Ep 56: Learning From Battlefield Trauma
Episode 56
Published Oct 23, 2023
Last updated Feb 18, 2026
Duration: 39:50
Episode Summary
Today, our discussion centers around the invaluable medical insights gleaned from battlefield experiences and how we can adapt these lessons to enhance survival rates in active shooter scenarios.
Episode Notes
NEW! Watch this show on YouTube at https://youtube.com/live/t2Qhoz7WTg4
Bill Godfrey, Jill McElwee, and Ron Otterbacher discuss valuable medical insights from battlefield experiences which can be applied to active shooter scenarios. The trio takes a deep dive with easy to understand explanations about the value of using the military’s BATH assessment technique and the mechanics of tension pneumothorax, how it can kill, how you can fix it, and how to know the difference.
Whether you’re a responder with little medical training or a paramedic, you don’t want to miss this discussion! Knowing these things and the differences between them can help you save lives!
Transcript
Bill Godfrey:Welcome to the…that's a way to start. Welcome to the Active Shooter Incident Management podcast. My name is Bill Godfrey your podcast host, and on good days I can actually speak the good king's English. I'm joined by two of our fantastic C3 Pathways instructors, Jill McElwee and Ron Otterbacher. Thank you guys for being back in the studio.
Ron Otterbacher:
Thanks for having us.
Jill McElwee:
Oh, thanks for having us.
Bill Godfrey:
Yeah, so today we are going to talk about medical lessons learned from the battlefield and things that we can apply in the active shooter environment to hopefully save some additional lives. There's a lot of very brave men and women in our military that have served our country well and in some cases lost lives. And the medical practices in the military that study those fatalities have really learned some things that make big differences. And I think we would all agree if we fail to put that information to good use, then shame on us.
Ron Otterbacher:
Absolutely.
Bill Godfrey:
And so we're going to talk about two things specifically today, A focused assessment, a special assessment that's been designed for these traumatic events. Now it was adopted from the military for battlefield stuff, but in this case, penetrating injuries it makes sense, called BATH. The acronym stands for bleeding, airway, tension pneumothorax and Hypothermia. And they're done in that order for survivability. And then I also, once we kind of talk through that, I'd like to spend a little bit of time talking specifically about tension pneumothorax, some of the mechanics behind that and why that's one of the things that we can actually make pretty substantial difference on it. So let me lay out the BATH for everybody real quick.
I think when the three of us all went to paramedic school, it was a head to toe assessment. Even the trauma assessments that we were taught in BTLS and PHTLS were still head to toe assessments. This one is not. The first thing we look for is major bleeding. And we start by sweeping the legs front and back because the legs have the biggest vessels, and they're the most likely to have a point of controllable bleeding. We then move to the neck, obviously gunshot wounds to the neck could be particularly bad. Control that bleeding, sweep the arms, then the chest and the abdomen and then the back, and that's all done just looking for bleeding so that if we can discover any holes, major bleeding, you're actually using your fingers to rake down the body, looking for any holes or anything like that or coming up with any blood.
So after we check for bleeding, then we check the airway, not only looking, do they actually have an open airway, is there anything obstructing the airway? If they've had, for instance, a gunshot wound to the head or facial trauma, we may have some traumatic injury to the airway that needs to be taken care of. Then of course, tension pneumo. And lastly, hypothermia, which I think we ought to talk a little bit because that's one that really surprised me. And Ron, I know it was for you as well. So who wants to start off and just kind of talk about why we're doing things in that order? And I mean, we don't need to quote the studies, but what was the major lesson that we learned from the military on this stuff?
Ron Otterbacher:
Again, as a country, we've done well at taking the lessons from the military, whether it be from Vietnam War and the progression we made in medical service from that era. And then we'd take a look at the Iraq War and the Afghanistan War and even Kuwait, we've changed the way that we treat these type of injuries because of the lessons learned in the battlefield. They adapted over there, and they found out what was more successful than maybe the way we did it in the civilian world. And understanding how their medical training goes in military, a lot of that is spent in civilian hospitals learning in big cities that have a lot of trauma to learn how to best treat these type of injuries. Then they took it over the battlefield and tried all those methods, and then they had to adapt on their own from there.
