A chest seal is an occlusive dressing that covers an open chest wound so air can't be sucked in through the hole. Current military guidance prefers a vented chest seal and accepts a non-vented one if that's all you have. The 2015 civilian TECC guidelines accept either. Whichever seal you use, the job isn't done when it's stuck on. You have to keep watching for tension pneumothorax.

Penetrating chest trauma sits at "R" (respirations) in the MARCHE sequence, right after massive bleeding and airway. For most patrol officers, the realistic scope is simple: find the hole, seal it, recognize when breathing gets worse, and get the casualty to someone who can do more.

This guide explains what the guidelines say and why. It quotes the June 2015 C-TECC guidelines. We could not open the 2024 C-TECC First Responder guidelines when this was written, so check current C-TECC wording and your local protocols.

What is an open chest wound?

An open chest wound is any penetrating injury that breaks through the chest wall. Guidelines often call it an "open and/or sucking chest wound." Air can move through the wound as the casualty breathes, and the lung on that side can collapse.

These wounds are easy to miss. Blood, clothing, armor and darkness hide them, and a wound on the back or under the arm won't be seen unless someone looks. A hit to an armored officer still needs a look. In May 2026, an Indiana trooper shot in the chest was reported to be wearing body armor and still needed surgery. The practical rule: after any torso hit, expose the chest and check front, back and sides once the threat allows.

What do the guidelines say about chest seals?

All three sources agree on the first step. Cover the hole right away.

  • C-TECC (2015): "All open and/or sucking chest wounds should be treated by immediately applying a vented or non-vented occlusive seal to cover the defect."
  • TCCC (1 May 2026): "All open and/or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal."
  • JTS Wartime Thoracic Injury CPG (ID 74): "Initial management with placement of a vented chest seal is reasonable until a tube thoracostomy can be performed."

Chest seals belong to Indirect Threat Care. Under active threat, the priority is getting to cover and stopping massive bleeding. For more on sequencing, see the MARCHE assessment and TECC's three phases.

Vented vs non-vented chest seal: what's the difference?

A non-vented chest seal is a solid sheet with adhesive. It stops air from being sucked in through the wound, but it also stops air from escaping.

A vented chest seal has a valve or channels designed to let air and blood out of the wound while keeping outside air from getting in.

That difference matters because of tension pneumothorax. If air keeps leaking into the chest from the injured lung and can't get out, pressure builds. A vent gives that air a way out through the wound. It doesn't guarantee it, since blood or clotting can block a vent.

On what to carry:

  • The military TCCC guidelines name the vented seal as the first choice, and the JTS thoracic guideline calls a vented seal reasonable initial management.
  • The 2015 C-TECC civilian guidelines accept either vented or non-vented.
  • If all you have is a non-vented seal, use it. TCCC says so directly. Covering the hole matters more than the brand of seal.

Which seal your agency issues is a decision for your medical director. Whatever you carry, train with it, including on a sweaty, bloody or hairy chest where adhesive struggles.

What are the signs of tension pneumothorax?

Tension pneumothorax happens when air builds up in the chest and can't escape. It crushes the lung and eventually interferes with the heart's ability to fill and pump. It can follow any chest injury, including one that's already been sealed. That's why every guideline tells you to keep watching after the seal goes on.

How the guidelines describe it:

  • C-TECC (2015): "Monitor the casualty for the potential development of a subsequent tension pneumothorax (e.g. progressive respiratory distress, hypoxia, and/or hypotension in the setting of known or suspected torso trauma)."
  • JTS Wartime Thoracic Injury CPG: "severe or progressive shortness of breath or hemodynamic compromise in the setting of chest trauma." The CPG adds that telling a simple pneumothorax from a tension pneumothorax "is based on the presence of hemodynamic effects (hypotension and decreased perfusion)." It also states: "Clinical suspicion of tension pneumothorax requires rapid treatment."
  • TCCC (2026): lists findings including severe or progressive respiratory distress, severe or progressive rapid breathing, absent or markedly decreased breath sounds on one side, oxygen saturation below 90% on pulse oximetry, shock, and traumatic cardiac arrest.

