What is the immediate prehospital management for a patient with suspected tension pneumothorax?

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Relieving intrapleural pressure rapidly is essential because a tension pneumothorax traps air under pressure, collapsing the lung and shifting the mediastinum, which severely reduces venous return to the heart and can cause shock or death if not treated immediately. The quickest way to restore circulation in the field is needle decompression: insert a large-bore needle (about 14–16 gauge) into the chest to vent the trapped air, typically in the second intercostal space at the midclavicular line or another protocol-approved site. After decompression, continue high-flow oxygen and arrange rapid transport for definitive care, such as chest tube placement. Bronchodilators or simply observing will not relieve the life-threatening pressure, and a field chest tube is typically not performed due to time and equipment constraints.