So I think that's what we've done good as a country is we've taken the lessons learned there. And they brought those lessons back to teach us again, giving back to community. And they help enable us to do a better job of treating the same type of injuries on the streets of Atlanta or Chicago or any city in the United States as they would have over in Afghanistan or Iraq.
Bill Godfrey:
That makes perfect sense. Now, Jill, you, in addition to being a paramedic, you are a trauma nurse and worked in a trauma center for quite a few years. Walk through, if you can, just at a high level, the mechanics of why getting that bleeding controlled before we mess with the other stuff is such a priority.
Jill McElwee:
Yeah, so trauma with bleeding has followed other medical components such as cardiac. I think all of us have our CPR card and we learned that, and those are just in lay rescuers. It was the ABCs of CPR. We learned airway, we open that airway first. Then we high five our partner, then we go on to breathing and then finally circulation. Well, the lessons learned, Ron was spot on. We have unfortunately learned a lot of lessons on the battlefield that the circulation of blood, when we talk about breathing, and I'll try to keep a high level. Circulating blood, well what is blood? Those red blood cells are the little transport trucks of oxygen. So if we want to maintain and when the bleeding has stopped or in our situation for trauma, if the blood is not where it's supposed to be which is in the vessels where it can be absorbed, and all of those red blood cells that are loaded with oxygen, that's their job.
If instead of being in the vessels, if they're either in a cavity, which is back to your point on why we start with the legs, if they're either out of the vessels and within a cavity or on the floor, they're not circulating any oxygen. So we have found that by stopping that bleeding first, by stopping the flow of that blood, maintain that blood where it's supposed to be, we have a higher chance of saving the injured person's life by maintaining that blood flow. We only have about 10 units of blood circulating at any time in our body. So as long as if that heart's still pumping but it's pumping that blood where it's not supposed to be, then that's a problem. Then we're not going to... The survivability is less. So bleeding has moved once we have found success by putting priority on bleeding. And this BATH assessment is phenomenal in the fact that it identifies those things we can fix fast, the items where we can have a positive impact.
When we're looking at a penetrating wound, a penetrating injury that potentially anything penetrating is going to open both blood vessels and tissue. And if the tissues either letting blood out of where it's supposed to be or letting air in and blood in where it's not supposed to be, that's where our patients, the mortality rate raises dramatically. But there are things we can do to fix that. And so that's what the BATH patient assessment does. It gives us a very fast, rapid, and systemic assessment tool so that we can have a positive impact on the patients.
Bill Godfrey:
I was stunned. And I unfortunately don't have it memorized well enough to quote it, but I was stunned when we looked at the data with Landon and we saw how much difference it made in survivability just in eliminating the blood loss a little bit. To get that femoral artery to stop bleeding 30 seconds earlier than you did, had this huge difference. And it wasn't even a ton of blood. I mean, every pint that got lost had this horrible deleterious effect in the survivability ratings. And so sweeping those areas that are the biggest potential losers of blood to get that blood loss under control immediately was one of the most significant findings from all of those military studies and more so than the airway because at the end of the day, you could spend three minutes, four minutes to fix the airway, but if they had a femoral artery bleed or they've lost their leg, they're already done.
So it makes sense in that aspect, but it's so easy to overlook. I am not aware of any other civilian variants of the BATH assessment based on the medical lessons learned that are in use and practice. There may be some, but I'm not aware of any. Do either of you know any?
Ron Otterbacher:
No. And I think the key is when you talked about sweeping, Bath assessments are aggressive physical assessment. We may be used to the way we learn we're feeling, but we're not being. This is an aggressive sweeping, we're using tips of our fingers. If we can't see a hole, we may feel a hole. And because of the situation, because of bleeding associated with it and stuff like that, it's changed the way we look at patients and the way we assess them. I remember the first time I did a BATH assessment, and I was rightfully coached, Hey, you got to get in there, and it's just this full contact sport. But I learned so much from it.
Bill Godfrey:
Yeah, I remember Landon yelling at me a lot to get it right, and I always struggled to remember. I knew legs come first, but I used to mix up neck and arms, and it just drove him nuts. He's like, I've told you this, and then it kind of got fun to do it.
