CHEST SEALS (Vented)
Let’s start off with the bottom line up front: Non-medical personnel that are faced with a penetrating chest injury should only be using vented Chest Seals. Period. No further discussion. Don’t even think about putting on a chest seal that isn’t vented. Don’t even carry one in your kit. If you have a non-vented chest seal in your kit and aren’t trained to properly place a needle thoracentesis or chest tube thoracotomy, throw the chest seal away and purchase a vented chest seal.
Now because I know you are all inquisitive, free-thinking, red blooded Americans that question everything, I will explain why. If the patient suffers any sort of penetrating trauma to the chest such as a gunshot wound, knife wound, blast injury, or severe rib fractures…..we MUST assume initially that there has been some sort of underlying lung damage. Trauma of these types may cause air and blood to escape from the lungs and enter the chest cavity. This excess air and blood in the chest cavity is going to cause some serious problems with breathing, by possibly causing the lungs and heart to collapse. (See the article on Pneumothorax/Hemothorax).
There are three main objectives we try to achieve with a chest wound:
► Maintain the integrity of the chest cavity so outside air is not entering through the wound
► Ensure that the trapped air and blood is removed so internal pressures do not increase
► Seal the wound completely
In other words, we want to completely seal the wound while allowing air and blood to escape, without having outside air enter through the wound into the cavity. Simple….right? The problem arises with the various products available for us to use. Non-vented seals work great in the hands of personnel trained in their use. The vented chest seals work best for those people that don’t have a lot of medical training.
For those that had previous medical training, you might have learned how to improvise a “three sided flutter valve” for a sucking chest wound. This used to be a part of the military’s common task training. You made it by using the plastic covering from a bandage package, taping it down on three sides, and allowing the fourth side to act as a one way valve. This would allow air to escape from the chest cavity when the patient inhaled….and seal when they exhaled. This prevented the air from re-entering the chest cavity. They worked OK…..nothing great….but better than nothing. They also had a tendency to become clogged with dried blood, and we were taught to periodically lift the flutter valve and “burp” the wound. This was achieved by sticking our fingers into it and opening up the wound again to allow the air and blood to escape.
Today, we have much better alternatives for providing a one-way valve. HyFin and SAM both make a good product with an excellent adhesive seal. You apply them both in the same manner by:
► Wiping the blood, sweat, and dirt away from the wound with a piece of gauze
► Peel the backing off the adhesive
► Place the valved portion of the seal directly over the wound with firm pressure
The differences in the two are minor. The SAM Valve is very sturdy and raised up, which gives it more durability. The HyFin has three separate channels allowing the air and blood to escape (not as sturdy, but more compact for those that have space limitations or may need a highly concealable package, such as for a Protective Service Detail). The HyFin also comes with a piece of gauze to enable cleaning of the wound site before application of the seal. Nice touch by HyFin. I highly recommend either of these products and I carry both. I have the SAM in my Aid Bag where I have more space to play with. I have the HyFin in my truck console and in personal First Aid Kit, where space is a little limited.
In a nutshell, which one would I pick? I would choose the HyFin because it is more compact and flatter, making it easier to store in your Aid Bag or Kit. The adhesive works extremely well and will not fall off when subjected to dirt or blood.
Patrick O’Neil, PA