Bolin vs Halo chest seals

Not being a trained medical professional, is it better to invest in Bolin Chest seals or the Halo chest seals. My uneducated read on this is that if I use a Halo and tension pneumothorax develops I have to use a decompression needle with cath if the injured party can't get to a hospital right away. If I use the Bolin, with the three one way valves in the first place, will the likelihood of tension pneumothorax be lessened?

I know it's a simplistic statement, but a shove in the right direction is a grand thing. If you have minimal training, what is the better chest seal? And yes, I understand that the training is important and I am seeking out competent training, it's just not happening this week.

Bolin, Fox, Halo, all three are great. I have carried and trained on all. You cannot go wrong with any of them as far as I am concerned. After 9 years as a medic on a team, 13 as a Paramedic and multiple TCCC and LETTC courses, I have heard many opinions on chest seals. Last year a renowned course instructor told us that "FOX" was the chest seal to use. I have met Chuck Bolin and believe his seal is a good one based on solid ideas.

The fact is, a chest seal can be as easy as a plastic material and tape or an EKG defib pad placed over the site(s). With solid training and instruction, anyone should be capable of being trained to assess and treat a "sucking chest wound". Addressing your concern of causing a tension by sealing the wound, just remember, the patient already has a hole or two (remember to assess the back for an exit/entrance wound). You can just as easily, "burp" or release the tension pressure by removing the seal temporarily, if that did not work due to clotting or other causes, then the trained and qualified care provider could move on to proper needle decompression.

Currently I have a mix of Fox and Halo seals in multiple IFAK and Med kits.


I hope this helps.

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Originally Posted by Clay34

Not being a trained medical professional, is it better to invest in Bolin Chest seals or the Halo chest seals. My uneducated read on this is that if I use a Halo and tension pneumothorax develops I have to use a decompression needle with cath if the injured party can't get to a hospital right away. If I use the Bolin, with the three one way valves in the first place, will the likelihood of tension pneumothorax be lessened?

I know it's a simplistic statement, but a shove in the right direction is a grand thing. If you have minimal training, what is the better chest seal? And yes, I understand that the training is important and I am seeking out competent training, it's just not happening this week.

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Packaged, set-and-forget solution for a lay, modestly trained rescuer: vented seal of your choice. Lots of good options out there. If you know to burp it or can dart the chest, non-vented are GTG. Good news: A tension pneumo is a delayed event, and outside response times for most folks. It can be a moot point.

Specific to your inquiry, I found this manufacturer reference: "Study reports Bolin Chest Seal superior to non-vented chest seals in treating tension pneumothorax"
http://gohandh.com/bolin-chest-seal-...n-pneumothorax

I use a variety of seals, and have no distinct preference for one.

Thanks for the thoughts and links. I thought I would buy a completed kit but didn't like what I saw in most kits. I will be buying stuff for it piecemeal and choosing exactly which components that I want. Thanks for a shove in the right direction.

I liked the Halo chest seal since they already came in a pack of two. Even heard of people cutting the chest seal in half, if the wound size would allow it and making 4 seals out of a single package of Halo chest seals. Then I liked the idea of the vented seals. I thought that I would end up with the Bolin chest seals in my kit. While shopping at North American Rescue, I came across a pair of vented chest seals by HyFin: http://narescue.com/Portal.aspx?CN=77F301F14058 They came in a pair, they were vented, the price was right and the expiration dates were better buying direct than buying something off of Ebay that was expired or about to be expired. I ended up buying the HyFin's.

First off I agree 100% with TacMedic556, I also have several different seals in kits that I use and a few back up plans to make seals if needed. Heck even your hand will work as a seal, RIGHT NOW!

Regardless of when you have someone with a penetrating chest injury, they have a pneumothorax. It may not be a TENSION pneumothorax (TPX) at this moment, but there is air outside of the lung. They need a MD/DO ASAP and it helps to have a real deal 18D or Paramedic (CONUS civi land) to move the patient to said Dr. After that they will most likely need to go to a Level I Trauma Center in a large city.
It does not matter what you use for a chest seal. Just seal the chest.

