Chest Seals

M

Mountainman

Super Moderator
Hi All,

I'm after getting some information from the medical fraternity on the use of Chest Seals. I don't want to get into the debate on 'well on my trauma course they said don't bother and just occlude it' etc etc, just useful info on Chest Seals if you've used them.

I've added a couple of headings to help.

Cheers
-=MM=-


 1-Has the profile of the chest seal valve for the Asherman ever been an issue or concern?

 2-Is there a concern with the Asherman valve collapsing or getting bent where it cannot function?

 3-Has there been any feedback on the necessity of the gauze that is included with various chest seals such as the Asherman or Hyfin?

4-Are there any packaging concerns?

 5-With the current products in the marketplace, are there likes/dislikes/improvement that could be made?

6-What are your opinions of the Bolin Chest Seal
 
MM,

I've always been issued with / used ACS rather than Bolin so I can't comment on one versus another.

This said, while the ACS is a nice piece of kit to have for whatever reason people seem to pilfer them and I've always been left with a DIY seal made from sterile kit packaging and black nasty on 3 sides. Always the bloody way.

ISD
 
Mountainman said:
Hi All,

I'm after getting some information from the medical fraternity on the use of Chest Seals. I don't want to get into the debate on 'well on my trauma course they said don't bother and just occlude it' etc etc, just useful info on Chest Seals if you've used them.

I've added a couple of headings to help.

Cheers
-=MM=-


1-Has the profile of the chest seal valve for the Asherman ever been an issue or concern?

2-Is there a concern with the Asherman valve collapsing or getting bent where it cannot function?

3-Has there been any feedback on the necessity of the gauze that is included with various chest seals such as the Asherman or Hyfin?

4-Are there any packaging concerns?

5-With the current products in the marketplace, are there likes/dislikes/improvement that could be made?

6-What are your opinions of the Bolin Chest Seal
Click to expand...

Here's a good article regarding a comparison between ACS vs Bolin Chest Seal

[URL]http://www.ncbi.nlm.nih.gov/pubmed/18589420[/URL]
 
The only problems I've experienced with the ACS is the sticky side not being very sticky. Easily combatted with ashed load of tape!
 
The ACS has just about been done away with with the US militry in afghanistan. they use the Bolin and the Hyfin with a 14g decompression needle.
From personal experience of using the ACS on a actual casualty was that the bloody thing didnt stick in place until i taped it down with lots of surgical tape. The other problem was that the casualties blood made the flutter valve stick together,
and thus inoperable.
The gauze swab just isnt sufficient enough if there is a lot of fluid present. So dont see the need for it myself, ive used dressings, paper towels etc to wipe the casualty prior to applying a seal. The adhesive properties of the hyfin and the Bolin are far superior to the ACS but they do stick to gloves as well!. The base patch of the Bolin is made from the same material as the Hyfin. This is thicker than the base of the ACS and sticks far better.
The main drawback of the Bolin is the packaging. It is the same standard as the ACS and is prone to damage from damp or wet conditions. It tears easily once wet.
If the Bolin chest seal was packaged the same as the hyfin, in a foil outer packet. Then it would have ticked the boxes as far as a pre hospital chest seal goes.
Im currently working as a Team medic in afghanistan and the Bolin and Hyfin are the only two chest seals that are available from US military supply. The ACS are been turned in by the US military medics for replacement. Both the Bolin and Hyfin are covered on the CLS course which i sat last year.
The ACS is only of use to correct a pneumothorax but the bolin is used for both haemothorax and pneumothorax.
The Hyfin is purely an occlusive dressing used in conjunction with a decompression needle.

kTM
 
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Cheers for that Kev, pretty much the same thoughts as I had having used the ACS & Bolin in Afghan. Have relayed comments to the interested party for their comments.

Thanks for everyones input and all stay safe.

-=MM=-
 
Mountainman said:
Hi All,

I'm after getting some information from the medical fraternity on the use of Chest Seals. I don't want to get into the debate on 'well on my trauma course they said don't bother and just occlude it' etc etc, just useful info on Chest Seals if you've used them.

I've added a couple of headings to help.

Cheers
-=MM=-


 1-Has the profile of the chest seal valve for the Asherman ever been an issue or concern?

 2-Is there a concern with the Asherman valve collapsing or getting bent where it cannot function?

 3-Has there been any feedback on the necessity of the gauze that is included with various chest seals such as the Asherman or Hyfin?

4-Are there any packaging concerns?

 5-With the current products in the marketplace, are there likes/dislikes/improvement that could be made?

6-What are your opinions of the Bolin Chest Seal
Click to expand...

1. Yes

2. Yes (especially on back wounds)

3. Yes (There is not enough)

4. Not really (Fairly well packaged but with bloody gloves and in limited light they can be difficult to open)

5. Yes (See below)

6. Bolin seal all the way

The chest seal obviously had its teething problems but now the military have had it for some time it is improving. I would pick the Bolin version over the original and now that it has the improved adhesive its for winners. Before they improved the adhesive we just robbed the Plastic Explosive adhesive tape (Stuff they use to stick it to walls etc) from the Dems lads, it worked a treat. The Dems adhesive tape was also good for covering open chest wounds even if there was fluids around the wound it would stick firm... And before anyone mentions it we didn't cover all the chest wounds, we would use a chest seal then cover the rest.
 
