Abstract

Tactical Combat Casualty Care defines tension pneumothorax to be the second leading cause of preventable death on the battlefield.5 A tension pneumothorax occurs when there is a buildup of air within the pleural space due to a lung laceration caused by gunshot, stabbing, blunt force, or blast injury. This buildup of air causes the injured lung to collapse. Once the lung has collapsed, pressure begins to compress the heart and shift the mediastinum to the uninjured lung. All of which cause decreased cardiac output, decreased oxygenation, rapid deterioration, and death if not treated. This traumatic injury must be treated in the field in austere environments. To date there has been no developments that ensure needle decompression catheters remain in place. Tension Square has developed a propietary solution which we explore here.

Revolutionary Method for
Securing Needle Decompression Catheters

Tactical Combat Casualty Care defines tension pneumothorax to be the second leading cause of preventable death on the battlefield.5 A tension pneumothorax occurs when there is a buildup of air within the pleural space due to a lung laceration caused by gunshot, stabbing, blunt force, or blast injury. This buildup of air causes the injured lung to collapse. Once the lung has collapsed, pressure begins to compress the heart and shift the mediastinum to the uninjured lung. All of which cause decreased cardiac output, decreased oxygenation, rapid deterioration, and death if not treated. The treatment of such injury is by needle decompression. A 14- or 10-gauge needle is inserted through the chest wall into the pleural space to relieve the build up of air. This procedure stabilizes the patient until reach of a medical facility where a chest tube can be placed, and time will heal the lung. However, the issue with this procedure arises during continued treatment, packaging, and transport. Needle decompression continues to be the standard of treatment for tension pneumothoraces with the only shortcomings being kinking, plugging, and dislodgement.2

At this time, the standard method for securing the catheter used for needle decompression is with simple tape. Many issues arise from this securing method; including its ineffectiveness and disruption of treatment. The angiocatheter used for needle decompression can occlude causing reaccumulation of tension pneumothoraces and patient demise during military transport.1 Occlusion happens when the hub of the catheter bends over on itself causing kinking. This can happen when the catheter hub comes into contact with EKG wires, backboard straps, or the tape securing it becomes a hindrance. In a study done by the

Traditional methods of securing catheters can cause occlusion
of the catheter, rendering the treatment ineffective,
and endangering the patients health.

Canadian military, out of nineteen pneumothorax events five catheters failed.4 They visually observed bending/kinking of the angiocatheter, especially when straps were placed to secure the arms in the adducted position.4 Another study showed, when adult swine underwent needle decompression 83% failed due to kinking or dislodgement.7

Approximately 90% of combat related deaths occur prior to a casualty reaching a medical treatment facility.3 An article in the International Journal of Critical Illness and Injury Science suggest that catheter dislodgement and or kinking occurs during transport, particularly if the catheter is not secured.7 In any setting where a needle decompression system is being used, the patient and/or environment are often covered in blood, sweat, dirt or other various contaminants not conducive to simple tape. This type of austere environment, along with barriers to prehospital care such as logistical or combat related delays in treatment/evacuation, and lack of specialized medical equipment contribute to patient demise.3

Common practice for failed needle decompression due to kinking, clogging, and displacement is to reattempt the procedure.2 Multiple attempts may need to be performed in order to reach patient stability. Not only does repeating the procedure cause more harm to the patient by increasing the risk or procedural complications, but it also causes valuable time to be wasted. The Platinum 10 was developed by tactical combat casualty care as a standard of patient viability. The Platinum 10 is the maximum amount of time in minutes that should be spent on scene of a trauma.6
Patient viability should not be compromised due
to inability to secure a life saving treatment.

The simple and effective design of TensionSquare ensures
that needle decompression catheters remain free of occlusions and kinks.

