Trauma : just another statistic?

This article explores the clinical assessment, diagnosis and current management of tension pneumothoraces in the pre-hospital arena by UK ambulance service paramedics. The signs and symptoms, aetiology and clinical manifestations of tension pneumothoraces are examined, with the specific aim of achieving an accurate diagnosis and effective pleural decompression. This article explores the effectiveness of needle thoracocentesis: the sole method of pleural decompression currently available to UK paramedics. It aims to compare the effectiveness of this procedure with other, and considered more reliable, methods of pleural decompression. Inherent risks and associated complications are examined and conclusions are drawn, including the proposal that Critical Care Helicopter Emergency Medical Services (HEMS) Paramedics who have completed additional educational programmes, operating under strict clinical governance systems, and who are frequently exposed to seriously injured patients, be afforded the autonomy to practice incision thoracostomies in traumatic cardiac arrest patients in the absence of their medical colleagues.