A Matched Cohort Study of Open Thoracostomies Performed by Ground Medics

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Alison Smith, MD, PhD
Angelo Ciaraglia, MD
Benjamin Axtman, MD
CJ Winckler, MD
David Wampler, PhD
Maxwell Braverman, DO
C. Patrick Shahan, MD
Rachelle Babbitt Jonas, RN
Michael Shiels, MSN, RN, CSTR
Brian Eastridge, MD
Ronald Stewart, MD
Susannah Nicholson, MD
Donald Jenkins, MD


Background: Tension pneumothorax resulting from chest trauma is a rapidly fatal condition that requires prompt treatment.  Prehospital open thoracostomy (POT) is a potentially lifesaving intervention that can be performed in the field to treat tension pneumothorax. However, the results from POT performed by ground EMS providers have not been well-studied. The objective of this study was to compare outcomes for patients with chest trauma who underwent POT performed by ground EMS providers with a matched cohort who did not undergo this procedure in the field.

Methods: A retrospective chart review of consecutive adult patients presenting to a Level I trauma center with chest trauma were analyzed from 2017-2020. Outcomes were compared to a patient cohort who did not undergo POT matched by severity of injury and prehospital CPR.

Results: A total of 14 POT patients were identified.  Majority of POT were bilateral (n=11/14, 78.6%) and all of these patients (n=14/14) had prehospital cardiac arrest. Return of spontaneous circulation was obtained in 2 patients with penetrating injuries (14.3%). There was no difference in total and scene EMS time compared to the matched cohort without POT (p>0.05).

Conclusions: This study demonstrated that open thoracostomies could be performed by ground EMS units without increasing prehospital time for severely injured trauma patients and greater achievement of ROSC. Larger, prospective, multi-institutional analyses are needed to further evaluate outcomes.

Article Details

How to Cite
Smith, A., Ciaraglia, A., Axtman, B., Winckler, C., Wampler, D., Braverman, M., … Jenkins, D. (2023). A Matched Cohort Study of Open Thoracostomies Performed by Ground Medics. International Journal of Paramedicine, (2), 10–18. https://doi.org/10.56068/QMBV3502
Research Reports


Aylwin, C. J., Brohi, K., Davies, G. D., & Walsh, M. S. (2008). Pre-hospital and in-hospital thoracostomy: Indications and complications. The Annals of The Royal College of Surgeons of England, 90(1), 54–57. https://doi.org/10.1308/003588408x242286

Axtman, B. C., Stewart, K. E., Robbins, J. M., Garwe, T., Sarwar, Z., Gonzalez, R. A., Zander, T. L., Balla, F. M., & Albrecht, R. M. (2019). Prehospital needle thoracostomy: What are the indications and is a post-trauma center arrival chest tube required? The American Journal of Surgery, 218(6), 1138–1142. https://doi.org/10.1016/j.amjsurg.2019.09.020

Butler, F. K., Holcomb, J. B., Shackelford, S. A., Montgomery, H. R., Anderson, S., Cain, J. S., Champion, H. R., Cunningham, C. W., Dorlac, W. C., Drew, B., Edwards, K., Gandy, J. V., Glassberg, E., Gurney, J., Harcke, T., Jenkins, D. A., Johannigman, J., Kheirabadi, B. S., Kotwal, R. S., Zietlow, S. P. (2018). Management of suspected tension pneumothorax in Tactical Combat Casualty Care: TCCC guidelines change 17-02. Journal of Special Operations Medicine, 18(2), 19. https://doi.org/10.55460/xb1z-3bju

Chesters, A., Davies, G., & Wilson, A. (2015). Four years of pre-hospital simple thoracostomy performed by a physician-paramedic helicopter emergency medical service team: A description and review of Practice. Trauma, 18(2), 124–128. https://doi.org/10.1177/1460408615619197

Dickson, R. L., Gleisberg, G., Aiken, M., Crocker, K., Patrick, C., Nichols, T., Mason, C., & Fioretti, J. (2018). Emergency medical services simple thoracostomy for traumatic cardiac arrest: Postimplementation experience in a ground-based suburban/Rural Emergency Medical Services Agency. The Journal of Emergency Medicine, 55(3), 366–371. https://doi.org/10.1016/j.jemermed.2018.05.027