Jill McElwee:
You think it's of cavities. And our legs, our upper legs, they can hold a lot of blood before we know it, before we realize it. And Ron's right. This isn't a sweet sweep. This is through the clothes. We're not taking time using your trauma shears that we all had mounted on our sides when we were new medics. We're just on top of the clothes doing a deep sweep. You can also tell a difference if this right leg where the penetrating wound is, it kind of feels larger than the left leg, then we know to ourselves that there's blood not where it's supposed to be, and the patient has a loss of blood.
Ron Otterbacher:
And if they're conscious, they'll let you know.
Bill Godfrey:
Oh yeah, that was the other. You want them to have a communication with you while they're still conscious. It was interesting training to say the least. So let's talk a little bit about airway. So in airway, we're looking for a number of things. It's not just do they have an open airway, but we're looking for a number of visual indications of trouble. Walk through some of the things that you want to look for on a quick airway assessment when you're working down the BATH.
Jill McElwee:
So you want the airway to be open first. And so when you first are doing your BATH, say, Hey, if they're conscious of you, then we're check. We're going to maintain that conversation as long as we can. But when you have an unconscious patient where they aren't letting you know that their airway is open, then you're going to want to make sure that you've gotten that airway open. Because once that loss of blood happens and they drift off into unconsciousness, there could be a lack of the ability to maintain that. And it's a simple mechanical movement that we can do for this person opening that airway. And that may be all it takes.
Bill Godfrey:
Yeah, I think you want to grab a hold of the jaw do a visual inspection, especially if they've had any kind of head injury or facial trauma. Make sure that that's not an issue. And also you want to look at the trachea position. Is it shifted?
Ron Otterbacher:
Deviation.
Bill Godfrey:
Yeah, which by the way, it doesn't mean you do or don't have a tension pneumo. I mean there's a lot of reasons why that stuff can shift around or not, but you at least want to pay attention to it.
Jill McElwee:
But definitely if you see that, that's a later sign. So if during your airway, you see a shifted trachea, then you have led yourself right into the third component after airway.
Bill Godfrey:
And the reverse of that is true as well. You do the initial assessment and the airways fine, and three or four minutes later you notice that they've gotten some difficulty breathing, and it is deviated. I think the FBI calls that a clue. So the checking for blood loss, quick check of the airway. Next thing is tension pneumo.
Jill McElwee:
Right.
Bill Godfrey:
Why?
Jill McElwee:
Because that is deadly, but we can fix it fast. It's just that simple. Penetrating wound to the chest. When we're looking at truncal injuries, if that truncal injury is a penetrating wound to the chest, well, that penetrating wound may or may not. It's likely if it hasn't yet, it typically will introduce air and/or blood into that opening. And we talked on our earlier podcast, we said something about how neat our thorax is designed in that everything has a place, and there's very little room. I mean, when we take a breath in, we've got some room there, but once you get an enormous amount of air or blood into that thoracic cavity, and if it's pushing the lungs over, what's a beautiful muscle that sits right between our lungs is a heart.
When we start pressing on that heart, then we really are moving into a slippery slope that is a fast downhill slope. So removing that air, preventing air from even entering that cavity or that space initially, that's number one. But we want to make sure that a penetrating wound in the airway of the center of our chest in the trunk is addressed, that we've made sure. That's something that we can fix fast before it gets on that slippery slope.
Bill Godfrey:
So tension pneumos are also one of the documented causes of fatalities in civilian active shooter events. And in some cases, they may have been potentially survivable injuries. They had a tension pneumo, but no other major organs were hit. Had it been recognized and caught earlier enough, might've been a potentially survivable injury. So it's an...
Jill McElwee:
Frustrating.
Bill Godfrey:
Important one to stay on top of. And I want to come back to that discussion of tension pneumo and chest seals. But let's go ahead and finish this out with hypothermia, which I just was almost laughing when it was originally.
Jill McElwee:
You thought it was a typo, didn't you?
Bill Godfrey:
I thought this cannot be serious. Why in a trauma event are we worrying about hypothermia? And Ron, you were there with me in the same training class. We had our heads corrected very quickly. But let's talk a little bit about why that actually matters so much in trauma.
Ron Otterbacher:
Because it causes the rest of your body to have to respond to it. I know from, I do a lot of fasting now, and I find myself even on a summer night, I may have to have two blankets on. My whole body's trying to respond to the fact that I'm getting cold. It's the same way with them, with their blood loss and everything else, they're automatically going into that. And I couldn't understand. They said, yeah, in the middle of the desert, we turn the heater up in the box as high as it'll go, and we're transporting with as much heat. And being a Florida boy, I'm sitting back saying, no, I'm transporting with them much air conditioning.
