I thought that I would throw this out there because there are some people here with some strong opinions. You’re hours away from an ambulance or hospital, and somebody gets shot through the chest. You patch up the entry and exit holes, but the lung starts to collapse. Breathing is extremely limited. You’ve had instruction on how to dart a chest. Do you do it and take the chance with the lawyer, or put on a Bolin knowing that it won’t be nearly as effective but you probably won’t be sued? You get the idea. Thanks.
Who is the patient? Stranger? Or someone you know? Do you have access to a cell phone or other communications? How much instruction/practice are we actually talking about? Are you a paramedic? Do you have command?
For the lay person, at first blush I’d say no, because if you don’t practice it and/or you do something wrong you can actually collapse the lung further or (heaven forbid) the wrong lung.
There is already a hole in the system and you can try to “burp” the pneumo.
First rule of medicine…do NO harm.
What he said. The holes are already there, so no point in needling. ‘Burp’ the wounds, and get thee to an ED.
Concur with Gutshot.
Me too.
I concur with this concurrence. 
If that’s allowed anyway.
Otherwise I say… well you get my point. You present a pretty hairy scenario that does not have much win in it.
Thanks for the viewpoints. I was expecting those answers. The scenario that brought on my question was the amount of camping that I used to do with some friends, and the 10’s of thousands of rounds we used to expel. We were safe, but there can always be an accident. I am not a paramedic, but I’m thinking about taking the EMT-B classes now. The local firehouse is always looking for volunteers. I was shown the procedure by a SF medic under the supervision of a trauma doctor, and we practiced on some pig ribs. It was more like a college science lab with them saying “DON’T DO THIS, but this is how we do it.” I found it extremely interesting so that’s why the interest in the EMT-B classes.
All that Paramedic stuff looks really easy and straightforward on television. In reality the skills and knowledge are quite perishable for those who don’t use it on a regular basis. The chance of hurting or killing someone trying to apply some half-remembered concept of advanced emergency care is very real.
You took trigonometry in high school. Can you tell me how to calculate the angle of the hypotenuse if x and y are known? Off the top of your head?
I have great respect for people at all levels of the medical profession. Training must continue throughout the span of the career to stay on top. Not to be a smart ass, but you can’t find the hypotenuse with the information given, but I fully understand your point.
Lol. Touché. Been a long time since I took trigonometry, or had to use it.
I agree with everything stated above, especially that these are skills that must be applied or practiced on a more than regular basis! In Iraq, you can see our evac sections skills diminishing because they really don’t get to apply what they know all that often. We have regular classes to try to prevent this.
On a side note, if your camping and spending rounds and someone gets shot on accident… You’re probably getting sued anyways… lol only joking
If you have to ask, you shouldn’t do it.
do no harm.
The easiest answer is to say NO, dont needle the chest.
The real world answer is you have to decide for yourself. Is it worth potentially jail time, losing your house, and all assets to the point that you are bankrupt? If it was my best buddy probably so. If it is a stranger, I will be calling for medical control if I can or treating BLS all the way. BUT…THAT IS A DECISION YOU MUST MAKE. Also, you must make it after being trained and maintaining that knowledge. Be self-critical, if you are not absolutely sure you can perform the procedure without screwing up then dont even move onto the decision about accepting consequences for actions, etc.
Most of the things we do in this life are based on evaluating the reward vs. the consequences, or should be. If I drop the hammer on some dirt bag in the local stop-and-rob because he is holding the place up it is because he tilted the scale in favor of me accepting the consequences for using lethal force. He made a decision to break the law and threaten someone with bodily harm and is accepting the consequences being stopped by lethal force. I am making a decision and accepting the consequences that I may miss, be shot, die, kill someone, be sued, etc.
I equate this to informed consent on a medical procedure. Before you consent to something you understand the need for the procedure, the risks, and the rewards. In this scenario you must understand the need for needle decompression, the procedure, the risks (both physical and legal), and the rewards. DO NOT ASSUME THAT YOU WILL BE ON THE FRONT PAGE OF THE NEWS PAPER FOR SAVING A LIFE. ASSUME THAT YOUR PATIENT WILL DIE AND YOU WILL HAVE TO EXPLAIN WHY YOU DID WHAT YOU DID.
As for what I would do, as a Remote Duty Medic/RMO, I would either needle the chest or perform blunt dissection (with my finger if I could avoid broken ribs) to the open wound until I had a release of air/blood and apply a Bolin chest seal.
Folks,
I have a different perspective….
Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.
Methods: After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.
Results: Initial training resulted in a significant increase in knowledge (pre:1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.
Conclusions: Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration for at least six months.
More info full article here:
http://pdm.medicine.wisc.edu/Volume_23/issue_6/sztajnkrycer.pdf
Tom Perroni
Doc “Gwedo”
“Trust me, I’m a medic”
The “State of the Art” in medicine is constantly changing –unlearn outdated medical training @ CCJA.
While that works great in the military where there is no such thing as liability lawsuits, in the civilian world it becomes a bit more problematic.
As for the 6 month window, I know as a paramedic we didn’t recert on a 6 month basis. PHTLS is a 4 year cert.
As for LEOs, many departments don’t even have the cash to get them on the range. Being able to draw it on a piece of paper/quiz is one thing, being able to find the landmarks on a real person is something else.
