As I mentioned earlier, WizardPC and I decided to check out a 4 hour traumatic injury course hosted by the local chapter of the Zombie Squad. Turns out that it was done by Paul Gomez of Gomez Training International. Man talks fast and manages to shove a lot of information in a small amount of time. I’m not someone that writes an obscene amount of notes, and I used about 4 pages in my notebook. Wizard didn’t bring anything to write on, but I noticed he was frantically punching notes into his cell phone.
Most of the class was centered around what you should pack in a blow out bag and why. There wasn’t a whole lot of discussion about how to use the items, but most of the items are fairly easy to use and you’ve probably been taught how to use them in basic first aid classes. The one that I think most people didn’t know about, was also the one that made people the the most squeamish. Namely a needle that’s at least 14gauge and 3.25″ long used to ventilate the chest in case of air in the chest where air shouldn’t be (think of the movie Three Kings).
The best part of the class was when he essentially did a show and tell of various equipment. He showed what he thought worked and what didn’t. This included a couple products that were complete wastes of money in his mind (SWAT-T tourniquets was one big example), and some that were great cheap items that weren’t really designed for that use (fly paper actually works pretty well for sucking chest wounds). He mentioned a couple all inclusive kits on the market that were good, or good starters, which is probably the way I’ll go. I know Wizard said he’d buy two or three of them from the guy right then and there, if he sold them (he doesn’t sell any kits, but pointed us to a couple good places to look). I’ll probably do a better write up of one of the kits when I get one in.
Overall, I think the guy did a great job and I’d recommend taking advantage of his knowledge if he ever comes through your neck of the woods or you’re in his.
Make sure you acquire the one thing you can’t buy: someone who doesn’t panic at the sight of injury.
Yeah, between the needle and learning what “direct pressure” means (the gauze doesn’t go on the wound, so much as in it), this stuff is not for the queezy.
Fly paper for sucking chest wounds? How does the air get out (which is just as important as stopping the air from getting in, more so if air was already getting out)? It’s worth the extra expense to get a proper chest seal made for that type of wound, with a proper one-way valve built in.
Be aware, there are legal issues with having those 14g needles without a prescription. That’s also not a procedure I would want anyone doing without more training than what it sounds like you got – fatal complications are a distinct possibility. In my area, even paramedics can only do it on patients in cardiac arrest without extensive consultation with the ER physician, and EMT-B’s cannot do it at all. In my roughly 15 years in EMS, I have never seen this procedure done on a living patient (though I have performed it more than once in traumatic cardiac arrests).
I’ll buy your last paragraph, but you gotta remember that /this/ course, at least, is regarding what to do before you/EMTs get there, in which case, yeah, fly paper isn’t as good as the chest seal, but it’s a hell of a lot better than nothing. See also: a bandsaw cut on thumb needs stitching, but for gods’ sake, apply papertowel and pressure while you’re on the way!
The fly paper solution (and similar purpose-made products) would require the needle to be used for ventilating. This, if nothing else, is a reason for me to pack a seal that has a built-n one-way valve, as you recommend. Also, as Naienko said, this is for the short term before EMS arrives, and it hopefully won’t be an issue.
As for the procedure of using the needle, that was something of interest that he discussed. Apparently, that’s something that the military and civilian authorities are still at odds with each other about. As you said, Civvy EMS pretty much can’t do it unless their paramedics and under the direct orders of a physician. The military, on the other hand, apparently teaches it to everyone that is getting any medical training. The thought is that even a needle as big as these suckers arn’t going to do any more significant damage than is already done by the large hole in the chest.
We’ll actually use the seals on any chest wound, without decompressing, to prevent a tension pneumothorax from developing. The needle is only for when there actually is a tension pneumo present (based on clinical signs).
The military also assumes that they’ll be operating under battlefield conditions, where it’s harder and takes longer to get to more skilled care. A wounded Marine could have a corpsman 10 feet away who can’t get to him for half an hour because of enemy fire, and then have to wait another hour or two or five under fire before getting moved to a field hospital. Because of this, the military is usually much more permissive with what they let their people do than non-combat oriented civilian agencies are. And, of course, they do give at least a minimum amount of training for these things, and (I assume) requires regular refresher training.
I do know someone who has had a needle decompression done, while he was awake. He fell off a 60 foot rock face. He’s actually one of my fellow EMS providers and realized he had a tension pneumo, and told the crew getting him out of the woods to do it. It’s the only case I know of around here where it’s been done on a patient with a pulse, and definitely the only one where the patient was awake and alert.
Actually, depending on the wound, it might be worse than nothing. If the wound is letting air out as well as in, and you seal it up, air can leak from the damaged lung into the chest cavity and have no way out.
On the other hand, you can get the chest seals for your personal kit on Amazon for about $13 each, and they’re very simple to use. The potential negatives of flypaper outweigh the savings.
So what exactly are the signs that your sucking chest wound needs to have the air let out instead of trapped in? Are these signs easily recognised? Should they be included in future curricula of this nature? Will those signs be listed on the packaging of the seals you’re recommending?
If 2 or 4 are answered ‘no’, I’m buying flypaper.
“So what exactly are the signs that your sucking chest wound needs to have the air let out instead of trapped in?”
The main sign is the presence of the sucking chest wound. You always want to let air out and not let it build up inside the chest wall, which is why we use the chest seals on any penetrating trauma to the chest. That way, if air is also leaking from the lung into the chest wall, it should still have a way out.
“Are these signs easily recognised?”
As the victim, steadily increasing difficulty in breathing is the one you’re going to notice the most. As a lay observer, you might see the trachea start to deviate to the side away from the injury (this is a late sign), and as a provider, if you have the tools (stethoscope) you’ll notice decreasing lung sounds on the injured side and a greater resonance if you tap the chest. If you see the jugular veins start to protrude, that’s a very late sign, as the pressure in the chest wall starts to push the lung against the heart.
“Should they be included in future curricula of this nature?”
It might be useful, but it’s not really necessary – see my first answer. They are necessary if teaching needle pleural decompression, along with some other information to help distinguish a hemothorax or hemopneumothorax (blood or blood and air in the chest cavity) from a pneumothorax (air in the chest cavity), especially since we don’t decompress a hemothorax or hemopneumothorax in the field (flight medics can place a chest tube, but they’re specially trained).
“Will those signs be listed on the packaging of the seals you’re recommending?”
Most likely not. Again, see my first answer.
Short biology lesson: The lungs are surrounded by a membrane. Another membrane lines the chest wall. A pneumothorax is simply air trapped between these two membranes. A tension pneumothorax is when air is entering that space but can’t escape, causing the pressure in that space to increase. This causes a growing “bubble” that compresses the lung, collapsing it. This is what kills you, by reducing your ability to breathe. If the pressure gets high enough, it can also compress the heart and reduce its ability to pump blood.
If we’re talking a gunshot or other penetrating trauma, chances are some of that air is coming from the lungs. It may or may not have a path out through the original wound. You definitely do not want to keep it from being able to escape that way, but you do want to keep air from getting in that way. The chest seal will do both. The flypaper will only keep air in.
Pingback: Accident at the local range | Guns, Cars, and Tech
So chest seals randomly came up in conversation with a doctor I know; he said he used to serve on a ski patrol a couple decades ago before he became a doctor. They used saran wrap with duct tape on the top and sides, but the bottom left open.
The gap in the bottom allowed air to flow out, but inhaling would tighten the plastic against the wound and seal it.
Pingback: Basic Gunshot Wound Kit | Guns, Cars, and Tech