In plain terms for patrol: breathing that keeps getting worse, a casualty who's fighting harder for air, and signs of shock after a chest injury. You don't need a stethoscope to see the trend. Say it on the radio and at handoff: "Chest wound, sealed at [time], breathing getting worse."

What does "burping" a chest seal mean?

Burping means briefly lifting the edge of the seal, or removing it, so trapped air can escape through the wound. Both the civilian and military guidelines describe it.

  • C-TECC (2015) lists "Removing the occlusive dressing and 'burping' the chest seal" as a response to a developing tension pneumothorax.
  • TCCC (2026): if increasing hypoxia, respiratory distress or hypotension develops and a tension pneumothorax is suspected, "treat by burping or removing the dressing," or by decompression.

Burping is simple, and for many responders it's the only intervention within scope when a sealed casualty gets worse. Make sure your training and protocols cover it before you need it.

What about decompression?

When burping doesn't fix it, or there's no open wound to burp, a tension pneumothorax needs a procedure. The 2015 C-TECC guidelines say: "If tension pneumothorax is present or developing, decompress the chest on the side of the injury."

This is advanced care. Finger thoracostomy with needle decompression is performed only by personnel trained and authorized for it under medical direction, such as tactical medics and paramedics working under protocols that include it. Most patrol officers are not in that group. Their job is to recognize it, report it and move the casualty to someone who is.

How should you position a casualty with a chest wound?

The TECC guidelines' positioning language is about protecting the airway. In Direct Threat Care, the 2015 C-TECC guidelines say to "Consider quickly placing casualty, or directing the casualty to be placed, in position to protect airway if tactically feasible."

Beyond that, follow your training and protocols. A conscious casualty who's struggling to breathe will often find their own position of comfort. Don't force them flat without a reason. An unconscious casualty needs their airway protected and needs close watching. Either way, keep reassessing breathing every time the casualty is moved. Moving a casualty can also loosen a seal, so check it's still stuck down.

Why TECC and TCCC differ here

The TCCC guidelines and the JTS thoracic CPG are military documents, written for military providers and deployed trauma systems. They are the best available evidence base, but they don't automatically become civilian law enforcement protocol. C-TECC adapts that evidence for civilian responders, and your medical director turns it into what your officers and medics are allowed to do. Our guide to TECC vs TCCC covers the differences.

Scope depends on training level, local protocols and medical direction. Reading this page is not a substitute for hands-on training.

Frequently Asked Questions

Should I use a vented or non-vented chest seal?

Military TCCC guidance prefers a vented chest seal, the JTS thoracic guideline calls one reasonable initial management, and TCCC says to use a non-vented seal if a vented one isn't available. The 2015 civilian C-TECC guidelines accept either. Your agency's medical director should decide what you carry.

What is a sucking chest wound?

It's a penetrating wound through the chest wall that lets air move in and out as the casualty breathes. The guidelines say to cover it right away with an occlusive chest seal, then watch closely for tension pneumothorax.

What are the signs of a tension pneumothorax?

C-TECC's 2015 guidelines list progressive respiratory distress, hypoxia and/or hypotension in someone with known or suspected torso trauma. The JTS thoracic guideline describes severe or progressive shortness of breath or hemodynamic compromise after chest trauma. Breathing that keeps getting worse after a chest injury is the red flag.

How do you burp a chest seal?

Burping means briefly lifting or removing the seal so trapped air can escape through the wound. Both C-TECC and TCCC list it as a response to suspected tension pneumothorax. Learn it hands-on, and follow your protocols.

Can police officers decompress a tension pneumothorax?

Only if they're trained and authorized to do it under medical direction. For most patrol officers, it's outside scope. Finger thoracostomy with needle decompression is typically reserved for tactical medics and advanced providers whose protocols include it.

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