NREMT Skillset/Improvised Occlusive Dressing

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Occlusive dressings are a vital treatment of open pneumothoraxes as they are able to limit or stop air from entering the pleural space. In addition, many commercial devices contain one way valves which allow air or blood to escape the chest, ideally resulting in an overall improvement in the patient's condition. In the absence of a commercial occlusive dressing, EMTs may use a variety of materials to improvise in the best interest of the patient.

When choosing materials to create an improvised occlusive dressing, remember that the dressing will be covering a hole into the patient's body, and as such any measures the responder should take as much care as possible to reduce infection and exposure. Materials like the inside of sterile packaging and petroleum soaked gauze packaging make good occlusive dressings from this standpoint. Another aspect to keep in mind is that the dressing should be flush to the skin in order to prevent air entry into the chest cavity.

As a last resort, gloved hands may be used to prevent air entry, but be mindful of the fact that a rescuer must stay in place if performing this action.

• For example, if a unit only carries 4 Asherman Chest Seals and 20 packs of petroleum gauze: "Patient assessment reveals 6 entry wounds to the anterior chest (3 to the left, 1 midline, and 2 to the right) and 5 exit wounds to the back (2 to the left and 3 to the right). Commercial occlusive dressings applied to 4 of the anterior chest wounds; improvised occlusive dressings applied to all other torso wounds."