ABSTRACT

Bandages have been used in hemorrhage control since at least ancient Egyptian, Greek, and Roman times. The design remained unchanged until the fifth century BCE, when gauze was introduced. Modern bandages are relatively expensive and heavy and are not widely available in low-resource environments. Packaging wrap, sometimes called Saran wrap, cling film, cling wrap, or Glad wrap, is widely available in many countries. It is used commercially with handheld dispensers to bind goods to pallets for secure transport. In austere settings, packaging wrap has a large number of improvised medical uses. It can be used as a dressing to apply pressure to wounds, as covering for burns, to splint limb fractures, to occlude bowel evisceration, and to ensure the security of casualty cards. It can also be used to create an endotracheal tube tie, an improvised intravenous fluid pressure infuser, an improvised pneumatic limb tourniquet, or a head immobilizer for spinal immobilization. Large numbers of dressings can be created from a single dispenser, making this a cheap and light alternative to conventional dressings. Packaging wrap is not intended as a replacement for commercially available, approved products but rather to assist in packaging and for use in austere, remote and tactical environments, where space and weight are limited.

Keywords: wilderness medicine; dressings; packaging wrap; bandage; hemorrhage; austere settings

10-Gauge versus 14-Gauge Fenestrated Needle/Catheter Units for Decompression of Tension Pneumothorax in Cadaveric Model

Long AN, Achay J, Hudson IL, Lowe JB, Epley E, Bolleter S, DeSoucy ES, Hewitt CW, Rollman JE, Swenson JF, Wampler D, Raetz E, Kruse A 25(4). 20

Abstract:

Background: Needle decompression (NDC) is the primary treatment of tension pneumothorax (tPTX) in prehospital settings. This study compared 10-gauge (10ga) and 14-gauge (14ga) fenestrated needle/catheter units for NDC. We hypoth-esized 10ga needle/catheter units would demonstrate higher tPTX decompression rates compared to 14ga needle/catheter units. Methods: A non-randomized, non-blinded study was conducted using human cadavers with artificially induced tPTX (pleural pressure of 15mmHg). A 10ga or 14ga unit was in-serted into the 5th intercostal space, anterior axillary line, or the 2nd intercostal space, midclavicular line. Successful NDC was defined as a pressure decrease to less than 4mmHg. Results: In 116 NDC attempts, there was no difference in the success rate of NDC between 10ga versus 14ga units (91.1% vs. 91.1%, P=1.0). The median time to decompression of tPTX was faster using 10ga at 22.0s (IQR 14.5-42.0) vs. 14ga at 39.8 seconds (IQR 30.3-57.6, P<.001). No difference was found in time to successful decompression between AAL and MCL sites (36.0s [IQR 21.7-51.7] vs. 30.4s [IQR 18.7-49.5], P=.46). The 10ga needle/catheter units achieved an audible release of air with the needle still in place during successful NDC more frequently compared to the 14ga units (65.3% vs. 34.7%; P=.034). Con-clusion: NDC with 10ga fenestrated needle/catheter units was similarly effective, but significantly faster than 14ga units for tPTX in a cadaveric model. A safe, depth-limiting technique was over 90% effective across all NDC sites.

Keywords: tension pneumothorax; needle thoracostomy; decompression; cadaver; needle gauge; gauge size

ABSTRACT

Objectives: Intraosseous (IO) access is a medical procedure primarily used in emergencies when peripheral venous access is unobtainable or delayed. The IO procedure is commonly performed using the EZ-IO, a battery-powered intraosseous driver. In contrast, the newer SAM IO is a less costly and manually powered driver. Our objective was to compare the EZ-IO and SAM IO by examining insertion times and EMS clinicians’ preferences. Methods: This randomized prospective trial was performed with EMS clinicians after watching in-structional videos. Participants practiced insertions with both drivers on plastic task trainers and porcine bones until they self-reported proficiency. Participants were randomized to one of the drivers, and insertion times into a porcine humeral bone were analyzed. All participants completed a post-study survey. Results: Study participants (n=106) using the EZ-IO had faster insertion times, mean 1.1 seconds (s) (95% CI 0.8-1.4), versus the SAM IO, mean 2.8s (95% CI 2.5-3.1), P<.001. The mean difference was less than 2s and unlikely to be clinically signif-icant. All attempts were deemed successful. Most considered the SAM IO easy to use 68.6% (74/106), and 80.0% (85/106) reported confidence in patient use. Despite this, participants expressed some reservations. Conclusions: In the largest ran-domized controlled trial to date, we found that the EZ-IO had a faster insertion time compared to the SAM IO, but the time difference was unlikely to be clinically meaningful. Although participant responses indicated a preference for the EZ-IO, most felt confident using the SAM IO in an EMS setting.

Keywords: EZ-IO; SAM IO; intraosseous; prehospital; emergency medical service; emergency vascular access; porcine bone model

Current Episode is Fall 2025

Our JSOM podcast team will be reviewing the following articles for our newest podcast: 

Penetrating Axilla Injuries in Ceramic Plate Coverage: Matthew unpacks a compelling case series on the effectiveness of four-plate body armor systems in protecting vital axillary structures, drawing from his own experience as a Ranger medic.

https://jsomonline.org/product/penetrating-axilla-injuries-and-ceramic-plate-coverage-a-special-operations-case-series/

Mitigating Heat Loss in IV Tubing During Austere Blood Transfusions: Sydney reviews a West Point study quantifying how cold environments impact transfusion safety—and what innovations might help preserve blood temperature in the field.

https://jsomonline.org/product/mitigating-heat-loss-in-iv-tubing-during-austere-blood-transfusions/

Lab Evaluation of Four Ukrainian-Manufactured Tourniquets: Jessica breaks down a comparative study assessing the performance, durability, and design of Ukrainian tourniquets under simulated battlefield conditions.

https://jsomonline.org/product/lab-evaluation-of-four-ukrainian-manufactured-tourniquets/

Plus, Dr. Dan Godbee highlights two additional must-read articles on prehospital blood use and JSOM’s ongoing commitment to mentoring medics through the publishing process.



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