OCCLUSIVE DRESSING / NEEDLE DECOMPRESSION
Conditions: Teammate received GSW to upper body. Conscious, complaining of difficulty breathing. Non-CBRNE. Behind cover, security established.
Understanding This Task
This task covers two critical chest wound interventions. First, apply occlusive dressings to both entry and exit wounds. Then if tension pneumothorax develops, perform needle chest decompression (NCD).
NCD primary site: 5th intercostal space (ICS) at the anterior axillary line (AAL) on the injured side. Insert at 90 degrees over the superior border of the lower rib.
Always check for BOTH entry and exit wounds by log rolling the casualty.
Common NO-GO Mistakes
- Not checking for exit wound
- Wrong NCD site (must be 5th ICS, anterior axillary line)
- Not inserting needle at 90 degrees
- Not advancing needle all the way to the hub
- Forgetting to stabilize catheter with tape
Task Basis: 081-833-0069, 081-833-3007, 081-833-0164, 081-000-0013
Video Resources
ATP 4-02.11 Doctrine
From Army Techniques Publication 4-02.11, 23 March 2026 — Chapter 6: Respiration and Breathing Control
Vented vs. non-vented chest seal (para 6-8, 6-24, 6-25): The CoTCCC-recommended chest seal is a vented (preferred) self-adhering chest seal. Vented seals allow air to escape from the chest while non-vented seals do not. If a vented chest seal is NOT available, a non-vented chest seal should be used. When the casualty inhales, the plastic is sucked against the wound preventing air entry; when exhaling, trapped air can escape through the valve. Ensure the edges of the chest seal extend two inches beyond the wound. Apply upon full expiration.
NDC site selection (para 6-36): The needle decompression of the chest (NDC) site is placed at either: (1) the 2nd intercostal space in the mid-clavicular line (ensure site selection is outside the nipple line), or (2) the anterior axillary line in the 5th intercostal space. Watch needle placement to avoid the heart and arteries. The CoTCCC-recommended catheter-over-needle device is either a 10-gauge, 14-gauge, or 3¼ inch long device.
NDC procedure (para 6-37): Place the NDC perpendicular to the body (90 degrees to the chest wall). After the NDC is placed, hold in place for 5–10 seconds before removing the needle and leaving the catheter. Document all interventions on DD Form 1380. Do NOT put an NDC through a chest seal — use an alternate site. Tension pneumothorax is the second-leading cause of preventable deaths on the battlefield.
7+ signs of tension pneumothorax (para 6-31): Early signs: increasing difficulty breathing over time; shortness of breath; confusion, lightheadedness, or agitation from low oxygen; bluish discoloration around the mouth and lips; rapid pulse. Late signs: swollen neck veins; tracheal deviation (windpipe shifting to one side); severe difficulty breathing, often with chest pain or anxiety.
Source: ATP 4-02.11, Chapter 6, para 6-8, 6-24 through 6-37
- NCD primary site: 5th ICS, anterior axillary line.
- Needle at 90 degrees, superior border of lower rib, advance to hub.
- Always check for BOTH entry and exit wounds.
PERFORMANCE MEASURES
0/6 GO- 1
Apply occlusive dressing
- Expose injuries.
- Apply dressing to entry wound upon full expiration. Cover wound 2 inches beyond edge. Tape all 4 sides (if non-adhesive).
- Log roll casualty to unaffected side. Apply dressing to exit wound with same standards.
- 2
Verify tension pneumothorax (3+ indicators)
- Difficulty breathing, pain on affected side, coughing blood.
- Poor respiratory rate and depth, abdominal distension.
- Tracheal deviation and/or jugular distension.
- Subcutaneous emphysema (crackling sensation on chest).
- Unilateral chest distension — place hand on each side, observe height difference.
- Cyanosis (bluish skin).
- Signs of shock.
- 3
Identify needle decompression site
- Primary: 5th intercostal space (ICS) at anterior axillary line (AAL), same side as injury.
- Alternate (primary pediatric): 2nd ICS, midclavicular line.
-
4
Perform needle chest decompression CRITICAL
- Clean site with alcohol or Betadine.
- Insert 3.25 inch, 10 or 14-gauge needle at 90 degrees to chest wall.
- Insert at superior border of lower rib at the ICS site.
- Advance needle all the way to the hub. Leave in place 5-10 seconds.
- Remove needle, leave catheter in place.
- If tension pneumothorax recurs: repeat NCD on injured side.
- Stabilize catheter hub to chest wall with adhesive tape.
- Listen for increased breath sounds or observe decreased respiratory distress.
- 5
Measure pulse oximetry (O2 SAT)
- Wipe fingertip with alcohol (clean and dry).
- Apply sensor. Document reading.
- 6
Record all treatments on TCCC card
- Front: EVAC priority, date, time, mechanism (GSW), injury sites, vitals, O2 SAT.
- Back: EVAC priority, breathing interventions (needle-D, chest seal), first responder info.
Go Deeper — ATP 4-02.11 Reference
Detailed doctrine from the Army Techniques Publication: