Sucking Chest Wound: First Aid for Penetrating Chest Injuries

A sucking chest wound is an open hole in the chest wall through which air can be drawn into the chest cavity with each breath. The air collects around the lung and can make it collapse, and if it cannot escape, rising pressure can squash the heart and the other lung. A penetrating wound may also damage the heart and major blood vessels. It is always a life-threatening emergency, and early first aid can protect the breathing while the ambulance is on its way.

Recognising a Sucking Chest Wound

• An open wound in the chest, often small and neat, from a stab, bullet, impalement or crush injury
• A hissing or sucking sound as the person breathes
• Frothy blood at the wound
• Increasing difficulty breathing, a fast pulse and blue lips
• Signs of shock

A small entry wound does not reflect the size of the internal damage. Check the back and sides too, since there may be an exit wound.

Sucking Chest Wound First Aid Steps

1. Call the emergency number immediately and protect yourself with gloves.
2. Help the person into the most comfortable position, usually half sitting and leaning slightly toward the injured side, with head and shoulders supported.
3. Expose the wound and find any exit wound.
4. Cover the wound. If you have a vented chest seal, apply it as taught. If you do not, current guidance allows leaving the wound open to the air or covering it with a clean, loose, non-airtight dressing. Do not close it completely with an airtight dressing, because air that cannot escape can build pressure inside the chest.
5. Control bleeding around the wound with the padding and pressure described in our severe bleeding first aid guide.
6. Monitor and prepare. Check breathing and pulse often. If the person worsens, loosen or lift any dressing to let trapped air escape. If they become unresponsive and stop breathing normally, begin CPR.

Why the Old Three-Sided Dressing Advice Has Changed

Many first aid workbooks teach sealing a plastic sheet or foil on three sides, so that it acts as a one-way valve. In practice, improvised dressings often stick or clot and block the open side. Current guidelines therefore recommend either a vented commercial chest seal, a non-airtight dressing, or leaving the wound uncovered, and tell first aiders to watch for worsening breathing. Always follow what your local training authority teaches.

If You Have Nothing Available

If no dressing is at hand, place a gloved hand lightly over the wound while you look for one, but release if breathing worsens. Never stuff material into the wound, and do not remove objects that are impaled in the chest. Stabilise them with bulky padding, as explained in embedded foreign objects.

What Happens in Hospital

Doctors confirm the injury with imaging, release trapped air with a chest drain, replace blood and repair damaged organs. Because deterioration can be fast, a person with a penetrating chest wound should never be driven to hospital unaccompanied or left alone.

Frequently Asked Questions

Can a sucking chest wound heal on its own?
No. Even when the person seems stable, there may be internal injury that needs hospital assessment.

Should I lay the person flat?
Usually no. Half sitting is more comfortable for breathing unless they are unconscious or in severe shock, in which case follow medical advice.

References and Further Reading

• American Heart Association and American Red Cross, Guidelines for First Aid
• American Heart Association, Top Things to Know: 2024 First Aid Guidelines

Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team

This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.

Related Guides

• Severe Bleeding First Aid: Direct Pressure, Dressings and Tourniquets
• Shock First Aid: Recognising Circulatory Shock and Acting Fast
• Embedded Foreign Objects: How to Bandage Around an Impaled Object
• The Secondary Survey: A Head to Toe Patient Examination
• Airway Management: How to Open, Clear and Protect an Airway