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When disaster strikes, the number of patients requiring treatment can be overwhelming. In low-income countries, resources to assist the injured in a timely fashion may be limited. As a consequence, necrosis and wound infection in disaster patients is common and frequently leads to adverse health outcomes such as amputations, chronic wounds, and loss of life. In such compromised health care environments, low-tech and cheap wound care options are required that are in ready supply, easy to use, and have multiple therapeutic benefits. Maggot debridement therapy (MDT) is one such wound care option and may prove to be an invaluable tool in the treatment of wounds post-disaster.
Discussion
This report provides an overview of the wound burden experienced in various types of disaster, followed by a discussion of current treatment approaches, and the role MDT may play in the treatment of complex wounds in challenging health care conditions. Maggot debridement therapy removes necrotic and devitalized tissue, controls wound infection, and stimulates wound healing. These properties suggest that medicinal maggots could assist health care professionals in the debridement of disaster wounds, to control or prevent infection, and to prepare the wound bed for reconstructive surgery. Maggot debridement therapy-assisted wound care would be led by health care workers rather than physicians, which would allow the latter to focus on reconstructive and other surgical interventions. Moreover, MDT could provide a larger window for time-critical interventions, such as fasciotomies to treat compartment syndrome and amputations in case of life-threatening wound infection.
Recommendations
There are social, medical, and logistic hurdles to overcome before MDT can become widely available in disaster medical aid. Thus, research is needed to further demonstrate the utility of MDT in Disaster Medicine. There is also a need for reliable MDT logistics and supply chain networks. Integration with other disaster management activities will also be essential.
Conclusions
In the aftermath of disasters, MDT could play an important role facilitating timely and efficient medical treatment and improving patient outcomes. Existing social, medical, and logistic barriers will need to be overcome for MDT to be mainstreamed in Disaster Medicine.
The challenge for any ancient military strategist who wanted to deprive his enemy of sleep would have been figuring out how to do so without exacting a comparable toll on his own troops. In this context, there is probably no better example of a strategy that achieved such an outcome than that employed by Alexander the Great at the Battle of Gaugamela. This chapter illustrates the manner in which sleep/sleepiness has remained a militarily relevant factor in modern times. This is best highlighted by the presumed military strategy of the former USSR/Warsaw Pact nations during the Cold War. Military sleep researchers have mostly been dedicated to performing studies with an ultimate aim of sustaining the military effectiveness (ability to perform those tasks required to successfully achieve mission objectives) of sleepy soldiers. The Walter Reed Army Institute of Research (WRAIR) is a comprehensive sleep/performance management system (SPMS).
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