Chest decompression for non-medics is a sticky subject. Recent observations overseas have seen an increase in improper location medially when inserting the needle. The causes of the high rate of improper placement are difficult to determine (i.e., environment, visibility, etc.) and have led to some medical directors prohibiting the procedure for non-medics within the military and LEO teams. However, the below study illustrates that proper initial training leads to high retention rates, thereby making this a skill that ought to remain at the operator level.
Abstract
Introduction: Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.
Methods: After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.
Results: Initial training resulted in a significant increase in knowledge (pre: 1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.
Conclusions: Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration
for at least six months.
In an age when hemostatic agents and pocket-sized BP cuffs monopolize most conversations regarding combat casualty care, a command of the basics is being lost. While the abundance of choices of pre-made kits addressing the majority of field-treatable injuries reduces the chance of needing to improvise, one ought to have a command of the basics using available materials.
A medic cannot have a more basic piece of kit than a triangular bandage. Therefore, we are having a contest to encourage submissions of different ways to use a triangular bandage to treat combat trauma. The details are as follows:
Prize: $200 in free Tac Med gear
Submission Format: Either submit a description to the comments section or email them to alan@tacmedsolutions.com. How-to videos are welcomed, but not required. We will be filming the most unique and helpful techniques for the blog.
Deadline: All submission must be in by 1 MAR 2010. We will announce the winner by 15 MAR 10. Due to concerns with operational anonymity, we will request your approval before sharing your name.
Below is an article from the latest Journal of Special Operations Medicine. It is an even-handed review of considerations when one is building a personal medical kit. It not only applies to SOF Operators, but to patrol officers and SWAT teams as well.
We have thus far discussed considerations for packing Level 1 and Level 2 equipment. Remember that Level 1 gear is what you carry on your person (e.g., IFAKs and Med Vests) and Level 2 gear is carried in your first-aid bag. Level 3 gear is generally considered kit stored on your vehicle or supplement packs pre-positioned on resupply platforms. For instance, you might want to store the following on your vehicle:
1) pre-made IV kits
2) hypothermia prevention kits
3) backboards, rigid litters, evacuation prep kits
4) splinting material
With regard to pre-made bundles on resupply vehicles, it is a good idea to meet with helicopter crews that are supporting you, or the QRF, and ask to have numbered pre-made bundles for which you can call. For example,specific hemorrhage control items in a bag they can kick out the door, or a whole pre-packed aid bag. The latter can be be a bad idea, because you could find yourself with extra gear you don’t need and can’t store.
In the end, you must pack for your needs and trust your skills to make due with what you have, lest you find yourself imitating a pack mule.
As mentioned in an earlier post regarding Level 1 kit, you must pack your medical gear to reflect the mission requirements and constraints. Here are some considerations when packing your Level 2 gear:
1) Pack supplements to Level 1. For instance, medics may need more bandages and tourniquets.
2) Pack for Tactical Filed Care phase of treatment. In this phase, you may need:
A. Drugs (e.g., Toradol) and associated items (e.g., syringes, heplocks)
B. Splinting material
C. Evacuation Platforms (e.g., poleless litters or a Foxtrot Litter)
D. Fluids
E. Needle Thoracostomy items
F. Hypothermia Prevention
G. Casualty Equipment Bag
H. Casualty Documentation
3) An aid-bag for the above items. Err on the side of too small, as carrying a “tick” on your back might be more of a burden than an asset, depending on the mission. That is your call.
The above serves as a framework. We will cover Level 3 in the next post.
Historically, tension pneumothax has been the 2nd leading cause of preventable death on the battlefield. Therefore, this is an important skill and is being taught to medics at the lowest level of care. However, as with all procedures, risks are involved. Feedback from the field has indicated that medics are performing this procedure too often and TOO medial, causing multiple complications.
The above video covers the hazards of a needle decompression. Below you will find a brief review of indications, contra-indications, etc. As always, please follow local protocols.
