In an active shooter/mass casualty incident, should you use a chest seal to treat an injury to the chest as a result of a gunshot?

An injury to the chest can be one of two problems, a breathing problem or a bleeding problem. You are concerned about a pneumothorax which is a breathing problem. Can be caused by any hole in the chest either from the inside such as a tear in the lung from a rib fracture after a blunt trauma to the chest.Can be caused by a hole created by a gunshot.

You can also have a bleeding problem, with massive bleeding from the lung after an open chest injury from a gunshot. The open injury and breathing problem is easily fixed with a chest seal and can by applied in the field. The closed pneumothorax is fixed in the hospital by making a hole, putting a chest tube in and connecting it to suction. 

The bleeding problem from a gunshot is more much more concerning since there can be massive blood loss and can only be fixed by a staple line across the lung injury in the operating room. So what if you seal the hole? The volume of blood can fill the chest cavity and push the heart and the great vessels to the other side and “Kink” the vessels and prevent blood flow , drop the blood pressure and perfusion of the head and other major organs. The dreaded “Tension Pneumothorax”. To treat this and relieve the tension, open the hole (Burp) that you sealed to release the pressure.

So why did you seal the hole in the first place. They need a surgeon in the operating room.So again I ask, why did you seal the hole in the first place? They need rapid evacuation to a higher level of care. 

Just a thought!