Chest Seal: Sucking Chest Wounds

In managing penetrating trauma in the tactical environment there are limited lifesaving interventions that are available to the tactical first responder. Mastering these skills under austere conditions requires repeated practice to build instinctive muscle memory. One such skill is familiarity with the use, placement, and venting of a chest seal device in the treatment of a sucking chest wounds.

A sucking chest wound (SCW) occurs when the chest is penetrated by a projectile or object, resulting in a defect (hole) that allows air to move between the chest cavity and the outside environment. When a SCW victim breaths in, air is drawn through the SCW into the chest cavity. This air may accumulate in a space between the lung and its lining called the pleural space. When breathing out, some portion of that air may escape. A SCW not only decreases the ability of a victim to breath, but puts them at risk for imminently deadly consequences. If air, drawn in through a SCW remains within the pleural space, over time it can accumulate under pressure, resulting in a deadly condition called a tension pneumothorax.

Chest Seal Devices

By placing a chest seal over an SCW, entry of air through the SCW is stopped, improving breathing, and reducing the risk of fatal complications.

Traditionally, a dressing taped on three sides was utilised to accomplish a one way seal over a SCW. This practice has been largely replaced with the use of a variety of chest seal products. Chest seals are divided into two general categories: vented and non-vented seals. Vented chest seals like those made under the trade names Asherman, Bolin, and SAM are constructed with valves that allow the one way movement of air out of an SCW, but reduce air entry into the chest cavity. The second group of chest seals are non-vented products that use advanced hydrogel or other fluid resistant adhesives, to provide a very aggressive seal around a SCW. This simple approach allows for reduced bulk of the device, excellent adhesion, but requires familiarity with venting of the SCW, if the complication of a tension pneumothorax is suspected.

Chest Seals available from Bound Tree Medical:

Chest Seal
Chest Seal
SAM Chest Seal
(With Valve)
SAM Chest Seal (Without Valve)


Porting of Sucking Chest Wounds

In the case of non-vented chest seals, if significant air accumulation within the pleural cavity is suspected from damage to lung, trachea, bronchi or smaller airways, re-exposing the SCW may be an option to relieve pressure within the pleural cavity. This process is referred to by some as venting, porting, or burping a SCW.

The venting procedure simply involves grasping the peel tab of a chest seal device and pulling back to expose the wound, and reapplying the dressing. Insodoing, the wound itself serves as a port to allow air to escape.

Practice and Training

The process of chest seal placement is about as straightforward as removing and placing a plaster on a paper cut and irrespective of what chest seal product is chosen, the technique for use is very similar. That said, the fine motor skills required to do this simple task degrade rapidly under austere or stressful conditions. Without familiarity with chest seal devices and their application, precious time can be lost when moments count.

The most true to life model for chest seal training is practicing with the actual medical chest seal that you carry. The only challenges of practicing with actual chest seal devices are mostly expense, discomfort and depilation (hair loss) associated with its removal. Discomfort is especially an issue with very highly adhesive products which are developed specifically for adhesion under conditions wrought with dust, dirt, blood and moisture.

It was for these expressed reasons that S.T.A.T developed the Practi-Seal line of training chest seals specifically for the practice environment. The Practi-Seal and Simu-Seal are constructed in the United States from quality latex-free materials allowing placement and removal of the device similar to actual medical chest seals.

Medical chest seals are the "Gold Standard" for practicing tactical medical skills. That said, the Practi-Seal line of products are similar in application to medical chest seal devices, yet without the discomfort and depilation (hair loss) associated with removal from human skin, and at a fraction of the cost. All Practi-Seal products are for training use only.

The Truth Hurts...

The arm on the left had a medical chest seal placed and removed (note the complete loss of hair). The arm on the right with a watch had a Practi-Seal placed and removed resulting in no hair loss.

Centralised Placement

At the center of all Practi-seal products is a small hole which signals the operator to center the seal to the bullet hole or other SCW. This approach is especially important for vented devices which depend on centralised placement over a SCW in order for effective wound ventilation to occur.

The Pract-Seal and Simu-Seal are also engineered with 3 pull tabs which not only facilitate ease of removal, but also allow the trainee, when prompted to lift an edge for mock venting, as would be done with non-vented chest seals.

Training Chest Seals

 The full range of training chest seals including Practi-Seal and Simu-Seal are available from Bound Tree Medical all available with free delivery to the United Kingdom:

Practi-Seal Original Practice Chest Seal
Pack of 2 (Red)

The Practi-Seal Original Practice Chest Seal is a training only device developed to simulate medical chest seal placement in the mock treatment of sucking chest wounds.

Click here to find out more about Practi-Seal

Simu-Seal Practice Chest Seal
Pack of 2 (Blue)

From the makers of Practi-Seal, comes the same great training chest seal colour coded to "training blue", the universally accepted colour designation for "non-live" training exercises.

Click here to find out more about Simu-Seal

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