Last edited:
Just have to remember that the Asherman as with all the chest seals have actually been designed primarilly for application by Doctors / Physicians in the semi contriolled environment of an Accident and Emergency Department Resuscitation Room or Operating Theatre.

As such, they are never going to be perfect, but, if due care is applied in constantly checking the seal, then they do work and work well without much hastle.

One thing that people find is that when applying a chest seal, there can often be an amount of the red stuff around or the casualty is perspiring excessively. Two good additions to the trade tools in this situation where the seal is not going to adhere to the skin (apart from the gaffa tape) is:

1. Supa Glue applied to the seal and then wipe the skin and apply and it will stick very quickly.

2. an older method that has been used BUT and a very big BUT do not get this stuff near any broken skin and that is Tink Benze. It gets very sticky quickly, and with the heat out there, it will stick very quickly.

But Be Warned, Even with a hole in the chest, if Tink Benze gets into any open wound the casualty will get up, run for about 2 miles and all the time will be calling you names your mother would blush at lol.

again, its horses for courses
 
On this subject does anyone know where you can purchase Bolin seals at a good price in the UK. My sources say the MOD have just bought up an entire suppliers stock.
 
MisterBoop said:
On this subject does anyone know where you can purchase Bolin seals at a good price in the UK. My sources say the MOD have just bought up an entire suppliers stock.
Click to expand...

You cvan go direct to the manufacturer or try NHS Supplies in England or NHS Suplies Cymru Wales or NHS Suplies Scotland
 
you might be better ordering them from the US mate...

Chinook Medical Supplies
North American Tactical

I've just done a CLS course with US Mil here in Basra, and the Bolin is the mutts nuts and they no longer issue ACS in their IFAK's
 
Argyl
Just remember that each and every device has its pro's and Con's, and Whaqt the US Military recommend in one unit today may not be recommended in the same unit tommorrow. This is down to many factors, but you only need one senior person to start talking down a peice of equipment and suddenly everyone under them believes they are correct and that the particular peice of kit is not suitable.

As i have previously stated, you must bear in mind that these chest seals are primarily designed for application in a semi or fully controlled setting of a hospital. Therefor, it can be a bit like taking a two wheel drive car on a cross country route, sometimes it will be excellent, but on other times it may not function as it would on a metaled road.

Horses for Courses
 
KEVTHEMED said:
...the bolin is used for both haemothorax and pneumothorax.
kTM
Click to expand...

Kev,

Can you expand a bit on that please as I'm interested in how the Bolin can be used for a haemothorax in a pre hospital setting?

Also, with the seals, could you use one over both the entry and exit wounds, if both were in the chest?

Regards,

Peter
 
Hi MM,

Agree with the comments of Kev. I've only used the ACS once in anger. Single gunshot wound to the back that exited via the arm pit. The first thing i reached for (after the shears to assess the injury) was the ACS and found the following:

1. The gauze wasn't enough and I needed to crack open other more absorbant dressing (Time).
2. Even when dry (ish) the sticky side just slid around and wouldn't adhere.
3. Once secured in place, was effective to prevent further deterioration.
4. It would be handy if the ACS was supplied with another 'simple' occulusive dressing (without valve) for ease of access and use on any additional wounds. Whilst the packaging itself can be used, it requires more fiddling around with tape, which is time the casualty may not have.

Hope this helps.

Stay safe M4MED
 
PeteE said:
Kev,

Can you expand a bit on that please as I'm interested in how the Bolin can be used for a haemothorax in a pre hospital setting?

Also, with the seals, could you use one over both the entry and exit wounds, if both were in the chest?

Regards,

Peter
Click to expand...

The bolin has a dual valve assembly. The normal plastic flutter valve and then three rigid plastic grommits. Theses are to prevent the valve becoming sealed should blood get into the valve assembly.
In the treatment of a haemothorax the bolin is applied to the entry wound with the possible exit wound been sealed with a occlisive dressing or similar ie HYFIN chest seal. the casualty is then placed with the seal/injured side downwards. drainage of blood is facilitated via gravity. in a spontaneous breathing casualty the plastic flutter valve will seal the hole on inhalation.
The casualty should be encouraged to fully exhale before any seal is applied to evacuate as much air as possible from the pleural cavity.

hope this helps
KTM
Afghanistan
 
KEVTHEMED said:
The bolin has a dual valve assembly. The normal plastic flutter valve and then three rigid plastic grommits. Theses are to prevent the valve becoming sealed should blood get into the valve assembly.
In the treatment of a haemothorax the bolin is applied to the entry wound with the possible exit wound been sealed with a occlisive dressing or similar ie HYFIN chest seal. the casualty is then placed with the seal/injured side downwards. drainage of blood is facilitated via gravity. in a spontaneous breathing casualty the plastic flutter valve will seal the hole on inhalation.
The casualty should be encouraged to fully exhale before any seal is applied to evacuate as much air as possible from the pleural cavity.

hope this helps
KTM
Afghanistan
Click to expand...

Kev, Thanks for that, its very much appreciated!
 
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