Bill Godfrey:
Exactly.
Ron Otterbacher:
Again, not understanding that.
Bill Godfrey:
That's right.
Ron Otterbacher:
We learned from our experiences, and this was one of the wake-up calls that I got that said never even crossed my mind, nor was it ever taught to me until the recent times where they came back from the battlefield injuries that they were experiencing in the Middle East. And then you sit back and say, yeah, that makes perfect sense. I was just too dumb to realize it.
Bill Godfrey:
And I had the exact same experience sitting right next to you as Landon made it very clear that he was damn serious about this. And then he started walking through the numbers and the mechanics of it, and you have this holy crap moment. The blood is part of the system for maintaining heat in our body and moving heat around the body more importantly. And so as we begin to get blood loss, we lose the ability to maintain that heat. And you think, well, okay, what's the big deal? Because in some cases, to save people's lives, we put them in hypothermia. But there's a number of physiological changes that occur within the body. Chemistry changes. And I'm not even going to attempt to go down that road because chemistry was one of the subjects I struggled with just a little bit in college. But there's some significant changes that occur.
And just getting a half a degree or a degree of hypothermia had a very significant impact on mortality, they could have lost the blood. But if you kept them warm, if you stopped the bleeding and kept them warm, their survival rate went up dramatically. And you looked at the number, the numbers were stunning. We're not talking about two or three people. We're talking about hundreds. Hundreds of these things that they had that showed how important it is which like you, Ron, I mean, I did my career in Florida. And I don't think I transported any trauma patients in the heat. In fact, back in the day, we would give them a bag of ringers or a bag of saline, and we were further making them more hypothermic. We didn't know what we didn't know back then. So I think that this is one of the really, really important lessons is we need to keep them warm. And we need to be aware of that, not only in that initial care phase, but also in the transport phase I think.
Ron Otterbacher:
Absolutely. You realize how the body reacts. And I go back again to personal experiences. When I had sepsis, I went into a hypothermic state. My body was reacting to the poison within my body, and it took it all down. So then you realize that there are things you've got to do to bring it back up. And that's one of the first signs and symptoms they look at in sepsis is are you hypothermic? And it's not because I'm out in the cold, it's just your body is reacting differently.
Jill McElwee:
When we think about just body temperature, is 98.6 normal. How many people put their thermostat even anywhere close to that, right? No, we're not.
Bill Godfrey:
Are you kidding?
Jill McElwee:
Exactly.
Bill Godfrey:
The fire service, it was a meat locker. You could hang.
Jill McElwee:
Oh, definitely. Yes.
Bill Godfrey:
Cold. Cold.
Jill McElwee:
Yeah, ridiculously cold I believe is the term I used for 30 years. But yeah, so now most of our standard operating guidelines in pre-hospital EMS, we have warmers in the back of our rigs. We are giving warm fluids to your point, because if our rig's 72 degrees in the back of our rig, guess what temperature the fluids were? So we're introducing a 20-plus degree, and that's my worst math. Never do math in public, so I'm going to keep it. It's at least 20 degrees less than what normal body temperature is. So you know that already we're doing damage, and that blood loss. Blood is absolutely, you hit it, it is a thermal regulator. So as it crosses through that magic spot in the back of our skull that regulates temperature, it's maintaining that. And any loss of blood, you are losing the ability to regulate. It's just the simple loss of that blood flow causes that regulation to be hampered. And again, I keep going back to, but that's something we can fix.
Bill Godfrey:
Exactly.
Jill McElwee:
That's it. We can address that. And to that study that shows the increased survivability by introducing these simple measures, it cannot be ignored.
Bill Godfrey:
No, no.
Jill McElwee:
And especially when we have the ability in the field in pre-hospital setting in most of our communities to fix most of these.
Bill Godfrey:
And I mean to say it's conclusive, there were numbers before they did it and the fatality rates. And then there were numbers after that. And I mean, it's just incontrovertible evidence that that matters. All right. So I'm going to take this from the top. Then we're going to look at tension. So the BATH assessment, we're going to check for bleeding first. We're going to hit the legs, front and back of the legs sweeping with our fingers, feeling for holes, looking for holes. Then we're going to check the neck, being real careful to get down into the clavicle area, especially sweeping if it's a police officer that's got a vest or body armor on sweeping underneath that. There's been a number of incidents where they've gotten shot there. So checking the neck then... Go ahead.