And for civilians it’s wholly unrealisitic.
As for the very real hazards associated with doing it wrong, and thereby opening yourself to significant liability…graphic video illustrates the complications perfectly.
http://www.tacmedsolutions.com/blog/?p=86
Burping a pneumo is a far safer option with significantly less liability.
Have you ever done this?..I have had several Docs tell me that it is BS!
Who said Military? the study was on LEO?
I know what the study said but it’s not applicable to the question posed by the OP. He’s not Military and he’s not LEO.
I can actually see LEO/Firefighters being trained to do it assuming they have some amount of medical command/oversight and the appropriate training regimen. In that limited circumstance I do see the value.
Absent that, they are the same as lay civilians…just like the OP is a lay civilian. Keep the information focused on that.
And your point is? This was a study …You seem to like clinical studies.
The study isn’t relevant to the OP’s question. The thread is about civilian medical training. Civilians are subject to lawsuits that military people are not. You should understand that.
They did both in the test.
The stuck live human beings? As any medic with any experience will tell you, there is a difference. Namely that the practice dummy doesn’t give you the practice to recognize the signs/symptoms you need to properly identify when a stick is appropriate. How much training do you give them on physical examinations? How much practice do you give them on recognizing breath sounds, or percussing the chest? This isn’t something that gets taught in a couple of days, it takes experience on live patients. Most importantly the dummy you stick or its family won’t sue you if you do something wrong.
Sticking needles into peoples chest, any invasive procedure carries risk. It can be fucked up, no matter what your Docs say is BS. I’m sure they’re all very competent and never make a mistake, other people however aren’t as perfect. Just because they’ve never seen something, doesn’t mean it never happens or that it’s impossible.
Why? One has a badge pined to thier chest the other did not? Having a badge or military uniform gives you magic medical powers?
In the case of the military, yes, it gives you the magical power of never being sued. In the case of military and LEO, you have a logistic infrastructure behind you, which includes, training dollars that civilians don’t have.
Nice video…leave the cath in take the needle out once you make sure you are lateral of the niple…How hard is that?
Not hard but you still have to use the needle the make the hole. The video was used to illustrate what can happen before you take the needle out.
You’ve had numerous medics, including those with extensive military and real world medical experience (not to mention TacMedSolutions) disagree with your assessment. I’m sure you think you know better than all of those people but you’re not only opening your civilian student to significant potential liability but you’re also opening yourself to it as well.
Are you willing going to go into court and stand behind your student and say, the person did exactly what I told them to do? What happens if they didn’t? What if they missed something important? Are willing you going to go into court and explain how your student got all the nuances of performing the procedure in a 90 minute training session, when that person probably had no other medical training experience? Are you willing to explain why you taught a lay civilian a technique that’s not even within the scope of practice of trained/experienced EMTs. You should be because you’re going to be held responsible for their actions for better or worse.
There’s already a hole in the system, teaching the civilian to burp the pneumo through the existing hole is the safer alternative and carries with it far less liability. Yes in the military/combat world there is value since it is the second leading cause of death. In the civilian world this doesn’t apply.
First rule of medicine…do no harm. I think Mike G gave the best answer here so I’ll defer to his judgment.
The clinical diagnosis of tension pneumothorax is hard enough in a warm, lighted ED, let alone in the dark, at the roadside, or in the back of an ambulance. Making needle thoracostomy part of civilian or even LEO first aid is silly, needless, and dangerous IMHO. I’d want to see far more data, and more relevant data than that one study before I’d ever let it happen around here.
It is only silly and needless until you or someone close to you catches a bullet or frag and has a negative outcome.
Do I think the skill needs to be as widespread as CPR? NO. Do I think lay people need to be restricted from learning this skill because ::gasp:: they may actually decide to use it on themselves or a relative some day? NO!
Diagnosis on the battlefield consists of identifying true shortness of breath or a decrease in tidal volume NOT due solely to discomfort and identifying mechanism of injury consistent with a tension pneumo (i.e. penetrating trauma between the clavicles and the umbilicus).
A local system study based on the Level 1 in my area found that EMS providers were under treating TP, they also found that the few patients that got needles and didnt need them didn’t end up with chest tubes because the volume of air fell within the range of “wait and see”. Point being, if you can select your patient correctly, and more importantly place your needle correctly the physical complications are minimal. The legal side is a different story: see my comment above about front page of the news paper.
Just to head off an argument, HMAC, I am not saying you are wrong I just dont agree with restricting this level of information from people. I have taught people skills, techniques, and procedures necessary to kill other people both domestically and down range, part of that time is spent explaining the responsibility and consequences of inappropriate use of that knowledge. I have difficulty with the concept of withholding information because they can not be trusted to use that info responsibly but they are good to go for carrying a pistol or rifle around.
As to trusting weapons to cops and not needle…if our local LEO’s want to train, practice, and qualify for treating tension pneumothorax as often as they have to with their firearms, then we can talk. But I can tell you with certainty, they’re not interested. Civilians? Even more unlikely.
I have no intention of trying to tell you what to do in YOUR service area. In mine, undertreatment of tension pneumothorax isn’t a problem. Your mileage may vary according to where you work. Penetrating trauma is rare around here.