The TensionSquare is an adhesive based stabilization device designed to secure a chest decompression catheter after a needle decompression of a tension pneumothorax. The TensionSquare utilizes a uniquely designed silicone retention grommet to keep the hub of the catheter in place and free from kinking to eliminate occlusion and dislodgement. With the catheter in place and free from occlusion during rapid extrication/ evacuation and transport, the needle decompression treatment remains effective. The need for repeated procedures is eliminated, subsequently preventing patient demise. Tested against the standard tape method, the TensionSquare withstood against EKG wires, backboard straps, and CPR every time. The specialized adhesive on the TensionSquare is designed to maintain its adhesive properties in an austere environment where blood, sweat dirt, and other contaminants are present.

With a simple 4 step process, the TensionSquare is easily deployable by one person; saving valuable time and resources to be used elsewhere. A perfect conjunction to the principles established by the Platinum 10 method. An underlying 10 by 15 millimeter adhesive free section along the left side of the device facilitates an easy handling experience during placement. Priced at eight dollars a unit, the TensionSquare is a priceless lifesaving asset.

Whether transporting via air, ground, or sea, the TensionSquare fits seamlessly under a large variety of patient anchoring systems. Measuring 60 by 70 millimeters, the TensionSquare allows the anchoring systems to be placed appropriately without having to compromise patient safety by modifying strap placement; all while the decompression catheter remains accessible and secure. Weighing 13.3 grams with packaging,
the TensionSquare effortlessly fits in uniform
pockets of military personnel.

Tension Square, LLC conducted testing at a regional trauma center, resource hospital, schools, and local Fire/EMS departments with a variety of surgeons, ICU staff, physicians, paramedics, nurses, and EMS personnel. All agree that the TensionSquare is a vital asset to the prehospital care provider and more importantly, to the patients they care for. It was the consensus that the TensionSquare is a substantial improvement over the current ineffective method.

Needle decompression catheters have been helping save lives for years. Emergency medicine and prehospital care would not be the same without them. The crucial lack of stability during patient movement in combat situations, has been this treatment’s only shortcoming. However, when paired with the Tension Square this weakness is eliminated. The Tension Square will revolutionize combat medicine by decreasing the battlefield mortality rate and increasing the warfighters chance to reunite with his or her loved ones.

References

1. Beckett, A., Savage, E., Pannell, D.,
Et all; (November 2011). Needle Decompression for Tension Pneumothorax in Tactical Combat Casualty Care: Do Catheters Placed in the Midaxillary Line Kink More Often Than Those in the Midclavicular Line? Journal of Trauma: Injury, Infection, and Critical Care 71(5). S408-S412. doi: 10.1097/TA.0b013e318232e558
2. Jones, R. & Hollingsworth, J. (August 20, 2001). Tension Pneumothoraces not Responding to Needle Thoracentesis. Emergency Medicine Journal, 19(2), 176-177. http://dx.doi.org/10.1136/emj.19.2.176
3. Kotwal, Russ S., Montgomery, Harold R., and Bari M. Kotwal. (August 15, 2011). Eliminating Preventable Death on the Battlefield. JAMA Surgery. 146(12), 1350-1358. doi:10.1001/archsurg.2011.213.
4. Moy, Hawnwan P., (February 5, 2015). Evidence-Based EMS: Needle Decompression. EMS World. Retrieved from: https://www.emsworld.com/article/12041960/what-s-the-best-site-for-needle-decompression
5. NAMET. (2009). Introduction to Tactical Combat Casualty Care [PDF document]. Retrieved from: http://www.naemt.org/Education/IGa%20Intro%20to%20TCCC%20with%20Notes%202-17-09.pdf
6. Watson, Len. The Platinum Ten [PDF document]. ResQmed: http://www.resqmed.com/GoldenHourPlatinum10.pdf
7. Wernick B, Hon HH, Mubang RN, et al. (July 2015). Complications of needle thoracostomy: A comprehensive clinical review. International Journal of Critical Illness and Injury Science. 25(3), 160-169.
Video Links
TensionSquare application:
https://vimeo.com/288099094
TensionSquare VS standard tape:
https://vimeo.com/291195473