Prehospital Trauma Compendium: Traumatic Pneumothorax Care: Position Statement and Resource Document of NAEMSP

Emergency medical services (EMS) clinicians manage patients with traumatic pneumothoraxes. These may be simple pneumothoraxes that are less clinically impactful, or tension pneumothoraxes that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Furthermore, there is also ambiguity regarding EMS management of open pneumothoraxes. To provide evidence-based guidance on the management of traumatic pneumothoraxes in the EMS setting, the National Association of EMS Physicians (NAEMSP) performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.