Tactical medicine and Safety Pins

[Armymedic]

I heard of something quite interesting recently. Use safety pins to close large abdominal or gaping wounds to prevent fluid loss and prevent further contamination. Basically take a pin, take one edge, put the pin through as per a suture needle, grab the other edge, put it onto the pin, and secure the pin closed.

Also in the case of emergency cricothyroidotomy, a safety pin and be inserted through the skin and the ET to secure it.

My sources say this is much quicker and as effective as suturing gaping wounds and taping cric tubes. Anyone hear of this before or play with this idea?

 

[forcerecon85]

I have seen safety pins handing off the folding flap on US surgical sets, I had no idea why, but this could be it.

 

[Blackadder1916]

I've heard of using safety pins as a "field expedient" method of wound closure, but only when the right equipment was not available. 

In the movie "The Longest Day" the RAF fighter pilot character protrayed by Richard Burton supposedly had his wound (split open from the crotch to the knee) pinned together by safety pins by a medic who found him but who had lost all his equipment when he landed.

Backcountry 911: 1,001 Uses for Duct Tape and Safety Pins,  Eric A. Weiss, MD, FACEP
http://meetings.acep.org/NR/rdonlyres/AB3A23E8-D645-4BBD-9631-4E04AE952832/0/TH264.pdf

I have seen safety pins handing off the folding flap on US surgical sets, I had no idea why, but this could be it.

The most probable use of these safety pins would be to anchor Penrose drains so that they do not slip into the wound.

 

[geo]

Safety pins - yes
How about "Gun" or "duct" tape?

 

[Armymedic]

How about "Gun" or "duct" tape?

Peeling it off of the skin would not be a pleaseant experience for the casualty.

 

[Bane]

    I could see the wound being pulled open a bit when try to take the tape off so in that way it may be an issue. But if you are talking about pulling at hair and skin, I don't think that is a factor at all as we're assuming that the person would have a significant wound and who would really care right?
    Tape might work well on limbs where you can wrap it around back onto itself, other than that I don't see it as being useful.

 

[Staff Weenie]

I'll see if I can get more info on it, but one of my Med Techs said that during his roto, somebody used safety pins on an abdomen to hold the intestines in after an evisceration. Basically, they rinsed off the small intestine with some bottled water, gently pushed them back in place, and then used the safety pins to close the wound temporarily.

 

[Armymedic]

somebody used safety pins on an abdomen to hold the intestines in after an evisceration. Basically, they rinsed off the small intestine with some bottled water, gently pushed them back in place, and then used the safety pins to close the wound temporarily.

This is exactly the use I was asking about.

 

[geo]

Note that I figured the guntape would be uncomfortable while being removed.
I just figured that, as a field expedient way to close and keep close a wound, it would do the job that was being asked of it....
Also figured that, by the time they got the patient to a cat 3 hospital, the injured would be "under" and not really cognisant of the tape's removal.

 

[Kyu]

When I was in the air cadets, I borrowed the US Army Survival Guide at my school's library to learn a few tricks. It was my father that suggested me to read that book, since there was quotes from it in the survival guide he receive during his forestry course. There is a chapter about first aid.

There is a part about patching open wounds with adhesive tape.

Sometimes we must do with what we have in our hands. 

 

[medicineman]

I think you'll find that little buterfly bandaids aren't in quite the same league - they're meant for reasonably minor wounds, not for an eviserated abdomen.  It's that thing about keeping the insides in that they tend to have problems with...

MM

 

[Kyu]

Of course it's not on the same scale. But I think that someone asked if adhesive tape could be used to mend wounds, and I thought I could show some kind of proof. I do not pretend to have any medical training beside my first aid training I had over a decade ago.

 

[Blackadder1916]

... someone asked if adhesive tape could be used to mend wounds...

Actually they referred to 'gun tape' which has probably been used to repair everything, including aircraft.  I've used it on more than one occasion for wound closure.  While adequate at the time, it did not have as good skin adhesion properties as some types of surgical tape.  Did not stick well to skin if the site was not completely dry, and, when it did stick, was difficult to remove to access the wound for later (proper) care.

Kyu, if you are interested in the scale that is being discussed re abdominal wounds try these sites.  I hesitate to post the photos here, some get squeemish.
http://www.trauma.org/index.php/main/image/569/C13
http://www.trauma.org/index.php/main/image/566/C13
http://www.trauma.org/index.php/main/image/565/C13

 

[Kyu]

You are very right, any kind of tape won't do it.

 

[Franko]

This is exactly the use I was asking about.

On the last TCCC one of the instructors was explaining that to close an evisceration using 5" or smaller safety pins was acceptable after the bowel was rinsed and lightly packed back in. Mind you that it would have to be before the bowel inflated.

She also mentioned that the wound had to be pulled open slightly and raised to help get it back in as well. From there get the pins out and close him up as best as possible, get Israeli bandages damp and place them over the wound and get tension on them.

We were never shown how to do it, just explained and it seemed rather simple...seeing as your mitts are going to be in there anyways might as well stabilize it than have it split more open. I'm thinking that this would have to be used in the case of a 6" wound or larger. An Israeli would do for a smaller one.

Obviously a medic would have to be there and do the procedure, the TCCC would assist.

Regards

 

[medicineman]

Back to the original safety pin question - grand rounds on the Trauma Service yesterday at VGH oddly enough was about abdominal compartment syndrome and temporary abdominal closure.  One of the methods employed was a crap load of towel clips, so I guess using safety pins isn't really that out in left field.

MM

 

[PMedMoe]

a crap load of towel clips

Towel clips?  Aren't they IV holders? 
I can remember losing a "crap load" of them every time we went to the field.  People would forget about them when they took the tentage down and the following week, there would be an order into Bde Pharmacy for more!!