This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. PHR is edited by the Swiss School of Public Health (SSPH+) in a partnership with the Association of Schools of Public Health of the European Region (ASPHER)+
Dear Editors,
We read with great interest the work from Martín-Moreno et al. [
Following the DANA disaster, our Emergency Department (ED) treated more than a hundred patients with extremity wounds related to the flood, providing us an opportunity to analyze injury patterns, microbiology and outcomes. Most patients were men (70%), with a mean age of 47 years. Two-thirds of wounds (68.5%) occurred during cleanup efforts, highlighting the risks faced not only during the disaster but also in its aftermath. Lower extremity wounds predominated (53.7%). While most injuries were superficial abrasions or lacerations, 11% of patients required surgery.
Among hospitalized cases, wound cultures revealed a predominance of Gram-negative organisms (67.7%), particularly
Our standardized protocol was based on five pillars: - Wound care: low-pressure, high-volume irrigation with gravity-fed saline (5–12 L; sterile or potable water if unavailable), with selective direct closure. - Tetanus prophylaxis: toxoid (devitalized tissue, stagnant water exposure) or immunoglobulin (major soft tissue loss, open fractures) administration. - Antibiotic prophylaxis: in the ED, intravenous Amoxicillin–Clavulanate or Cefazolin; and intravenous Piperacillin-Tazobactam at hospitalization. - Surgical management: debridement and delayed wound closure in contaminated or infected wounds. - Multidisciplinary team: coordination between the Emergency Department, Orthopedics, Infectious Disease, Plastic Surgery, Rehabilitation, and Psychology proved essential in minimizing complications and optimizing functional recovery.
In conclusion, our experience illustrates that a structured, evidence-based protocol for wound irrigation, antibiotic use, and surgical management, combined with multidisciplinary coordination, is feasible in disaster contexts. We believe that sharing these practical lessons can support preparedness and improve healthcare responses in future mass-casualty scenarios.
The studies involving humans were approved by Instituto de Investigación Sanitaria La Fe. The studies were conducted in accordance with the local legislation and institutional requirements. The study does not adversely affect participants’ rights or welfare, and obtaining written consent was impracticable given the nature of the observations.
Material preparation, data collection and analysis were performed by MG-G, AC-F, AO-Y, VG-B, and AT. The first draft of the manuscript was written by MG-G and all authors commented on previous versions of the manuscript. All authors contributed to the article and approved the submitted version.
The author(s) declare that no financial support was received for the research and/or publication of this article.
The authors declare that they do not have any conflicts of interest.
The author(s) declare that no Generative AI was used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.