermore, this study can be used as a comprehensive guide to help facilitate the suitable treatment of wounds in a resource-limited setting, instilling trust between patients and their physicians.