MARCH Module 03 of 05
R — Respiratory Support
The airway may be open while the chest cannot move air effectively. A penetrating chest wound can progressively collapse a lung — and a sealed wound that stops being monitored can quietly kill. R is about ventilation: getting oxygen in, and recognizing when the chest is failing.
The Physiology
Why R Comes Third
A failing chest kills slower than a gushing artery but faster than shock — and it is the module where complacency after an intervention becomes lethal.
Wounds To Find
Penetrating torso wounds are frequently paired — entrance and exit. Examine front, back, and sides. The wound you don't find is the one that collapses the lung.
Way Valve Gone
An open ("sucking") chest wound lets air enter the chest cavity on inhalation. Each breath builds pressure and steals lung volume — a sealed wound restores the one-way system.
Tension Builds Quietly
After any chest injury, trapped air can progressively compress the heart and lungs. Deterioration after seal placement is not a failure of the seal — it is the problem evolving.
Monitor, Don't Admire
A chest seal is a monitored intervention, not a sticker. The respiratory assessment restarts the moment the seal goes on.
Recognize — Look At The Entire Torso
Front. Back. Sides. Every penetrating torso injury gets a full visual and manual sweep.
- Penetrating chest or upper torso injury — any mechanism that breaks the chest wall.
- Open or sucking chest wound — audible airflow or bubbling at the wound site.
- Increasing respiratory distress — faster, shallower, harder work of breathing.
- Unequal chest movement — one side lagging or not moving.
- Increasing agitation or anxiety — hypoxia frequently looks like restlessness before it looks like collapse.
- Deterioration after chest-seal placement — the highest-value red flag in this module.
Act — Seal The Hole, Then Watch The Chest
Open chest wounds
C-TECC guidance includes vented chest seals for open or sucking torso wounds. Wipe the skin, apply over the wound, and — if there is an exit wound — check the back and seal it too.
- Expose and sweep — find all wounds before sealing; a missed exit wound undermines everything.
- Vented seal preferred — lets trapped air escape while blocking air entry.
- Position to breathe — injured-side-down or position of comfort per protocol and training.
- High-flow oxygen — for trained providers with equipment.
- Needle decompression — for trained providers, where tension physiology is suspected and authorized by protocol.
Placement ends the first assessment and starts the next one. Monitor breathing continuously after sealing.
Check — Reassess After Every Intervention
- Reassess breathing after every seal — watch for developing tension physiology.
- Worsening distress after placement means the problem is evolving, not solved.
- Repeat the work-of-breathing check on every loop cycle: rate, depth, effort, symmetry.
The chest seal did not end your respiratory assessment. It started the next one.
Don't — The Failure Patterns
- Examining only the front of the chest — exit wounds hide on the back and sides.
- Applying a seal and never reassessing it or the casualty's breathing.
- Missing progressive respiratory distress because early changes look like "stress."
- Interpreting post-seal deterioration as equipment failure and re-sticking the seal instead of escalating care.
What This Looks Like At Your Level
Switch roles to compare scope
Civilian / Prepared Citizen
Recognize the wound, apply a vented seal where trained and equipped, monitor breathing continuously — and if condition worsens after placement, follow trained guidance and get EMS moving urgently.
Recognize · Apply vented seal where trained · Monitor breathing continuously · Escalate emergency response
Law Enforcement / First Responder
Everything the civilian carries, plus tactical evacuation and repeated assessment en route — you are frequently the monitor between scene and EMS.
Same + tactical evacuation · Repeated assessment en route
Medic / EMS / Clinician
The full respiratory stack: structured assessment, oxygenation, ventilatory support, capnography, tension physiology recognition, and needle decompression where indicated and authorized.
Full respiratory assessment · Oxygen · Ventilatory support · SpO₂ · EtCO₂ · Tension recognition · Needle decompression where authorized
Module Self-Check
Test Your R Knowledge
1. You find a penetrating wound on the front of the chest. What must you do before sealing?
2. You seal the wound and breathing improves. What now?
3. Ten minutes after a seal, the casualty becomes increasingly agitated with faster, harder breathing. Interpretation?
4. Why is a vented chest seal preferred over a plain occlusive one?
5. An agitated, anxious casualty with a torso wound. Why does agitation matter?
Equipment
Build Your R Capability
Chest seals and respiratory tools, live from the store's respiration catalog.
Beacon Chest Seal – okklusiv/ohne Belüftung
Beacon Brustabdichtung – belüftet
HALO XL
HALO Seal COMBO IFAK Zweierpack
Continue The Sequence
Next MARCH Modules
TCCC content reviewed against CoTCCC Guidelines — 1 May 2026 · Civilian / LE content reviewed against current C-TECC guidance
Guidelines evolve. Agency protocols and scope of practice control. Educational alignment — not a certification.