Your thoughts on carrying a "chest dart"...

Matt Babika

CLEER Medical
http://handguncombatives.blogspot.com/2015/04/chest-decompression-needles-vital-kit.html?m=1
Handgun Combatives

Monday, April 27, 2015

As will be the case in this often trend driven industry, yet another tactical talisman has entered the must have lists of many a preparedness minded individual. You’ve all seen them, or bought them, yet very few have any legitimate training or authority to even posses them. We are talking about the chest decompression needle. It must finally be said, please STOP; you know not what you do.

I have been an instructor in most disciplines of Fire, EMS, and Technical Rescue operations for several years now, operating on the streets for 17 years. Like most in my service, I have responded to thousands of calls that include pretty much any insult to the human form an individual could imagine. But guess what, I’ve seen more double rainbows in my life than I’ve even heard of pre-hospital tension pneumothorax decompressions.

You might be interested to know that ER physicians have an approximately 68% success rate of successfully detecting tension pneumothorax within the controlled environment of an emergency room. Yet thousands of people believe they can pull it off with no training in the uncontrolled environment of a trauma scene. There are also a great number of false positives that end up “darted” that complicate patient condition greatly. This procedure is an extraordinarily rare need and NOT a “ground ball” to perform.

I am very happy that there has been an increased focus on civilian trauma management education. Please stop calling it “tactical” or “extreme” to sound cool; it’s just trauma management. I instruct civilians. I instruct my family and friends. So I obviously believe it is vitally important that you are able to stop bleeding and live, whether it’s a gunshot wound or a workshop injury. I encourage everyone to attend a class and learn real world LSIs (Life Saving Interventions). Afterward, buy some appropriate kit and strategically locate it. You are good to go. A well intended tip; Like the shooting world, there are many instructors on this topic who’s credentials are suspect to say the least. Vet your instructors!

Some folks have taken the next step and decided to attend an Emergency Medical Technician course. This is a great effort, easily completed in a few weeks, but be careful, far too often I see these folks carrying more advanced care crap in their kits than many of my physician friends. The quickest way to not be an EMT anymore is to carry advanced kit, made much worse if you dare attempt to use it. If you are an EMT, you are required to stay within your scope of practice BY LAW, and decompressing a pnuemo isn’t in your lane.

Hypothermia management aside, there is no trauma intervention easier to master than modern bleeding control. This mastery however only comes from continual training, as these skills are perishable even for the professionals. The equipment used is top notch, represents a statistically relevant injury occurrence, and are actually LEGAL for civilians to obtain and posses without a prescription.

I understand people’s attraction to do-dads, especially items of a tactical nature. I understand that there is a certain implied CDI factor to visually conveying an “I got this” attitude by wearing a full blow out kit on your belt. But when you take up a 3 ¼ inch, 10 or 14 gauge needle and attempt to place it perfectly within the plural space without any confirmation methods or true understanding of the indications or contra-indications, you have ventured out of your league. The patient outcome implications can be severe, and you will be challenged. Your good intentions, and one-day class on the matter cannot help you.

Now I understand this will have the potential to offend a great many well-intended people, but know your efforts to learn are a tremendous positive step. Some of my most enjoyable teaching experiences come from working with civilians that truly wish to expand their skillset in appropriate trauma management techniques. I’m just sharing that there are FAR more important techniques and concepts upon which you should be focusing your time, effort, and money.

I discussed this matter recently with a physician friend of mine. Not some technically a doctor type, but a down and dirty, aggressive young doc that is a driving force in trauma management and EMS operations in a significant metropolitan. For the ninjas among us, also a Brazilian jujitsu loving SWAT team member, with extensive military deployment experience in our recent conflicts. He echoed my sentiment saying frankly, “Too many folks just want to do the sexy advanced stuff. They need to be concentrating on BLEEDING CONTROL, AIRWAY MANAGEMENT, HYPOTHERMIA, and EXFIL.” Hypothermia and exfil are so ridiculously easy, but blankets and truck beds just aren’t that interesting. If I invented the Tacti-Quilt and patented Tac-Exfil Truckbeds I may be a millionaire sooner than I thought. But I digress. My friend added some other expressions against the absurd trend of civilians carrying pnuemo kits, but I’ll keep this family friendly. Sincere thanks for keeping it real Doc.
In closing, there are many myths that have in recent years been debunked through real science and research. Back-boarding, Big bore IVs, TQ disasters, just to name a few. Add to that list, the misguided expectation that you aren’t on the cool kid list without a chest decompression needle. Stick to the list above from the good doc, with quality up to date training, and you are good to go!

