I approach this from several angles. As an urban paramedic, I generally deal with severely injured patients; my main concerns are ensuring an adequate airway and circulation and dealing with major life threatening injuries. Generally, with lacerations my main concern is controlling bleeding. We also, would flush wounds contaminated with dirt or chemicals with just sterile saline and cover with sterile dressings. Transport time is generally short. However, in the wilderness setting, where I may have to treat a patient for an extended period of time, the approach is a little different. While still concerned with major life threating injuries, we also may an attempt to clean wounds more thoroughly. I also make trips to rural Ecuador to provide disaster preparedness and response training; we also provide direct patient care. In these cases we treat wounds, generally on the feet and depending on the severity aggressively, because of the environment, lack of clean water and follow-up medical care. Generally cleaning with Povidone-iodine scrub, triple antibiotic ointment, sterile dressings and occasionally, oral antibiotics. Pete