Fairley, R. R., Ahmed, S., Schauer, S. G., Wampler, D. A., Tanaka, K., Everitt, B., Sparkman, M. K., Casanova, R., Sifuentes, J., & Winckler, C. J. (2021). A pilot study to assess urban, fire-based paramedic accuracy in identification of anatomical landmarks necessary for cricothyrotomy and needle chest decompression using live patient models. Prehospital and Disaster Medicine, 1–4. https://doi.org/10.1017/s1049023x21000340

Fok, P. T., Teubner, D., Purdell-Lewis, J., & Pearce, A. (2019). Predictors of prehospital on-scene time in an australian emergency retrieval service. Prehospital and Disaster Medicine, 34(03), 317–321. https://doi.org/10.1017/s1049023x19004394

Hannon, L., St Clair, T., Smith, K., Fitzgerald, M., Mitra, B., Olaussen, A., Moloney, J., Braitberg, G., Judson, R., Teague, W., Quinn, N., Kim, Y., & Bernard, S. (2020). Finger thoracostomy in patients with chest trauma performed by paramedics on a Helicopter Emergency Medical Service. Emergency Medicine Australasia, 32(4), 650–656. https://doi.org/10.1111/1742-6723.13549

High, K., & Brywczynski, J. (2016). Safety and efficacy of thoracostomy in the Air Medical Environment. Air Medical Journal, 35(5), 286. https://doi.org/10.1016/j.amj.2016.07.027

Jodie, P., & Kerstin, H. (2017). BET1: Pre-hospital finger thoracostomy in patients with traumatic cardiac arrest. Emergency Medicine Journal, 34(6). https://doi.org/10.1136/emermed-2017-206808.1

Jodie, P., & Kerstin, H. (2017). BET 2: Pre-hospital finger thoracostomy in patients with chest trauma. Emergency Medicine Journal, 34(6). https://doi.org/10.1136/emermed-2017-206808.2

Kaserer, A., Stein, P., Simmen, H.-P., Spahn, D. R., & Neuhaus, V. (2017). Failure rate of prehospital chest decompression after severe thoracic trauma. The American Journal of Emergency Medicine, 35(3), 469–474. https://doi.org/10.1016/j.ajem.2016.11.057

Martin, M., Satterly, S., Inaba, K., & Blair, K. (2012). Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Journal of Trauma and Acute Care Surgery, 73(6), 1412–1417. https://doi.org/10.1097/ta.0b013e31825ac511

Massarutti, D., Trill, G., Berlot, G., Tomasini, A., Bacer, B., D??Orlando, L., Viviani, M., Rinaldi, A., Babuin, A., Burato, L., & Carchietti, E. (2006). Simple thoracostomy in prehospital trauma management is safe and effective: A 2-year experience by helicopter emergency medical crews. European Journal of Emergency Medicine, 13(5), 276–280. https://doi.org/10.1097/00063110-200610000-00006

Mistry, N., Bleetman, A., & Roberts, K. J. (2009). Chest decompression during the resuscitation of patients in prehospital traumatic cardiac arrest. Emergency Medicine Journal, 26(10), 738–740. https://doi.org/10.1136/emj.2008.065599

Robitaille-Fortin, M., Norman, S., Archer, T., & Mercier, E. (2021). Prehospital decompression of pneumothorax: A systematic review of recent evidence. Prehospital and Disaster Medicine, 1–10. https://doi.org/10.1017/s1049023x21000509 San Antonio Fire Department. (2022). Instrument/Finger Thoracostomy. San Antonio Fire Department Retrieved December 6, 2022, from https://www.acidremap.com/sites/SanAntonioFD/

Shapey, I. M., Kumar, D. S., & Roberts, K. (2012). Invasive and surgical procedures in pre-hospital care: What is the need? European Journal of Trauma and Emergency Surgery, 38(6), 633–639. https://doi.org/10.1007/s00068-012-0207-9

Sharrock, M. K., Shannon, B., Garcia Gonzalez, C., Clair, T. S., Mitra, B., Noonan, M., Fitzgerald, P. M., & Olaussen, A. (2021). Prehospital Paramedic pleural decompression: A systematic review. Injury, 52(10), 2778–2786. https://doi.org/10.1016/j.injury.2021.08.008

Weichenthal, L. A., Owen, S., Stroh, G., & Ramos, J. (2018). Needle thoracostomy: Does changing needle length and location change patient outcome? Prehospital and Disaster Medicine, 33(3), 237–244. https://doi.org/10.1017/s1049023x18000316