IFAK with Chest Darts- are they for everyone?

Have you received training to perform a Needle thoracentesis (Pleural Decompression) AKA, the use of a decompression needle? A Tension Pneumothorax is a medical emergency which requires timely intervention. 

Decompression Needle

A decompression needle is usually a 14 to 16 gauge, 3.25” catheter needle used to penetrate the chest wall and pleural cavity thereby releasing built up air pressure.  This process is referred to as a Needle thoracentesis or pleural decompression.  There are many dangers associated with untrained personnel attempting to utilize a chest decompression needle for the treatment of a tension pneumothorax. 

One-way chest seals are an alternative to decompression needles for treatment of a tension pneumothorax. In June 2013 USCENTCOM approved the following...

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Open Chest Wound

recommendation by the required two-thirds majority of the Committee on TCCC.

“All open and/ or sucking chestwounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression”

A pneumothorax is a collapsed lung.  Pneumothorax occurs when air leaks into the plural space between your lungs and chest wall.

A tension pneumothorax is the progressive build-up of air within the pleural space usually due to an open wound, caused by a blast injury, gunshot wound, knife stabbing etc. to the chest area. Air enters the pleural cavity and is trapped during exhale; air pressure builds within the thorax higher than external atmospheric pressure which compresses the lung.  This compression can place pressure on the heart and lung.

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Sierra12 IFAK

Sierra12 IFAK was built to address the 3 leading causes of preventable combat death:

1)Extremity Hemorrhage 60%

2)Tension Pneumothorax 33%

3)Airway Obstruction 6%

This IFAK contains tools which are designed for quick and intuitive application.  If you don't know how to use a decompression needle that doesn’t mean you can’t render aid to someone with a tension pneumothorax. This kit contains a total of 4 chest seals (2 HALO, 1 Asherman w/1-way valve, 1 Vaseline occlusive dressing).  The ASHERMAN chest seal is specifically designed to treat an open Pneumothorax and help prevent the onset of a Tension Pneumothorax in open chest injuries.  The Asherman seal utilizes a one-way valve which allows air and blood to escape while preventing air from reentering through the wound site.

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Needle Decompression is not to be discounted. A tension pneumothorax can be present in either a closed or open chest injury.  We know that internal and crush injuries do happen that will require a needle thoracentesis procedure, we believe that chest darts just require a higher level of training to use them effectively. In a closed chest injury with a tension pneumothorax a device such as a chest decompression needle would be an appropriate method of treatment. 

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Often time’s equipment and the responses are evaluated based on the level of training and likelihood on encountering a type of injury.  This specific IFAK was stocked based on the 80%-20% theory. This IFAK is addressing the majority of injuries found on the battle field. The Chest seals are very intuitive and address a very large percentage of battle field chest wounds such as a sucking chest wounds from a gunshot wound which can lead to a tension pneumothorax. It is highly suggest that everyone seek out qualified Tactical Combat Casualty Care classes. If someone chooses to carry a specific lifesaving piece of equipment, they should at least understand how to effectively use it.

Components included in the Sierra12 IFAK:

Standard IFAK Contents:

·         SOF® Tactical Tourniquet-W (1)

·         4 inch Olaes® Bandage (1)

·         Petrolatum Gauze occlusive dressing (1)

·         Nasopharyangeal airway 28F w/ Lube (1)

·         Pair of Gloves, nitrile, Size: Extra-large (1)

·         2 inch Tape, surgical (1)

·         Laerdal Face shield  (1)

·         Trauma shears 5.5"  (1)

·         CCT Card (1)

Upgrade IFAK Contents:

·         Includes all the above +

·         Tourniquet Case (1)

·         ASHERMAN chest seal (1)

·         HALO Chest seal (contains 2)

·         CeloxTM Rapid Ribbon Hemostatic gauze