Jill McElwee:
Bill, let me say something about sweeping. Put yourself in the position that we'll be doing this assessment. This is not someone that has no blood flow. I mean, like us that has no external blood flow right now. We're talking about potentially sweeping where there is blood there. We know they're bleeding from somewhere. So this assessment has to be very focused, and your gloves are going to have blood on them, but recognizing is this new blood, is this new blood flow. So this sweep isn't a clean, sterile environment. You're assessing where all, is probably what we should say, could they be bleeding from. Where all are they bleeding from?
Bill Godfrey:
Sure. So we're going to sweep the legs front and back. We're going to check the neck, including if you need to just under the body armor for law enforcement. Then we're going to check the arms, then the chest and abdomen, and then roll up and check on the back. And so that's going to be our bleeding sweep. Quick check of the airway, quick check to see whether we've got tension pneumo, and then address any hypothermia. So then we're going to, I want to switch gears and talk a little bit about the physiology of tension pneumo and some of the anatomical structures. And we thought about doing some drawings and diagrams, but a lot of people listen to our podcasts on audio only. So I was trying to figure out how best to explain this in a way that people can picture it in their mind's eye.
So for your lung, imagine a simple balloon. And we filled the balloon up, and that balloon is your lung. Now I want you to take a second balloon. And we're going to put the first balloon that is your lung, and we're going to put it inside of the second balloon. Your muscles that cause your chest to expand and open your lung to bring air in never touch the inside balloon. They're not allowed to touch the lung. They touch the outside balloon, but there's no airspace between the outside balloon and the inside balloon. So when you pull the outside balloon open, it draws air into the inside balloon because it's essentially a vacuum between those two spaces, almost like they're attached with a little bit of glue or tape or something. So you're grabbing the outside balloon and you're pulling it open, and it is pulling open the inside balloon to draw air in.
Okay, now you get shot. And it goes through the skin, through the tissue, through the outside balloon, through the inside balloon. Now we got a problem. So any air in the lung, any air that was in the inside balloon can immediately escape into the chest cavity, but it can escape into the part between the two balloons. So it can escape into that part between the inside balloon and the outside balloon. It can escape out the hole. It can do a number of things. The tension pneumo is what happens when we continue to pull on the outside balloon to do the breathing mechanics. So your chest pumps open, and pulls on the outside balloon. And it's pulling air through the inside balloon but there's that hole. And that air comes right out of the hole and goes into the space between the two balloons. And so now we're not pulling the inside balloon all the way open.
And if that air gets trapped in there, it begins to push and collapse the inside balloon. And every breath you take makes it worse until ultimately that space between the inside balloon and the outside balloon that's not supposed to have any air, has not only air, but it has air under pressure that has completely collapsed the lung and is pushing it across the other side of the chest, putting pressure on the heart, putting pressure on the other lung until the point where your body simply can't survive. You can't move any air, and it becomes a fatal injury.
So that's my best effort for trying to verbally explain the mechanics of the lung and the breathing mechanics. Now what can happen with the hole through the outside of the body is a couple different things obviously. We can have a hole that goes through and then it seals up right behind it, and no air passes. We can have a hole and every time you breathe and you're pulling the outside balloon, it's sucking air into the hole. You could also have a pressurized, so when you've got air coming from the inside balloon and it's in the space where it's not supposed to be, when you exhale, you can get air that's being pushed out of the hole.
So we could have no air moving through the hole. We could have air going in but not coming out. We can have air going out but not coming in. We can have air going both ways through the hole. Chest seals, why do we use them? And what's the purpose? It is to keep air from going in but not keep air from coming out.
Jill McElwee:
Bold, and repeat that for that bold point. Yes.
Bill Godfrey:
Hit it again.