If this person begins to develop the signs and symptoms of a TPX you can remove the chest seal for a breath or two and see is air leaks from the wound, this CAN reduce pressure in the chest and partly and temporarily reduce pressure inside of the chest, making it easier for the person to move air on their own. Even chest seals with vents in them may need to be burped, as sometimes the valves will get blood clots in them and they wont work.

Sadly in my experience most people ( <51%) who have a TPX need help breathing and their airway managed, before they need their chest decompressed.

Chest decompression and chest tubes are a big deal. While you can save a life by doing them properly, there is a chance to cause harm by doing these procedures as well. Just because a chest has been decompressed does not make the person better. They can and often do decompensate again. Chest decompression needles (even the 10g versions) will clot off and not allow air to escape. This can even happen (less common) with the huge finger sized chest tubes that are surgically placed.

In the end have a plan, have a back up plan and a few back ups to the back up plans. And ALWAYS reassess every patient with this level of an injury every 5-10 minutes.

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Originally Posted by TacMedic556

The fact is, a chest seal can be as easy as a plastic material and tape or an EKG defib pad placed over the site(s). With solid training and instruction, anyone should be capable of being trained to assess and treat a "sucking chest wound".

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When I went through Army Combat Lifesaver (CLS) training last year prior to deploying, the medics who taught the course addressed this several times during the week. They were not really big fans of any of the three chest seals we see in the Army - Bolin, Halo, or HyFin - and seemed to consider them to be kind of "gimicky," for lack of a better term. The main issue that they had with them was that the adhesives used to stick the seal to the area around the wound quickly became ineffective when placed over hair, sweat, and blood. Their solution (as with most dressings) was to completely wrap the area with tape and/or Ace bandages to hold the seal in place over the wound. This essentially meant wrapping around the patient's torso to hold the seal securely in place. They were also concerned about the valve getting clogged with fluid or debris and preferred to burp the seal as described earlier. Most of them were advocates of using plastic sheet, an MRE wrapper, etc. instead of a "fancy" seal, since they were going to end up taping and wrapping the whole thing anyway. It wasn't that they wouldn't use the seals if they had them, but they just cautioned us that they weren't as reliable as advertized, so it was more important to use whatever was on hand and focus on properly sealing and wrapping it to hold it in place.

These guys all had way more trauma experience from Iraq and Afghanistan that I would ever wish on someone, and it seemed like they prefered to simplify what they carried down to TQs, pressure dressings, combat gauze, tape, and Ace wraps so they could work quickly with that basic menu of items. I think their experiences dealing with mass casualty situations would probably differ from when you have the time to focus on a single patient. I fortunately have limited experiencing with real-word TCCC (although I did get to wrap a guy's leg that got sliced by a glass table last week!), so I'm just passing on the feedback I got from our trainers.

Dave

Dave- What you learned is a valid technique and one possible option. Here's a video: https://www.youtube.com/watch?v=7Jh4...ature=youtu.be

Problems with packaged seals include the things your instructors described. They may not stick, vents may clog, they may be fouled due to storage/environmentals. They may also work splendidly. The most important thing is to understand what the seal does and why you're applying it. If you know that, you can use any of them effectively, or make functional expedients. (See also: trauma dressings)

This video is a promo for the Russell chest seal, but does a good job of illustrating the principles at work: https://www.youtube.com/watch?v=GBvM...ature=youtu.be

Peel-and-stick packaged seals are easily taught, have few, easily-executed steps, and are one possible solution for the IFAK.

A seal that has been fielded overseas and just got approval for CONUS is the FastBreathe Seal. It was designed and field tested to mitigate some of the above concerns.

Hope it helps.

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Originally Posted by 3ACR_Scout

When I went through Army Combat Lifesaver (CLS) training last year prior to deploying, the medics who taught the course addressed this several times during the week. They were not really big fans of any of the three chest seals we see in the Army - Bolin, Halo, or HyFin - and seemed to consider them to be kind of "gimicky," for lack of a better term. The main issue that they had with them was that the adhesives used to stick the seal to the area around the wound quickly became ineffective when placed over hair, sweat, and blood. Their solution (as with most dressings) was to completely wrap the area with tape and/or Ace bandages to hold the seal in place over the wound. This essentially meant wrapping around the patient's torso to hold the seal securely in place. They were also concerned about the valve getting clogged with fluid or debris and preferred to burp the seal as described earlier. Most of them were advocates of using plastic sheet, an MRE wrapper, etc. instead of a "fancy" seal, since they were going to end up taping and wrapping the whole thing anyway. It wasn't that they wouldn't use the seals if they had them, but they just cautioned us that they weren't as reliable as advertized, so it was more important to use whatever was on hand and focus on properly sealing and wrapping it to hold it in place.

