Prevent and prepare

• In workplaces where there is a high risk of falls, crush injuries or explosion risks, such as construction and mining, include training on this topic and provision of appropriate first aid equipment.
• Wear a ballistic vest when entering a conflict zone if possible.

Early recognition

The person has experienced physical trauma such as from a road traffic collision, weapon or fall.  You may not be able to see the wound as it might be internal or under clothing. Talk to the person and ask them about their condition to locate the injury as quickly as possible.

A person who has experienced physical trauma may have an internal injury which bleeds inside their chest or abdomen. This may only become apparent if the person starts to show signs of Shock. 

A person with an open chest wound may have difficult or painful breathing and they may cough up blood.

First aid steps

Once in a safe location, examine the person as carefully and thoroughly as possible.

Abdominal wound

1. Help the person get into a comfortable position. Usually, this is a lying position with knees pulled up, as this reduces tension on the abdomen.
2. Control any external bleeding by applying pressure.
3. Access emergency medical services (EMS).
4. Place a clean dressing over the wound once the bleeding is controlled by pressure. If internal organs are bulging out, do not try to push them back into the abdomen. Cover them with a clean wet dressing.
5. Reassure the person and monitor their breathing, circulation and level of response, particularly looking for any signs of shock.

Open chest wound

1. Help the person get into a comfortable position. Usually, this is a half-seated position leaning slightly on their injured side to maximize the function of the other lung.
2. Control any external bleeding by applying pressure using your hands, ensuring the pressure does not completely seal the wound.
3. Access emergency medical services (EMS).
4. Reassure the person and monitor their breathing, circulation and level of response, particularly looking for any signs of shock or breathing difficulties.

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CAUTION

• Do not seal an open chest wound. If the wound is sealed, blood may clot and seal the wound and allow air to build up in the chest, which may lead to tension pneumothorax.
• If a dressing is necessary on an open chest wound, (e.g., to transport the person a long distance to medical care), a non-occlusive dressing can be used. Monitor the dressing to ensure it remains open, allowing air to pass through it.
• Do not remove any impaled objects from an abdominal or chest wound, as this may cause serious bleeding and makes it more difficult for a medical professional to determine the severity of the wound.

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Access help

• Access EMS immediately. Chest and abdominal injuries can be life-threatening and need medical attention.
• Chest and abdominal wounds are common in conflict and crisis situations. Before treating people, it is essential to call for help, including for the police or security services and to act only if it is safe for you to do so.

Context considerations

• Road traffic collisions are common across the globe and form a major cause of traumatic injuries.
• In fragile contexts where there is violence and injuries of this kind are more common, learners will have to pay close attention to issues regarding personal safety.
• Adapt the education and simulation appropriately as this topic can be particularly sensitive depending on cultural, religious or gender norms of the context.

Learner considerations

• Consider the context of learners’ helping behaviours or willingness to help. For example, learners may display a willingness to help friends or family in a community affected by conflict but may be reluctant to help state weapons bearers.
• Consider the psychological effect that injuries of this type (in conflict or peacetime situations) may have on first aid providers and explore options available for supporting them after the incident.

Facilitation tips

• The published literature indicates the importance of correct management of an open chest wound. Emphasise the importance of using a non-occlusive dressing to prevent the development of a potentially life-threatening complication of pneumothorax.
• Emphasise also that any non-occlusive dressing placed on an open chest wound should be closely monitored (as well as the person’s breathing). This is because all dressings can become sealed (occlusive), due to blood clotting.

Facilitation tools

• Prioritise simulation to give learners time to practise and develop their skills in managing chest and abdominal wounds, and to use their skills in a realistic scenario and to debrief.
• Use virtual reality, video, serious computer games or simulation manikins if available to explore this topic, particularly the application of dressings around impaled or embedded objects.
• Low tech, high-quality simulation can also be very effective. For example, rice or flour sacks can be stitched together and filled with straw or sand to create a manikin of adult size. Or a pillow could be tied to a post to act as a manikin. These can be used to simulate different injuries, including impaled or embedded objects.

Learning connections

• A wound may have external Bleeding.
• A person with an internal or external injury may develop Shock.
• Build realistic scenarios that emphasise the principles laid out in the General approach such as keeping safe.
• Chest and abdominal wounds may be more common in areas of Conflict or Disaster, and also might require the first aid provider to deal with multiple casualties (see General approach).