INDICATIONS:
Needle decompression is indicated for the treatment of:
A. Tension pneumothorax and / or
B. Tension hemopneumothorax
CONTRA-INDICATIONS:
A. Chest decompression is indicated in the field only in the face of a life-threatening
tension pneumothorax. In that situation, there are essentially no contraindications since
the only alternative is almost certain death.
CAUSES OF TENSION PNEUMOTHORAX:
A. Blunt force trauma to the chest that ruptures a portion of lung tissue
B. Fractured rib that punctures the lung tissue
C. Spontaneous pneumothorax for no apparent reason
D. Conversion of a simple pneumothorax to a tension pneumothorax by positive pressure
ventilation as with a bag-valve mask device etc.
E. Open pneumothorax that is covered and left unattended developing into a tension
pneumothorax
SIGNS/SYMPTOMS
A. Chest pain
B. Severe respiratory distress
C. Tachycardia
D. Hypotension
E. Decreased or absent breath sounds on affected side
LATE SIGNS / SYMPTOMS:
A. Cyanosis
B. Distended neck veins
C. Tracheal deviation away from affected side
(Source: Canadian Tactical and Operational Medical Solutions)
COMPLICATIONS:
A. Creation of pneumothorax where none existed previously
B. Laceration of lung tissue
C. Bleeding from laceration of intercostal blood vessels
D. Severe pain to conscious patient (since this is life-threatening, the procedure must be
continued )
E. Local hematoma
F. Laceration and/or puncture of the heart
As noted in the Tactical K-9 Care: Part 1, a tactical medic may be the only care provider able to assist a working dog that has been injured. The goal of the following article is introduce medics to common trauma associated with working dogs in a tactical environment. As previously suggested, medics ought to find a veterinarian that has experience with working dogs and work with them to become more familiar with anatomy and what is “normal” for canines, as well as become comfortable working with them.
The following article is from the Journal of Special Operations Medicine, vol. 9, edition 2, pg 14-21.
In the tactical environment, a tactical medic may be the only care provider able to assist a working dog that has been injured. The goal of the following article is introduce medics to common problems associated with working dogs in a tactical environment. In addition to this article, medics ought to find a veterinarian that has experience with working dogs and work with them to become more familiar with anatomy and what is “normal” for canines, as well as become comfortable working with them.
The following article is from the Journal of Special Operations Medicine, vol. 7, edition 2, pg 33-47.
Bombs aimed at civilian populations are the most common
weapon used by terrorists throughout the world. Over the last
decade, we have been involved in the management of more
than 20 mass casualty incidents, most of which were caused
by terrorist bombings. Commonly, in these events, there may
be many victims and many deaths. However, only a few of the
survivors will suffer from life-threatening injuries. Appropriate
and timely treatment may impact their survival. Due to the
complex mechanism of injury seen in these scenarios, treatment
of victims injured by explosions is somewhat different
from that exercised in blunt and penetrating trauma from
other causes. The intention of this article was to outline the
initial medical treatment of the injured victim arriving at the
emergency department during a mass casualty incident
caused by a terrorist bombing. Treatment protocols for stable,
unstable, and in extremis patients are presented.
In a previous entry, we discussed improvising in the field and demonstrated a method of creating a scalpel handle out of its wrapper. This entry will focus on the safety pin and several of its uses. It’s always a good idea to have 4 or 5 of these in your kit. They can be used to solve many medical and non-medical problems. They are inexpensive, don’t expire, and take up hardly any space.
Here is a list of a few things you can do with a safety pin:
-Pin the tongue to the lip to maintain the airway
-Splint a finger
-Make a sling out of a casualty’s shirt
-Close abdominal wounds or large lacerations
-Make a tracheal hook
-Secure an ET or Cric tube.
Like most improvised medicine, these techniques are not definitive treatments, but in certain situations you may not have any other option. You can never carry everything, so knowing how to employ items you have can be a life saver…literally.
