3-5. First Aid for Chest Wounds

Table of Contents

• a . Evaluate the Casualty. Be prepared to perform first aid measures. These measures may include clearing the airway, rescue breathing, treatment for shock, and/or bleeding control.
• b . Expose the Wound. If appropriate, cut or remove the casualty’s clothing to expose the wound. Remember, DO NOT remove clothing that is stuck to the wound because additional injury may result. DO NOT attempt to clean the wound.

NOTE

Examine the casualty to see if there is an entry and exit wound. If there are two wounds (entry, exit), perform the same procedure for both wounds. Treat the more serious (heavier bleeding, larger) wound first. It may be necessary to improvise a dressing for the second wound by using strips of cloth, such as a torn T-shirt, or whatever material is available. Also, listen for sucking sounds to determine if the chest wall is punctured.

CAUTION

If there is an object impaled in the wound, DO NOT remove it. Apply a dressing around the object and use additional improvised bulky materials/dressings (use the cleanest materials available) to build up the area around the object. Apply a supporting bandage over the bulky materials to hold them in place.

CAUTION

DO NOT REMOVE protective clothing in a chemical environment. Apply dressings over the protective clothing.

• c . Open the Casualty’s Field Dressing Plastic Wrapper. In cases where there is a sucking chest wound, the plastic wrapper is used with the field dressing to create an occlusive dressing. If a plastic wrapper is not available, or if an additional wound needs to be treated; cellophane, foil, the casualty’s poncho, or similar material may be used. The covering should be wide enough to extend 2 inches or more beyond the edges of the wound in all directions.
• • (1) Tear open one end of the casualty’s plastic wrapper covering the field dressing. Be careful not to destroy the wrapper and DO NOT touch the inside of the wrapper.
  • (2) Remove the inner packet (field dressing).
  • (3) Complete tearing open the empty plastic wrapper using as much of the wrapper as possible to create a flat surface.
• d. Place the Wrapper Over the Wound. Place the inside surface of the plastic wrapper directly over the wound when the casualty exhales and hold it in place (Figure 3-2). The casualty may hold the plastic wrapper in place if he is able.
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  Figure 3-2. Open chest wound sealed with an occlusive dressing.
• e. Apply the Dressing to the Wound.
• • (1) Use your free hand and shake open the field dressing (Figure 3-3).
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    Figure 3-3. Shaking open the field dressing.
  • (2) Place the white side of the dressing on the plastic wrapper covering the wound (Figure 3-4).
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    Figure 3-4. Field dressing placed on plastic wrapper.

    NOTE

    Use the casualty’s field dressing, not your own.

  • (3) Have the casualty breathe normally.
  • (4) While maintaining pressure on the dressing, grasp one tail of the field dressing with the other hand and wrap it around the casualty’s back. If tape is available, tape three sides of the plastic wrapper to the chest wall to provide occlusive type dressing. Leave one side untapped to provide emergency escape for air that may build up in the chest. If tape is not available, secure wrapper on three sides with field dressing leaving the fourth side as a flap.
  • (5) Wrap the other tail in the opposite direction, bringing both tails over the dressing (Figure 3-5).
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    Figure 3-5. Tails of field dressing wrapped around casualty in opposite direction.
  • (6) Tie the tails into a square knot in the center of the dressing after the casualty exhales and before he inhales. This will aid in maintaining pressure on the bandage after it has been tied (Figure 3-6). Tie the dressing firmly enough to secure the dressing without interfering with the casualty’s breathing.
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    Figure 3-6. Tails of dressing tied into square knot over center of dressing.

    NOTE

    When practical, apply direct manual pressure over the dressing for 5 to 10 minutes to help control the bleeding.

• f. Position the Casualty. Position the casualty on his injured side or in a sitting position, whichever makes breathing easier (Figure 3-7).
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  Figure 3-7. Casualty positioned (lying) on injured side.
• g. Seek Medical Assistance. Contact medical personnel.

WARNING

If an occlusive dressing has been improperly placed, air may enter the chest cavity with no means of escape. This causes a life-threatening condition called tension pneumothorax. If the casualty’s condition (for example, difficulty breathing, shortness of breath, restlessness, or blueness/grayness of the skin) worsens after placing the dressing, quickly lift or remove, and then replace the occlusive dressing.