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Document request

Roger Kieffer Rkieffer at oakcreekwi.org
Fri Aug 14 17:51:30 BST 2015


As a Tactical paramedic (TEMS) attached to a SWAT team we base a lot of our protocols based on the modalities and recommendations set forth by the Committee on Tactical Casualty Care (C-TCCC) and Tactical Emergency Casualty Care (C-TECC) which is the civilian form of TECC. C-TECC is comprised of a broad range of interagency operational and academic leaders in the practice of high threat medicine and fire/rescue from across the nation, including members from emergency medicine, emergency medical services, police, fire, and the military special operations community. It is the responsibility of C-TECC to maintain and update the TECC guidelines, incorporating new information and technology and reflecting the best evidenced-based medicine principles. Key word being EVIDENCE based.  I have attached a study that compared the efficacy of a preferred unvented with that of a vented chest seal that you may find helpful.

Based off of C-TECC recommendations our Tactical Paramedics  with needle decompression capabilities use a non-vented chest seal. Other prehospital providers that cannot perform a needle thoracostomy use vented chest seals to help mitigate the potential  for developing a tension pneumothorax. Also to address the comment made about most field needle decompressions not being effective due to the needle not being long enough, most tactical teams have switched to using the ARS needle which is a 14 GA needle at 3.25 inches long compared to your usual 14 Ga IV catheter generally used by prehospital paramedics which is only 1.75 inches long.

Stay safe,
ROGER KIEFFER
Firefighter/Paramedic/TEMS Assistant Team Leader

OAK CREEK FIRE RESCUE
7000 S. 6th Street
Oak Creek, WI 53154

TEL: (414) 570-5630
CELL: (414) 659-2881
FAX: (414) 570-5631
rkieffer at oakcreekwi.org




-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Stuke, Lance E.
Sent: Friday, August 14, 2015 9:13 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Document request

Our medics routinely perform needle decompression. Similar to what's been mentioned before, about half don't even enter the thorax due to needle size. Additionally, I don't think the procedure is indicated in the vast majority of cases, but this is difficult to prove retrospectively in the hospital. One thing our medics are doing, which I totally agree with, is they have adopted the military/TCCC  policy- all trauma codes (unless isolated head trauma) get bilateral needle decompressions. We haven't tracked post-procedure empyema rates but this would make for an interesting study.

Lance

Lance Stuke, MD, MPH, FACS
Associate Program Director
LSU Department of Surgery
PHTLS - Associate Medical Director
New Orleans, LA

________________________________________
From: trauma-list-bounces at trauma.org [trauma-list-bounces at trauma.org] on behalf of Young, Regena [Regena.Young at erlanger.org]
Sent: Friday, August 14, 2015 8:29 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Document request

Failure rates of needle decompression are usually related to not having a Large enough bore needle/catheter &/long enough one.  In addition, securing the catheter so that it does not dislodge during transfer is a challenge.

As far as chest tubes go, it depends on the agency's policy & adequate training w/ medical director approval of pre-hospital providers inserting them.

For instance, our flight paramedics are trained to insert them where ground paramedics in this community are not.

Hope this helps.

Regena Young

Sent from Divide

On Aug 14, 2015 9:00:13 AM, Greg Chapman <chapmgre1 at gmail.com> wrote:

So the question at hand is in a open (sucking) chest wound what would work
best.   Some recent data from the military suggests that the application of
a non-vented chest seal (or three sided dressing that has malfunctioned) can actually do more harm than no care at all.  If you take a simple pneumothorax and turn it into a tension by placing an occlusive dressing have we provided good patient care?

Greg Chapman BS.,RRT, REMT-P
Director, Center for Prehospital Medicine Carolinas Medical Center Charlotte NC
704-526-7525

On Fri, Aug 14, 2015 at 8:41 AM, Charles Krin <cskrin2 at hughes.net> wrote:

> I don't know about McSwain's Dart, but I understand that the failure
> rate of needle decompression is rather high...through a combination of
> adverse anatomy and diagnostic problems.
>
> Chuck
>
> On 8/14/2015 07:20, Robert Smith wrote:
> > Is there  a difference in empyema rate or other complication rates
> > chest
> tube vs. needle decompression?
> >
> >
> > Robert F. Smith MD, MPH
> > Cook County Trauma (ret)
> >
> >> On Aug 14, 2015, at 7:03 AM, Charles Krin <cskrin2 at hughes.net> wrote:
> >>
> >> I agree with Larry, but also pointed out that it is NOT something
> >> US paramedics are routinely educated and trained to handle, nor
> >> something that generally falls under a paramedic scope of practice
> >> to the best of my knowledge.
> >>
> >> And as more military medics transition back to civilian life, it
> >> will be interesting to see how it affects the National Registry and
> >> other Paramedic certifying groups. It is nice that most of the
> >> military medics are now able to test for appropriate NR levels
> >> (something that was not directly available when I was enlisted back
> >> in the early 1980s), but medics and corpsmen have been able to do
> >> *many* more procedures than their civilian counterparts, at least on other military members.
> >>
> >> Chuck
> >>
> >>
>
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