Medical. : Occlusive Dressings:


Verified Military
Jul 30, 2008
Wrong side of heaven, righteous side of hell
What are your thoughts on them? In civilian E.M.S. / P.H.T.L.S. they are big. In real life (civilian or military) what to you guys do.

Note: In civ. EMS we are trained and I have performed a few chest decomps. I have been reading from journals that it is of little to no value and that it was invented for the lay person back in the day. I know about the size of ther injury rule v/s. the diameter of the trachea thing. Thoughts?

The chest seal (not necessarily the ACS or Bolin) is one of the few products that works in theory and in practice. In my experience, there are very few "tricks" that need to be applied in order to make these things work as advertised. A little tincture of benzoil goes a LONG way in making these bad boys stick. And most of the time, in the prepackaged versions, they include a simple 4x4 to clean the area. Um, I call BS. If you have someone with a hole big enough to cause pmtx, guess what? THE PT IS BLOODY AND SWEATY. Clean, apply the tincture, and apply the chest seal.
The only beef I have is that average or new medics use this and forget it. For some reason, new guys I have seen treat a chest seal like its not an intervention. Apply, reassess, adjust, reassess, etc. I have personally seen a pt come to the er with 6 cx seals, 4 on front and 2 on back. Which brings me to my next point- just cause its called a "chest seal" doesnt mean its for the area extending from belt buckle to collarbone, shoulder to shoulder.

One real life "bad on me" learning points for me? I TOTALLY missed the worst injury a seemingly drunk mild fight pt. Dude said "I got in a fight at the bar", was MILDLY bloody at best, and i discounted his general pain complaint and missed the three 2cm lacs midaxillary that were cat-eye stab wounds from a 4 in dagger. No blood, BS throughout. Got to the ER and had a tension present while being admitted. Pt lived, and I got to have a GREAT conversation with an ER doc in the hospital about thorough patient assessment.
Overall, they are a great tool, but not an end all be all. Sometimes you apply them just right but still need to decompress. Sometimes they dont stick when you think they will. Treat them like any other intervention, know your equipment and its limits, and never be surprised. Thats a bad thing.
A.M. I agree with you on all points. I have been teaching that for years now and the new medics out there are more worried about seals that the actual treatment of TPT.

82nd: We still use the 3 sided chumpy but as A.M. said, re-assess ALOT! It can still become a tension requiring a needle decomp. The 1000 word thing will piss me off also.

not sure for anyone else... most recent standards say no 3-side. just stick it on, because it's likely you're going to decompress anyway. may as well secure the dressing well. Benzoin is like duct-tape..... it belongs in the aid bag up font where you can get it quick. Asherman's are SHIT. I like the new hyfin's and Bolin's, much stickier.
OK, So I am not the only player bothered by the 1000 character!

You know, that really shows the lack of understanding. the most any patient needs are two bolins, which may still require a needle decompression.

The chest is essentially three spaces, two with lung in them, and front-back-side in a warrior are all conneted. Seal the posterior wounds solid, "magic seal" (bolen etc) the anterior, and keep watch for signs of tension. There is a wall between the heart space (mediastinum) and each chest, so each side of the cehst deserves a venting seal.

And you make a great point, handeld by "E" exposure.

Naty wounds hide in skin folds, like upper abdomen is a chest, armpit is a chest, neck could be chest, etc.

One question for you guys: Do you have any experience with HALO seal (hydrophilic gel used as adhesive)? i played with them only in training environment, when they works quite well with fake blood...:/ It will be great to have some real-life info. Thanks