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** This question may contain medically unsound advice. Be sure you have read the answers and comments before making any medical decisions **

Recently a friend broke her arm while mountain biking and the bandages I was carrying proved invaluable for stopping(slowing) the bleeding and getting her away from the mountain.

In the hospital they prescribed her TWO concurrent types of antibiotics to combat the jagged cut with inserted sand and offered her a tetanus jab.

I know washing the wound with H2O2 is optimal while alcohol and iodine are not. But all those three are liquids and thus weigh rather much. Also the procedure to use H2O2 is quite wasteful: "wash the wound without touching it".

Does there exist an alternative immediate treatment to open wounds that weighs less and is just as effective as washing with plenty of H2O2?

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    – WedaPashi
    Sep 16 at 9:00
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Water.

The American Red Cross Wilderness First Aid courses in 2021 recommend irrigating wounds with at least a liter of potable water, using an irrigation syringe. If you don't have enough potable water, washing with non-potable water is acceptable and you should finish off with potable water.

The stronger antiseptic chemicals are indeed antiseptic, but they also can cause some damage to tissue with their antiseptic properties, and aren't typically used in sufficient quantities to thoroughly clean the wound. Water is more effective than hydrogen peroxide, alcohol, iodine, etc. for cleaning and irrigation. With larger quantities of water, you can flush more dirt out of the wound, reducing the chance of septic contamination, rather than trying to overwhelm it with antiseptic.

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    As reasonable as your answer is, it doesn't address the "lightweight" portion of my question. To be truly complete, an answer need to address why 5g of anibiotic powder is just as good as 1kg of water.
    – Vorac
    Sep 15 at 23:51
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    1kg of water is something that you might already be carrying for drinking, so it could be a zero weight penalty option. As for a comparison with 5g of antibiotic powder, I didn't see that in your question. I thought the question was about cleaning. Covering a dirty wound with antibiotics is different treatment than cleaning. If you cover a dirty wound with 5g of antibiotic powder, a good health care provider will probably debride and irrigate the wound, cleansing it of any field-applied antibiotic powder or other debris before closing it up and dressing it.
    – Dave X
    Sep 16 at 3:28
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    @Vorac the lightweight alternative to 1kg of water is....... less water. There isn't really an ultralight equivalent alternative. There doesn't exist something super light weight that will magically fix a wound.
    – noah
    Sep 16 at 5:21
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    @Vorac anything lighter than water would reasonably be used in addition to water, not in place of it. Removing debris is both more important than applying medication and a prerequisite for it; the treatments you can buy don't remove debris. Another way to look at it is that you can disinfect the outside of a lump of dirt, but not the side touching the damaged flesh (to a good approximation). Further the presence of even perfectly clean grit is a bad thing
    – Chris H
    Sep 16 at 7:34
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    One thing that may strike the balance is a saline spray (often used for sinus irrigation). Each can of saline is lighter weight than a comparable volume of water and the jet is powered by a propellant, helping to debride any dirt. The solutions are also isotonic, which will help mitigate the burning you would get from drinking water.
    – Greenstick
    Sep 17 at 7:58
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When someone is so badly injured that they need immediate professional medical treatment, and you are able to get them that treatment within a day, then wound disinfection isn't a priority. Infections take days to set in, and modern antibiotics administered at the hospital can prevent that from happening.

According to several first aid courses I did, trying to clean life-threatening wounds as a first aid measure can do more harm than good. You will wash away the blood which already started clotting the arteries. And trying to remove debris can cause further injury or open up blocked arteries. So by cleaning a wound you cause more blood loss. So focus on stopping the bleeding and getting an ambulance.

However, for smaller cuts and bruises which don't warrant a visit to a doctor, there is spray-on wound disinfectant which weights very little and can be applied in a contactless manner. You can buy it at any well-stocked pharmacy. Rinse away the debris with water, dry the wound with tissue paper and then spray the disinfectant onto the wound.

Regarding tetanus vaccination: Anyone who regularly engages in outdoor activities should take care to keep their tetanus shots up-to-date anyway. It's a vaccination which is easy to obtain and with very little risk of side-effects. Getting a tetanus booster when showing an injury to a doctor is usually standard procedure, just to be sure.

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    As for wound cleaning, advice varies. First aid at work course tend to assume help is near, and cleaning not advised. Wilderness first aid course are more likely to support prompt cleaning, subject to the priority of keeping the red stuff in. Of course the type of contamination is likely to be different. Outdoor activities not too far from hospitals fall somewhere in between, but if self-extraction is reasonable, a bit more cleaning and dressing might be worthwhile than in an office
    – Chris H
    Sep 15 at 11:49
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    My wilderness first responder courses certainly included flushing open wounds with water to remove debris. This was presuming that the bleed itself was not immediately life threatening. Fully agree with @ChrisH that back country and front country first aid are two different things.
    – Jon Custer
    Sep 15 at 13:11
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    @JonCuster I've only done outdoor first aid, assuming no more than about a day's walk from help or a few hours from a signal (though taught by a wilderness/expedition medic). Flushing with water, as you say, was the first call, ideally using the casualty's own bottle. Now, when leading rides etc., I tend to keep a clean 2nd bottle of water, decanting from it if needed for drinking (also handy for dehydration). Sterile saline is another useful option - I carry a couple of vials for rinsing eyes, but the narrow stream you get from them should be handy in some cases.
    – Chris H
    Sep 15 at 13:16
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    @ChrisH - bike bottles are nearly ideal to get a steady stream. One suggestion at the courses was to get a ~1 pint soft squeeze bottle for your back country first aid kit - it squishes down pretty small. But just dumping a liter bottle on would work too - you want to get any loose foreign material out before bandaging up. Full cleaning waits for the professionals at the hospital. One of those tradeoffs of being in the middle of nowhere.
    – Jon Custer
    Sep 15 at 13:23
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    Regarding "So by cleaning a wound you cause more blood loss. So focus on stopping the bleeding and getting an ambulance." Except in rare and severe cases of high quantities of blood loss cleaning should take priority in a wilderness setting.
    – noah
    Sep 15 at 14:49
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Having perused my well read copy of NOLS Wilderness Medicine (available e.g. through NOLS), there is no mention of hydrogen peroxide use at all. The only two things mentioned for wound cleaning are (1) water, and (2) water with povidone-iodine. Use of a syringe to irrigate the wound is strongly suggested. If you have limited clean water, rinse with untreated water first, then finish with the clean (filtered, iodine, ...) water last. Going with the povidone-iodine solution, you need to rinse out the wound after the povidone-iodine before bandaging.

Personal take, based on the training, is that I would use the povidone-iodine solution for abrasions, a large area of damaged skin, where the exposed surface area makes infections more likely. For a clean deep cut, I would rinse with water and bandage it, counting on the limited wound area at the surface to keep the infection possibility lower. In the whole wide grey area in between those, well, you get to choose at the time based on the wound, the person, your party size, distance to a trail head, communication options, etc.

If the bleeding is potentially life threatening (arterial for example), then immediate pressure and bandaging, with rapid evacuation, are the way to go.

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