Author: Jonathon Willis, Staff Member of Handgun Combatives
*For your questions on civilian trauma management, or to set up a real world trauma class visit: www.handguncombatives.com


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M Atwood

Newbie
Vendor
I've probably got more in my favor for it than Joe Hillbilly Prepper, or Jim CPR-trained Cop, and the only reason I have one in my EDC bag is because it's on the CLEER I've been working on a review of. :D My pocket kit certainly doesn't have one.
Great article.
 

PM07

Moderator
Staff member
Moderator
Interesting article. When I put together our Agency blow out kits, I did not add a needle. Even though as part of our yearly med training, we are taught how to and do practical exercises with them. A couple of guys added them to thier kits , no issues for me there. My Mil and personal kits had/have them. I agree that the time it takes for a tension pneumothorax to manifest LEO/Civ wise is unlikely in most situations but if history has shown us anything , shit happens beyond our control.
 

Mike G

Amateur
Vendor
VIP
BS. I have dropped a bunch of darts while working EMS so if this dude hasn't heard of that many he is from a slack system or is out of touch. Ever been on a trauma arrest? No reason not to decompress most if not all trauma arrests. Beyond that, TCCC has established that people who are shot or blown up and were not immediately killed have a common incidence of tension pneumo. People do need to be extremely cautious in who they are willing to do skills on (self and spouse) of an advanced nature but that doesn't mean you shouldn't learn it or spend the $15 on a tool that is otherwise hard to duplicate in the field.

I would be interested to see his data on tension pneumo id in the ER. If it was only 68% that means 32% of patients with tension pneumo either died or had severe impairment due to delayed treatment when moved onto the ICU. You don't walk off tension pneumo, the fact it is under tension means it is actively killing you by compressing your heart and great vessels. A simple pneumothorax can go untreated and eventually resolve on it's own if it isn't too large, to be determined by a chest x-ray and managed by a physician. Maybe he has his data mixed, or maybe he is just full of shit and left some details out.

When I first formally learned needle decompression the instructor giving the lecture showed the class a chest x-ray of a patient with a tension pneumo and he said "see this patient? this patient is dead because the team caring for them waiting for a chest x-ray to confirm tension pneumo to do a chest tube instead of just dropping a needle. Shortly after shooting this film the patient arrested." Needle decompression is not for every patient and it is not a definitive treatment but it address an emergent issue with a RELATIVELY low complication rate.
 

Mike G

Amateur
Vendor
VIP
I am also unable to find any biographical data for the writer or the guy who manages the blog.
 

DocGKR

Dr.Ballistics
Staff member
Moderator
Having at least a tourniquet and Z-fold Combat Gauze on your person, not just in the car, at ALL times, on and off duty, is a good idea, particularly for LE and medical personnel. Officers wearing tactical load bearing equipment, as well as those using the new outer armor carriers have room for a more effective Individual First Aid Kit/Blow Out Kit for treating gunshot wounds.

Below is what we have recommended to LE agencies in the area:

Key items for a CONUS urban/suburban IFAK/BOK include:

Tourniquet (SOFT-T wide)
Combat Gauze (Z-fold)
Kerlix
Coban and/or Ace wrap
Large safety pin
Hemostat
Shears/scissors
Nitrile gloves
Pouch to hold everything

Nice but less important include:
Israeli bandage
Nasopharyngeal airway (28 fr)
Lidocaine jelly
Suture (3-0 Vicryl w/SH needle or 4-0 w/SH-1)
CPR barrier
Band aids
Epi pen

Probably NOT necessary for most CONUS urban/suburban areas:

14 ga cath
 

Mike G

Amateur
Vendor
VIP
Maybe I am misreading your post and maybe we just have different opinions but you would carry suture material before a deco needle? Suture material in a BOK is not of high priority to me, an aidbag maybe and toss in the requisite items that make suturing easier like a needle holder, suture scissors, forceps, etc.

Deco caths are not required to treat a tension pneumo as you can do a simple thoracostomy but that is outside the comfort level of many and well into the "you have some 'splainin to do" realm domestically unless the provider is 'at work' and under protocol/clinical recommendations.
 

DocGKR

Dr.Ballistics
Staff member
Moderator
Your probably misreading my post. In a urban or suburban area, transport time to more definitive medical care is generally rapid enough that needle decompression is rarely as urgent as might occur in rural or field conditions where evac may be significantly delayed.
 
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