These guys all had way more trauma experience from Iraq and Afghanistan that I would ever wish on someone, and it seemed like they prefered to simplify what they carried down to TQs, pressure dressings, combat gauze, tape, and Ace wraps so they could work quickly with that basic menu of items. I think their experiences dealing with mass casualty situations would probably differ from when you have the time to focus on a single patient. I fortunately have limited experiencing with real-word TCCC (although I did get to wrap a guy's leg that got sliced by a glass table last week!), so I'm just passing on the feedback I got from our trainers.

Dave

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The Bolin seal is what started this "wont work on sweaty, hairy, etc..." rumor - When the Bolin went off to a larger manufacturer they used an inferior glue on the seal, and guys were having issues with it, and since then have dismissed these "gimicky" chest seals. As far as I know, this was resolved years ago.

As for the HALO, which is what I've trained with extensively, they will stick to anything, and are a bitch to get off.

Also, with the vented seals, remember that you have to place the vent directly over the wound - and - people forget that these holes bleed and more than likely will need some sort of kerlix/gauze placed over the hole with the chest seal over it.

It's not always "more important" to use whatever is available on hand - use the right tool for the job. Like I said, these holes bleed and need to be wiped/cleaned if possible before the seal goes on, with or without the kerlix/gauze placed over the hole.

IMO, nothing beats the orange 3M defib pads. They are resilient, have some self stick quality (gives you time to add tape, and can be repositioned easily.

Hold onto those seals, do not use them before their time!

When a lung drops, you aren't going to catch it by lung sounds until it crosses into 50% or greater (collapsed). It takes time to evolve. If you've got a vented chest wall, via sucking chest wound, or needle decompression, remember the lung can't expand without the pressure gradient created by the intact chest wall. That's when the seal becomes beneficicial, not in anticipation of a pneumo. The moral of the story, is to observe and only treat when symptoms become apparent. Anything before that, will speed the development of a tension pneumothorax.

The Bolin did have some adhesion issues early on and turned many people away. This was supposedly fixed- have not used one in a while. The Halo as previously stated will stick to damn near anything. The only issue is that it is non vented - I believe they have a new vented version or it's about to come out. I like the Sam chest seal- it comes in a vented and non vented version. The adhesive is like the Halo and will stick to anything. I wish the vented came in a two pack (with a non vented for the exit wound).

Halo now has a vented version (search "halo vent") comes with one vented and one non vented seal.

Have not had hands on however, and while presumably it has the same formula adhesive as the standard halo I can't say for sure.

Nice update, thanks.

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Originally Posted by Joelski

IMO, nothing beats the orange 3M defib pads. They are resilient, have some self stick quality (gives you time to add tape, and can be repositioned easily.

Hold onto those seals, do not use them before their time!

When a lung drops, you aren't going to catch it by lung sounds until it crosses into 50% or greater (collapsed). It takes time to evolve. If you've got a vented chest wall, via sucking chest wound, or needle decompression, remember the lung can't expand without the pressure gradient created by the intact chest wall. That's when the seal becomes beneficicial, not in anticipation of a pneumo. The moral of the story, is to observe and only treat when symptoms become apparent. Anything before that, will speed the development of a tension pneumothorax.

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is this to say you would not do chest seals until there are symptoms of tension pneumothorax?

If you hesitate to seal a chest until you have S&S of a TPX, that is a fail.
Seal the defect in the chest as quickly as possible. Even if it is just holding somebody's hand over the defect while chest seals are obtained/prepared for use.

edit/added

The goal should always be to treat the problem with the least invasive means as possible at the same time as preventing additional harm from occurring to your patient. Delaying care is barbaric.