Jill McElwee:
Yeah, it is for sure. So people are often afraid to do anything when it relates to air to the lungs. We're always like, oh, well, that's a high level skill. It's not that. It's nothing we should be afraid of in this setting, in an active shooter incident where we have got penetrating wounds to the thorax, a chest seal, a simple chest seal that is monitored. If it is not flappable, then we monitor that, and we can release it because it has got to be able to stop air, any additional air from going in, doing exactly what you said, putting that pressure on in the lung, pushing it over to the heart, but it has to be able to let air out. And simple patient assessment will let you know when it's time. If air has built up, it needs to be released, if the only thing you have is a non-occlusive dressing, then you may need to manually. So if it doesn't mechanically release by the type of chest seal that you have, then you manually can release that.
Bill Godfrey:
Yeah, and I'm going to take that a step further, Jill, because I really want to keep this simple because chest seals get over complicated. So you can buy commercial chest seals that have one way valves in them and all that other kind of stuff, and they're great, some of them better than others, but fine. I want you to think of a chest seal this way, for those of you listening. Grab a plastic Walmart shopping bag.
Put it over the hole, and tape it on three sides, not four sides, three sides. So that if they suck in the plastic gets sucked down against the hole and doesn't let any air in. But if air tries to come out under pressure, it can push up against the plastic, and come out the sides you didn't tape. It is that simple.
Jill McElwee:
Absolutely.
Bill Godfrey:
Oozing, yeah. It's very little, and it's typically not going to interfere with what you're trying to do. But understand very clearly the purpose of a chest seal is not to control the bleeding. It's to control the air and not the air coming out, keeping air from going in. That's all we're trying to do. It's all we're trying to do. So now in the case of tension, pneumo, what we haven't talked about is a needle decompression. And since we've laid the groundwork for this, I want to talk through the mechanics of that. So Jill, talk a little bit about if we have, let's assume obviously we've had a penetrating injury. And there is no air coming out. No air is coming out. Why do we need to do the needle decompression? What's the value of it and what good does it do for the patient?
Jill McElwee:
So the needle decompression, and you described it perfectly earlier when you said how air could go in but not come out, and it could come from inside with the two balloon example that you used. When air is built up within that cavity, it's not an open, and possibly we've addressed it with our seal and maybe that opening we haven't noticed hasn't allowed air to go out, whatever the reason, the patient's not going to have a billboard that says, I have tension pneumo. You're going to have to recognize that the patient's breathing has gotten very rapid, very labored. If they reach a point and can tell you if they're conscious, they have an enormous amount of pain, sharp, very targeted pain. We may notice in the unconscious a deviated septum.
Bill Godfrey:
Deviated trachea, you mean?
Jill McElwee:
Septum, sorry. Trachea, thank you.
Bill Godfrey:
I have the deviated septum.
Jill McElwee:
Yeah, where did septum come from?
Bill Godfrey:
That's all right.
Jill McElwee:
Deviated trachea.
Bill Godfrey:
I meant what you knew.
Jill McElwee:
I was testing you guys. Good job. You passed, Bill. So then the needle decompression is simply 14 or 16 gauge. So this isn't something that a civilian is going to carry around with them, but we have. So in pre-hospital EMS we just introduce a needle with a catheter because that is akin to a straw, something that we can allow air to escape out of. So it's a sterile... It looks bigger but when I say it's not a large opening because it's very small compared to the chest tube that this person is going to get when they come to the trauma center. So the needle that we're using, very small, we introduce that right in that second intercostal space. And then we valve that over because very much like you talked about with the chest seals, then we're going to put a little valve if it's the end of our glove or whatever to allow air out but not back in. So it's a means with which to provide an outlet for the air from that plural cavity from the chest.
Bill Godfrey:
Yeah. So I think that is a perfect description of the process. And what I also want to make clear to folks, because it can seem like a little bit of black magic, it's not. I mentioned the inside balloon and the outside balloon. So when you get that airspace between those two balloons where it ain't supposed to be, we're trying to get the needle into that space and allow that air under pressure to depressurize and come out. What it does not do is draw out all the air. It doesn't reinflate the lung. It doesn't do all of that. It takes a tension pneumothorax, a lung that's being collapsed under pressure, and it removes the pressure so that you have what we call a simple pneumothorax, which is just a collapsed lung. So the lung is still collapsed, they're still critical.
Jill McElwee:
We're not going to fix that in field.
