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M7: Apply an Occlusive Dressing and Perform a Needle Chest Decompression
1. Apply occlusive dressing.
a. Expose and assess the injury.
b. Place hand over the open chest wound to create a temporary seal.
c. Apply Occlusive dressing from the casualty’s IFAK over the wound. (First wound found first wound treated).
1. Wipe dirt and fluid from skin with gauze.
2. Place dressing on wound, vent directly over wound opening, upon full expiration, with adhesive side down (ensuring not to touch adhesive side of dressing).
3. Firmly press dressing on skin to ensure a good seal.
d. Log roll the casualty or have the conscious casualty sit up and examine the back for an exit wound.
e. Apply an occlusive dressing to the exit wound using the same standards as per (step c).
2. Verify the presence of tension pneumothorax by checking for at least three of the indications below;
verbalize as needed.
a. Question the casualty about difficulty in breathing, pain on the affected side, or coughing up
blood, and observe for signs of progressive respiratory distress. Grader will state, “Casualty is gasping
for air and has pain on the wound side.”
b. Observe the casualty’s bare chest for respiratory rate depth and abdomen for progressive distension.
Grader will state, “Casualty has poor respiratory rate and depth, and the abdomen is mildly distended.”
c. Look at and feel the patient's chest for signs of air in the chest wall (subcutaneous emphysema).
Grader will state, “You feel a crackling sensation on the casualty’s chest.”
d. Observe the chest for failure of one or both sides of the chest to expand normally upon inhalation.
Grader will state, “You observe one side failing to rise with the other.”
e. Look for bluish skin (cyanosis). Grader will state, “You observe mild cyanosis.”
3. Identify needle decompression site. Primary site: 5th intercostal space (ICS) on the lateral
chest wall at the anterior axillary line (AAL) on the same side as the injury.
a. Clean site with an antimicrobial solution. Note: Alcohol or Betadine.
b. Insert needle into the chest at a 90-degree angle to the chest wall. Remove the plastic
cap from the 3.25 inch, 10 or 14-gauge needle and remove the cover to the needle’s flash chamber.
c. Insert the needle into the skin over the superior border of the lower rib at the site and direct the needle into the ICS at a 90-degree angle.
d. As the needle enters the pleural space, a "pop” is felt, followed by a possible hiss of
air. Ensure the needle is advanced all the way to the hub and left in place for 5-10 sec.
e. Remove the needle, leaving the catheter in place.
f. If tension pneumothorax recurs (as noted by return of respiratory distress), repeat the
needle decompression on the injured side.
g. Stabilize catheter hub to the chest wall with adhesive tape.
h. Listen for increased breath sounds or observe decreased respiratory distress.
4. Measure pulse and O2 SAT. Candidate can perform this step on themselves, another soldier, or Grader may prep the device screen with degraded vitals.
a. Wipe the index, middle, or ring fingertip with alcohol to ensure it is clean and dry.
b. Apply the sensor and document readings on DD Form 1380.
5. Remove DD Form 1380 from IFAK and record all treatments. Administrative data will already be filled out.
a. Front of card.
1. Evacuation (EVAC) - Mark an “X” on the casualty’s evacuation priority/precedence (Urgent; Priority; or Routine).
2. Date - Write date of injury in DD-MMM-YY format.
3. Time - Write 24-hour time of injury, indicating whether local (L) or Zulu (Z) time.
4. Mechanism of Injury - Mark an “X” on the mechanism or cause of injury (artillery, blunt, burn, fall, grenade, gunshot wound (GSW), improvised explosive device (IED), landmine, motor vehicle
crash/collision (MVC), rocket propelled grenade (RPG), other (specify)). Mark all that apply.
5. Injury - Mark an “X” at the site of the injury (ies) on the body picture. For burn injuries, circle the burn percentage(s) on the figure. If multiple mechanisms of injury and multiple injuries, draw a line
between the mechanism of injury and the anatomical site of the injury.
6. Time - Write time of vital signs taken.
7. Pulse (rate & location) - Write casualty's pulse rate.
8. O2 Sat - Write casualty's O2 SAT.
9. AVPU - Write casualty's level of consciousness
b. Back of card.
1. Evacuation (EVAC) - Mark an “X” on the casualty’s evacuation priority/precedence (Urgent; Priority; or Routine).
2. C - Mark an “X” for all Circulation hemorrhage control interventions. For tourniquets (TQ), mark
category (Extremity, Junctional and/or Truncal) and write name of TQ(s) used. For dressings, mark category
(Hemostatic, Pressure, and/or Other) and write type of dressing(s) used.
3. B - Mark an “X” for all Breathing interventions oxygen (O2), needle decompression (Needle-D), Chest-Tube, (Chest-Seal) and write type of device(s) used.
4. First Responder Name
5. First Responder Last 4
c. Secure the DD Form 1380 to the casualty per Unit SOP.