Paramedic Use of Needle Thoracostomy in the Prehospital Environment

Objective. The use of prehospital needle thoracostomy (NT) is controversial as it is not without risk. Issues such as inappropriate patient selection, misplacement causing iatrogenic injury, treatment failures in obese patients, anddelaying definitive tube thoracostomy in the emergency department contribute to this controversy. The purpose of this study is to evaluate a cohort of patients undergoing NT by paramedics for tension pneumothorax andreview the indications for use, complications, andemergency department outcomes of NT. Methods. We conducted a retrospective review of patients undergoing NT in the prehospital setting andtransported directly to a Level 1 trauma center over a one-year period. Patients were transported by a single ground transport agency staffed by paramedics. All paramedics were trained to follow uniform protocols for treatment procedures. Variables included indications for NT, patient demographics, prehospital vital signs, injury mechanism, chest X-ray, andEmergency Department outcomes. Results. Paramedics responded to 20,330 advanced life support calls, and39 (0.2%) patients had a NT placed for treatment of tension pneumothorax. Twenty-two (56.4%) patients were in circulatory arrest, with 12 suffering traumatic arrest and10 patients in nontraumatic PEA arrest. The remaining 17 (43.6%) patients were treated for nonarrest causes. Conclusions. The use of NT appears to be a safe procedure when preformed by paramedics in an urban EMS system. Prehospital NT resulted in four cases of unexpected survival.