Bill Godfrey:
We are not going to fix it in the field. We can get rid of the pressure. We can get rid of that pressure that's built up and resolve the tension, which may well give them the time, the 10, 15 minutes to get in front of a surgeon, get a chest tube and begin to get that reinflated. But it's not one of those things that can wait. I mean, Ron, because it's been suggested by some people that chest seals are managing that component of it should wait until the transport phase. I know it's been a minute since you've dealt with penetrating trauma in the day, but you're one of the few people I know that's actually shot somebody and then turned around and had to be the medic taking care of them. Could you imagine somebody with a penetrating wound to the chest that's developing a tension pneumo and saying you're going to wait till transport?
Ron Otterbacher:
The one thing I tell everyone to think about, have you ever had trouble breathing? And if you've had trouble breathing, how much time can you let go by before you address it? And I don't care if it's just you were coughing too much and you started to lose your breath. Once you can't breathe, your body tells you, hey buddy, we got a problem here and I need to address it now. It's a right now, right now problem.
Bill Godfrey:
Yeah, absolutely.
Jill McElwee:
Whoever said that is spoken by someone who's obviously never had a penetrating wound that has caused a tension pneumothorax because it can be fixed right now. And it should be because it is excruciatingly painful for one, and it's deadly. More so than the painful, it's deadly.
Bill Godfrey:
Absolutely. So I hope that that conversation, that was a way more technical dive than we normally do in these podcasts. But I kind of felt like this discussion about the lessons learned from the battlefield and using this BATH assessment went right hand in hand with talking about tension pneumos because it is a unique animal. And you can get somebody get shot in the chest. They can have a simple pneumothorax, which means that they get air in between the two balloons, but other than the lung collapsing a little bit, it's still working. You can have a hemothorax where you don't get any air in there, but you get blood in there. Same difference. You're trying to pull on the outside balloon and the inside balloon is collapsed. There's blood in the space, or you can have a hemopneumo, which is air and blood mixed into it, but just the tension pneumo is the one where we've got to be really concerned about it.
Ron Otterbacher:
And I think as we expand on this, we've gone through a bunch, we talked about the BATH assessment, feeling for bleeding, trying to identify. Okay, we identify bleeding, now what do we do? What is our best method to stop the bleeding in that particular area? Is a tourniquet the best? Oftentimes it is. Wound packing, is that an option? Maybe it is. Maybe direct pressure, but as we go through this, okay, we found it. Now what do we do? And that's the key thing. And again, it may not be a trained medic. It may be a cop on the street that has everybody go down. And they find, okay, I'm bleeding here. What do I do?
Bill Godfrey:
Get some plastic over it.
Ron Otterbacher:
Absolutely. Whatever we can do.
Bill Godfrey:
Get some plastic over it, and slap some tape on three sides.
Ron Otterbacher:
Three sides.
Bill Godfrey:
And let a medic know. Because that's a right now right now problem. Right now, right now.
Jill McElwee:
It's fixable.
Bill Godfrey:
And it's fixable.
Jill McElwee:
Absolutely.
Bill Godfrey:
And can save a life.
Jill McElwee:
It's one of those fixable things that when you see it work, you'll be ready to do it even faster the next time because it is a rapid improvement in the patient. The patient feels it almost immediately.
Bill Godfrey:
It absolutely is. All right. Well, I think that we are, I'm getting a signal from Carla that we are on our 30 minutes. And so I want to thank you guys for coming in.
Ron Otterbacher:
It goes fast, doesn't it?
Jill McElwee:
It does. And so I thought we were going to talk about deviated septum’s later. We can do that maybe on another podcast.
Bill Godfrey:
Yeah, we can talk about that over frosted beverages.
Ron Otterbacher:
Talk about our allergies and...
Jill McElwee:
Apparently, I'm ready for one. Let's go.
Bill Godfrey:
Oh, that's okay. That's actually why the cameras are set up on an angle so they don't catch up my deviated septum here. You sound nasally. Oh, if you only knew. That sucker's about 40 degrees out of whack. Jill, Ron, thank you so much for coming in today and doing this. And Carla, thank you. Carla Torres, our producer here on the podcast. If you have not subscribed to the podcast, please do so and please share it with the people that you work with and encourage people to kind of do this. If you have questions for us, by all means send in the questions. You can send the questions to info@c3pathways.com. Again, that's info@c3pathways.com. And just let us know it's a podcast question. We'll get it out and give it some discussion. Thank you again for coming in. Thank you for listening. And until next time, stay safe.