Occlusive dressing use by civilians

[JB2000]

I was at a CERT (Community Emergency Response Team) first aid refresher last week where we reviewed the use of tourniquets and the newer types of bandages. I realized my FAK is a little outdated and that it wouldn't hurt to update it with some OLAES bandages and maybe a few other things.

In looking at the various threads on FAKs, blow out kits, GSW kits and the like there is a fair amount of discussion around occlusive dressings, Nasopharyngeal airways, and cath needles in kits.

My background is Red Cross first aid and CPR training and CERT training which deals with triage and basic first aid. I would like to take the Red Cross Wilderness First Aid class but do not plan to get any more advanced than that.

Based on my level of training I would never try to use a cath needle to do a decompression or try to insert an NA. My question is around occlusive dressings. If you have someone with an obvious "sucking chest wound" where there is clearly air moving through the injury and help is 30 or more minutes out, should an occlusive dressing be applied? It seems the potential complications are much more than putting pressure on a bleeding wound.

Thanks.

[nineteenkilo]

It really depends on the exact scenario. Could you be a little more specific about the scenario to which you are referring?

[JB2000]

Sure. And let me know if I leave out something important.

The most likely scenario - and I wouldn't consider these very likely in the first place - is out shooting with friends or my son's scout troop. We usually end up out a forest service road in the mountains with no cell phone coverage. The scenario would be someone gets careless and shoots someone else with a high velocity rifle round in the chest causing a wound large enough to create a defect in the chest wall that allows free flow of air into the chest and undetermined internal injuries.

My goal would be to send someone to call 911, provide first aid, and possibly move them closer to a the main road. I would be assessing the ABCs and applying dressings and pressure to bleeders. If there is an exchange of air, would it be better to put an occlusive dressing over the wound given that EMTs are roughly 30 minutes out and a trauma center even longer or would it be better to just bandage it and leave it at that.

In monitoring the ABCs if breathing was becoming more difficult I would assume I would try to burp the dressing and reseal when the person exhales. However, from the reading I've done it sounds like you really should be far better trained to diagnose a tension pneumo, etc.

In the CERT realm I would expect more closed chest trauma from crush injuries and in that case it would be get them to professional help ASAP. There would most likely be fire and EMT nearby anyway.

If I'm leaving out something important let me know.

Thanks.

[Hizzie]

Apply occlusive dressing. It is only contraindicated for injuries to the nose and mouth. Current trend is for fully occlusive dressings without any valve. Protocol is to burp dressing if needed before performing a needle decompression.

Get your EMT-Basic cert. There are numerous schools that have a Wilderness Training/EMT-B Program.

[nineteenkilo]

Apply occlusive dressing.

Get your EMT-Basic cert. There are numerous schools that have a Wilderness Training/EMT-B Program.

This sums it up nicely.

[JB2000]

Thanks gentlemen. My brother-in-law was in an EMT program of some type so I will ask him about schools in the area.

[Xenogy]

This is more of a Paramedic level scenario. An EMT-B course won't teach you past the occlusive dressing. Darting a chest without proper training would be a very last resort if your patient is about to suffocate. The EMT-B course however will help you to understand what is going on physiologically with a pneumo/ hemopneumothorax. I would suggest as a preventative measure going over safety with everyone and working through what you are going to do before commencing live fire.

[calicojack]

This is more of a Paramedic level scenario. An EMT-B course won't teach you past the occlusive dressing. Darting a chest without proper training would be a very last resort if your patient is about to suffocate. The EMT-B course however will help you to understand what is going on physiologically with a pneumo/ hemopneumothorax. I would suggest as a preventative measure going over safety with everyone and working through what you are going to do before commencing live fire.

actually the current NREMT curriculum does in fact teach about occlusive dressings, and (at least in my state) EMTs are allowed to use such devices

[chuckman]

actually the current NREMT curriculum does in fact teach about occlusive dressings, and (at least in my state) EMTs are allowed to use such devices

At first blush I interpreted the post the same as you, re-reading, he was talking about skills after occlusive dressing.

[calicojack]

At first blush I interpreted the post the same as you, re-reading, he was talking about skills after occlusive dressing.

your right. he was. my bad. i guess i missed the word "past"