Standards Procedure (Skill)


Chest Decompression


Clinical Indications:                                                               Level: EMT-P only


Ř      Tension pneumothorax

Ř      Consider in the setting of refractory pulseless electrical activity (PEA)





a.       Confirm the presence of a tension pneumothorax or identify strong clinical evidence in a rapidly deteriorating patient in the presence of trauma.  Consider in the setting of refractory PEA.

b.      Gather and prepare equipment.

c.       Locate the appropriate insertion site at the second intercostal space at the midclavicular line on the affected side of the chest.

d.      Prep the insertion site using an aseptic technique.

e.       Insert a 2-inch, 16-gauge angiocath (11/4 inch, 18 gauge angiocath in patients less than 8 years old) with a 10cc syringe attached.  Direct the needle just over the top of the 3rd rib (2nd intercostal space) to avoid intercostal nerves and vessels, which are located on the inferior portion of the rib border.

f.        Advance the catheter 1-2 inches (3/4 – 1 inch in patients less than 8 years old) through the chest wall.  Pull back on the plunger of the syringe while inserting.  Tension should be felt until the needle enters the plural space.  A “pop” or “give” may also be felt.  Do not advance the needle any further.

g.       Advance the catheter while withdrawing the needle until the catheter is flush with the skin.  Listen for a gush or “hiss” of air, which confirms placement and diagnosis.  Caution: This is frequently missed due to surrounding noise. 

h.       Dispose of needle properly and never reinsert into the catheter.

i.         Secure the catheter and rapidly transport the patient providing appropriate airway assistance.

j.        This procedure may be repeated if necessary after frequently reassessing patient status.

k.      Contact medical control and advised of procedure.

l.         Document procedure, results and time on the ACR.


Certification Requirements:

Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.