From Battlefield to Bystander: Bringing Chest Seals to Civilian Care
- Craig Hall
- Sep 28
- 6 min read
Gun violence continues to be a grave public health crisis across the United States, and recent events only reinforce how urgently we need to equip communities with lifesaving knowledge. On September 28, 2025, a gunman rammed a vehicle into a church in Grand Blanc, Michigan, then opened fire on worshippers and set the building ablaze, killing at least four people and wounding eight more. This tragic incident is just one of many mass shootings this year, underscoring the reality that more and more civilians may find themselves first on scene in moments of catastrophic injury.
Here in Philadelphia, we see the toll of violence up close. So far this year, the city has recorded 745 shooting victims. To help address this growing crisis, we recently hosted a Stop the Bleed training at a local community event. Stop the Bleed teaches nonmedical bystanders how to manage severe bleeding using direct pressure, tourniquets, and wound packing.
I believe Stop the Bleed is powerful because it brings critical medical knowledge into the hands of everyday people who could arrive before 911 responders. But there is one skill I believe most civilians should also know yet it is rarely included in training programs: chest seals or occulsive dressings.
Why Chest Seals/OCCULSIVE Dressing Matter
Trauma is the leading cause of death in people aged 1 to 44, and hemorrhage Hemorrhage is responsible for 30 to 40% of trauma mortality, and of these deaths, 33 to 56% occur during the prehospital period. Stopping bleeding is undeniably lifesaving, but intentional trauma such as assaults or shootings behaves differently than accidental trauma.
In accidental injuries, extremities such as arms or legs are commonly wounded, for example cutting a finger while cooking. Intentional trauma often involves more lethal targeting, such as shots to the chest, head, or neck that threaten vital organs. Studies show that in Active Shooter/Hostile events, many fatalities result from chest and head injuries.
It is important to understand that many civilian first aid models such as Stop the Bleed have roots in battlefield medicine. In combat settings, the greatest preventable threat was uncontrolled bleeding in limbs and armor often protected the torso. Civilians usually do not wear body armor, and acts of violence tend to be at very close range.
Applying battlefield lessons directly to civilian settings sometimes overlooks critical differences, especially the risk of thoracic (chest) injuries. In civilian violence, missing a chest wound because you assumed extremities were the only priority can cost lives.
That is why we need to discuss chest seals and occulsive dressings what they are, how they work, and how anyone can apply one.
Basic Chest Anatomy and Physiology
Before explaining chest seals, it is helpful to know a bit of anatomy and mechanics. When we speak of thoracic injuries or chest issues, consider the “chest” region to be the area between the base of the neck and the bottom of the rib cage, front to back, excluding the arms.
The chest cavity operates under negative pressure. When the diaphragm, the main breathing muscle, contracts, it increases the vacuum in the chest cavity, drawing air into the lungs like a balloon expanding in a vacuum chamber. When the diaphragm relaxes, pressure increases, pushing air out of the lungs. This process is known as ventilation.
When you sustain a penetrating chest injury such as a gunshot or stabbing, several dangerous things can occur:
Pneumothorax or “sucking chest wound” A hole in the chest wall allows air to enter the chest cavity. That air disrupts the negative pressure necessary for lung expansion, which may cause the lung to collapse or severely limit breathing. You might even hear air “sucking” in and out of the wound.
Tension Pneumothorax Air continues entering the chest cavity, often due to lung injury, but cannot escape. The pressure builds up so much that it prevents the heart from filling and pumping properly. This is an immediate life threat.
Given these mechanisms, the logical treatment is to prevent air from entering the chest cavity through the wound. That is exactly what a chest seal or occlusive dressing does.
What Is a Chest Seal/Occlusive dressing
A chest seal is simply an adhesive airtight device placed over a penetrating chest wound to block air from entering the chest cavity. Some seals have a vent, a one way valve, to allow air to exit which can help prevent tension pneumothorax. Others are fully nonvented.
Key points:
Commercial chest seals generally cost between $10 and $20.
In an emergency, improvised chest seals/occlusive dressing can work. Use any airtight material such as plastic wrap, duct tape, or even an AED pad and press or tape it down.
Preferred order:
Commercial vented chest seal (this is the current guide despite the efficacy of vents currently being reviewed)
Commercial nonvented chest seal
Improvised chest seal
How to Apply a Chest Seal — Step by Step
Anyone can apply a chest seal if the situation allows. Here is a recommended sequence:
Call 911 or your local emergency number: Do not assume someone else will call. Direct someone by name (“You, call 911 now”) to avoid confusion.
Ensure scene safety: Do not expose yourself to further harm. You cannot help if you also become a victim.
Treat massive extremity bleeding first: If a limb is bleeding heavily, stop that bleed before moving on to chest wounds because without blood flow, oxygen delivery is irrelevant.
Identify the chest injury: Look for primary (often called entrance wound) and secondary wounds (often called exit wounds in any area protected by the rib cage, front and back. Exit wounds are often larger. Use clues such as holes in clothing, seams, skin folds, or even hidden areas like the armpits.
Dry the skin around the wound: Fluids such as blood or sweat interfere with adhesion. Some commercial chest seal kits include gauze to dry the area.
Prepare your seal: Expose the adhesive or ready your airtight material in the case of an improvised seal.
Wait for exhalation if possible: The chest cavity has the least residual air at the end of exhalation, making it easier to obtain a better seal.
Apply the seal: Center it over the wound, ideally extending at least 2 inches beyond the edges. Press gently to secure adhesion for commercial seals. For improvised seals, tape or press down all four sides. There is ongoing debate about taping three sides to allow venting, but most evidence suggests a full seal is faster and often safer in civilian settings.
Position the patient in the recovery position: Place them so the injured side faces downward if possible, to aid drainage and reduce air entry. Generally we avoid laying casualties on the injured side, but laying a casualty injured side down, blood and fluids are not as likely to put pressue on an uninjured lung.
Monitor for signs of worsening breathing: If breathing worsens unexpectedly, it could indicate pressure buildup. You can “burp” the seal by lifting one corner as the patient exhales to release trapped air.
When EMS arrives, hand off the case: Tell them where and how many wounds you treated and what interventions you performed.
Why Everyone Should Carry or Know How to Use a Chest Seal/Occlusive Dressings
Simple, inexpensive, effective: A chest seal may literally save a life in the right scenario.
Low risk of harm: If the patient does not have a pneumothorax, applying a chest seal causes minimal risk.
Legal protection: Many states have Good Samaritan laws that protect bystanders who render aid from legal liability.
Practical inclusion: I strongly recommend adding a chest seal or materials for an improvised seal to your first aid or trauma kit.
Conclusion
As violence continues to impact our communities, it is vital that ordinary citizens feel empowered to act in the critical minutes before professional help arrives. Programs like Stop the Bleed have already shown that bystanders can save lives with basic skills. Expanding that knowledge to include chest seals is the logical next step. A chest seal is simple to use, inexpensive to keep in a first aid kit, and has the potential to make the difference between life and death. By understanding how to recognize and treat chest injuries, we can bridge the gap between tragedy and survival, giving our neighbors and loved ones a fighting chance when every second counts.
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