Good TCCC care is straight forward IMHO. But you must be aggressive.
STOP the bleeding, Get that TQ on and make sure that it is effective. If needed use additional TQ's for effective bleeding control. Pack central wounds.
Seal chest/abdominal wounds.
Prevent hypothermia.
Reassess and then reassess again. Treat additional problems as they develop. Remember to continuously reassess.

reassessment is everything. the status of their airway, breathing, and circulation is constantly changing. Ive sealed chest wounds with a tegaderm (pretty much saran wrap) on 3 sides so as pressure builds, air can leak out that 4th side. No matter what you use the principles are the same. What we use in the trauma bay (right before they're rushed to CT and the OR) is essentially plastic wrap.

Thanks for the continued thoughts on chest seals. I started this thread last June. It's funny timing because FINALLY, this Saturday, I have signed up for a real hands on class. I do really like the Panteao, Doc Spears Combat Medicine DVD (actually my favorite Panteao Productions DVD and I own several) but I am pumped about a real hands on class. It's taken a while to find a local class. This is a link to the trainer: http://midwestcivilianaid.com/

I think that this skill set is one that more people that shoot should acquire. Thanks again for the continued thoughts.

Necropost warning..

I put together some compact stopthebleed kits (SWAT-T, chest seal, Quikclot gauze, gloves) for my work, and used the HyFin Vent compact chest seal. Now H&H Medical might be able to put together a similar kit for me, but using the Bolin chest seal. I'm concerned because the medics I talked to said Halo or Hyfin are the best, hands down, and my "online research" shows mixed reviews on Bolin, and most of those reviews are old. Would anybody here think that the advantage of the kit being made for me is worth having the Bolin, or would you just make the kits yourself with the Hyfin? I vacuum package the kits so they stay dry, clean and tight for keeping in a pocket or pack. Also, North American Rescue can make the kits, but with a CAT-T, which I like a lot, but it's not as comfortable/convenient to carry in a pocket, so that means a lot of my guys won't carry the kit. They are in the field, sometimes even on horseback or ATV, and usually a minimum of an hour from higher level medical care.

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Originally Posted by sandsunsurf

Necropost warning..

I put together some compact stopthebleed kits (SWAT-T, chest seal, Quikclot gauze, gloves) for my work, and used the HyFin Vent compact chest seal. Now H&H Medical might be able to put together a similar kit for me, but using the Bolin chest seal. I'm concerned because the medics I talked to said Halo or Hyfin are the best, hands down, and my "online research" shows mixed reviews on Bolin, and most of those reviews are old. Would anybody here think that the advantage of the kit being made for me is worth having the Bolin, or would you just make the kits yourself with the Hyfin? I vacuum package the kits so they stay dry, clean and tight for keeping in a pocket or pack. Also, North American Rescue can make the kits, but with a CAT-T, which I like a lot, but it's not as comfortable/convenient to carry in a pocket, so that means a lot of my guys won't carry the kit. They are in the field, sometimes even on horseback or ATV, and usually a minimum of an hour from higher level medical care.

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Ditch the SWAT-T. It's fine for peds, secondary etc. but not a very good primary TQ in my opinion and they are much more difficult to get to stay put when moving or transporting a patient which is going to be an issue if you're an hour or more away from care. Not to mention one handed application requires more training and is more difficult especially when actually injured. Put in flat folded SOFTT-W instead. Identical in size, much more effective and usable.

Another option is mounting the CAT on the belt. Lots of companies make holders. 1110gear is what we use at work as well as most other agencies/departments that are issuing TQ's these days.

In addition, hypothermia and shock are a thing and if you're an hour or more away from care, a space blanket is a must. Even in the summer. Body heat is a must for effective clotting.

As far as the chest seals, HALO/FOX/HYFIN and SAM are what you're going to find the most. They're a known quantity, and it's what you're going to find at most rescue squads, departments etc. that are actually up to speed. I've never used the Bolins so I can't comment on their effectiveness but I have used HALOS and HYFINS and they work well.

Thank you for responding. I still went with SWAT-T because it’s much easier to put in a small package and carry in a pocket that you might even sit on. Also added a mini compression bandage and H&H made them for me. And after looking at the H-Vent, it’s pretty awesome, so I don’t have any heartburn including it. But it’s a single chest seal, not a twin-pack. I decided it’s hard to put a chest seal on your back by yourself..


https://buyhandh.com/products/easy-carry-trauma-kit

Same size and thickness.

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