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Perform First Aid for an Open Chest Wound
081-831-1026


Conditions: You see a casualty who has an open chest wound. The casualty is breathing. You will need the casualty's
emergency trauma dressing or field dressing, a large bore (14-gauge, 3-inch long) needle and catheter unit, and material
to improvise a dressing (clothing or blankets) in order to provide first aid.

Standards: Apply a first aid dressing to the wound following the correct sequence, without causing further injury to the casualty. Ensure that the wound is properly
sealed and the dressing is firmly secured without interfering with breathing. Perform needle chest decompression, if necessary.

Performance Steps
Note: Always check for both entry and exit wounds. If there are two wounds (entry and exit), apply first aid to the wound that appears more serious first (for example,
the heavier bleeding, larger wound, and so forth). It may be necessary to improvise first aid dressings for the second wound by using strips of cloth, a T-shirt, or the
cleanest material available.
1.        Uncover the wound unless clothing is stuck to the wound or you are in a chemical environment.
CAUTION: Removing stuck clothing or uncovering the wound in a chemical environment could cause additional harm.

WARNING: Do not attempt to clean the wound.
2.        Apply airtight material over the wound.
a.        Fully open the outer wrapper of the casualty's dressing or other airtight material.
b.        Place the inner surface of the outer wrapper or other airtight material directly over the wound after the casualty exhales completely.
Note: When applying the airtight material, do not touch the inner surface.
c.        Hold the material in place.
3.        Apply the casualty's dressing.
a.        Apply the dressing/pad, white side down, directly over the airtight material.
b.        Have the casualty breathe normally.
c.        Maintain pressure on the dressing while you wrap the tails (or elastic bandage) around the body and back to the starting point.
d.        For a field dressing, tie the tails into a nonslip knot over the center of the dressing after the casualty has exhaled completely. For an emergency trauma
dressing, pass the tail through the plastic pressure device, reverse the tail while applying pressure, continue to wrap the tail around the body, and secure the plastic
fastening clip to the last turn of the wrap.
e.        Ensure that the dressing is secured without interfering with breathing.
Note: When practical, apply direct manual pressure over the dressing for 5 to 10 minutes to help control the bleeding.
4.        Position the casualty on the injured side or in a sitting position, whichever makes breathing easier.
WARNING: If the casualty's respiratory condition becomes worse (rapid breathing, shortness of breath, restlessness, pale skin or bluish skin, pain in chest, or loss of
consciousness) after placing the dressing on the wound, assume that a tension pneumothorax has developed, and perform needle chest decompression.
5.        Perform needle chest decompression, if necessary.
a.        Locate the insertion site. Locate the second intercostal space (between the second and third ribs about two finger widths below the collarbone) at the
midclavicular line (approximately in line with the nipple) on the same side of the casualty's chest as the penetrating wound.
b.        Insert a large bore (14-gauge, 3-inch long) needle and catheter unit.
(1)        Firmly insert the needle into the skin over the top of the third rib into the second intercostal space, until the chest cavity has been penetrated, as evidenced by
feeling a "pop" as the needle enters the chest cavity. A hiss of escaping air under pressure will usually be heard.
WARNING: The needle must be positioned properly to avoid puncturing blood vessels and/or nerves. Blood vessels and nerves run along the bottom of each rib.
(2)        Withdraw the needle while holding the catheter in place. Secure the catheter to the chest wall with tape.
6.        Watch the casualty closely for life-threatening conditions, check for other injuries (if necessary), and treat for shock. Seek medical aid.

Evaluation Preparation:
Setup: Use the same dressing repeatedly. Prepare the dressing outer wrapper or provide a piece of airtight material (plastic, cellophane, foil). Have another Soldier
act as the casualty. Use a moulage or otherwise simulate the chest wound. If a mannequin that is capable of testing needle chest decompression is available, use it
to test step 6. Have an 18-gauge needle available.

Brief Soldier: Tell the Soldier to do, in order, all necessary first aid steps to treat the casualty's wound. When testing step 1, you can vary the test by telling the Soldier
that clothing is stuck to the wound or that a chemical environment exists. For step 6, tell the Soldier that the casualty's condition is becoming worse, and have him/her
show you (on a mannequin) or tell you what he/she would do to decompress the chest. Do not evaluate step 8 in the simulated mode.

                                                                                                                                                                                                            Performance Measures        GO        NO-GO
1.        Uncovered the wound unless clothing was stuck to the wound or a chemical environment existed.                                                                        ——        ——
2.        Applied airtight material over the wound without touching the inner surface of the airtight material.                                                                         ——        ——
a.        Fully opened the outer wrapper of the casualty's dressing or other airtight material.                
b.        Applied the inner surface of the outer wrapper or other airtight material directly over the wound after the casualty exhaled completely.                
c.        Held the material in place.                
3.        Applied the casualty's dressing.                                                                                                                                                                                                ——        ——
a.        Applied the dressing/pad, white side down, directly over the airtight material.                
b.        Had the casualty breathe normally.                
c.        Maintained pressure on the dressing while wrapping the tails (or elastic bandage) around the body and back to the starting point.                
d.        For a field dressing, tied the tails into a nonslip knot over the center of the dressing after the casualty exhaled completely. For an emergency trauma dressing,
passed the tail through the plastic pressure device, reversed the tail while applying pressure, continued to wrap the tail around the body, and secured the plastic
fastening clip to the last turn of the wrap.                
e.        Ensured that the dressing was secured without interfering with breathing.                
4.        When practical, applied direct manual pressure over the dressing for 5 to 10 minutes to help control the bleeding.                                                   ——        ——
5.        Positioned the casualty on the injured side or in a sitting position, whichever made breathing easier.                                                                           ——        ——
6.        Performed needle chest decompression, if necessary.                                                                                                                                                             ——        ——
a.        Located the correct insertion site.                
b.        Inserted the needle until the chest cavity was penetrated.                
c.        Withdrew the needle while holding the catheter in place, and secured the catheter to the chest wall with tape.                
7.        Performed steps 1 through 6 in the correct sequence.                                                                                                                                                               ——        ——
8.        Watched the casualty closely for life-threatening conditions, checked for other injuries (if necessary), and treated for shock. Sought medical
aid.                                                                                                                                                                                                                                                                             ——        ——

Evaluation Guidance: Score the Soldier GO if all performance measures are passed. Score the Soldier NO GO if any performance measure is failed. If the Soldier
scores NO GO on any performance measure, show or tell the Soldier what was done wrong and how to do it correctly.

References
Required        Related
FM 4-25.11
open chest wounds
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