Chest Decompression Needles: Vital kit or Tactical Talisman?

Written by Greg Ellifritz

Topics: Articles

  • SumoMe

This is a guest article from my friend and veteran paramedic Jonathan Willis.  Jonathan is a fire department lieutenant and teaches tactical first aid classes for Dave Spaulding at Handgun Combatives.  This is a good article.  I carry a needle in my kit, but I know how to use it and also go places where there is no possibility of receiving definitive medical care within 12-24 hours.  Your kit should be intelligently put together considering the availability of resources, your individual skill level, and your mission.  Here is Jonathan’s take on the topic.  Pay attention.

– Greg


As will be the case in this often trend driven industry, yet another tactical talisman has entered the must have lists of many a preparedness minded individual. You’ve all seen them, or bought them, yet very few have any legitimate training or authority to even posses them. We are talking about the chest decompression needle. It must finally be said, please STOP; you know not what you do.



I have been an instructor in most disciplines of Fire, EMS, and Technical Rescue operations for several years now, operating on the streets for 17 years. Like most in my service, I have responded to thousands of calls that include pretty much any insult to the human form an individual could imagine. But guess what, I’ve seen more double rainbows in my life than I’ve even heard of pre-hospital tension pneumothorax decompressions.



You might be interested to know that ER physicians have an approximately 68% success rate of successfully detecting tension pneumothorax within the controlled environment of an emergency room. Yet thousands of people believe they can pull it off with no training in the uncontrolled environment of a trauma scene. There are also a great number of false positives that end up “darted” that complicate patient condition greatly. This procedure is an extraordinarily rare need and NOT a “ground ball” to perform.



I am very happy that there has been an increased focus on civilian trauma management education. Please stop calling it “tactical” or “extreme” to sound cool; it’s just trauma management. I instruct civilians. I instruct my family and friends. So I obviously believe it is vitally important that you are able to stop bleeding and live, whether it’s a gunshot wound or a workshop injury. I encourage everyone to attend a class and learn real world LSIs (Life Saving Interventions). Afterward, buy some appropriate kit and strategically locate it. You are good to go. A well intended tip; Like the shooting world, there are many instructors on this topic who’s credentials are suspect to say the least. Vet your instructors!



Some folks have taken the next step and decided to attend an Emergency Medical Technician course. This is a great effort, easily completed in a few weeks, but be careful, far too often I see these folks carrying more advanced care crap in their kits than many of my physician friends. The quickest way to not be an EMT anymore is to carry advanced kit, made much worse if you dare attempt to use it. If you are an EMT, you are required to stay within your scope of practice BY LAW, and decompressing a pnuemo isn’t in your lane.



Hypothermia management aside, there is no trauma intervention easier to master than modern bleeding control. This mastery however only comes from continual training, as these skills are perishable even for the professionals. The equipment used is top notch, represents a statistically relevant injury occurrence, and are actually LEGAL for civilians to obtain without a prescription.



I understand people’s attraction to do-dads, especially items of a tactical nature. I understand that there is a certain implied CDI factor to visually conveying an “I got this” attitude by wearing a full blow out kit on your belt. But when you take up a 3 ¼ inch, 10 or 14 gauge needle and attempt to place it perfectly within the plural space without any confirmation methods or true understanding of the indications or contra-indications, you have ventured out of your league. The patient outcome implications can be severe, and you will be challenged. Your good intentions, and one-day class on the matter cannot help you.



Now I understand this will have the potential to offend a great many well-intended people, but know your efforts to learn are a tremendous positive step. Some of my most enjoyable teaching experiences come from working with civilians that truly wish to expand their skillset in appropriate trauma management techniques. I’m just sharing that there are FAR more important techniques and concepts upon which you should be focusing your time, effort, and money.



I discussed this matter recently with a physician friend of mine. Not some technically a doctor type, but a down and dirty, aggressive young doc that is a driving force in trauma management and EMS operations in a significant metropolitan. For the ninjas among us, also a Brazilian jujitsu loving SWAT team member, with extensive military deployment experience in our recent conflicts. He echoed my sentiment saying frankly, “Too many folks just want to do the sexy advanced stuff. They need to be concentrating on BLEEDING CONTROL, AIRWAY MANAGEMENT, HYPOTHERMIA, and EXFIL.” Hypothermia and exfil are so ridiculously easy, but blankets and truck beds just aren’t that interesting. If I invented the Tacti-Quilt and patented Tac-Exfil Truckbeds I may be a millionaire sooner than I thought. But I digress. My friend added some other expressions against the absurd trend of civilians carrying pnuemo kits, but I’ll keep this family friendly. Sincere thanks for keeping it real Doc.



In closing, there are many myths that have in recent years been debunked through real science and research. Back-boarding, Big bore IVs, TQ disasters, just to name a few. Add to that list, the misguided expectation that you aren’t on the cool kid list without a chest decompression needle. Stick to the list above from the good doc, with quality up to date training, and you are good to go!



*For your questions on civilian trauma management, or to set up a Real World Trauma class visit



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5 Comments For This Post I'd Love to Hear Yours!

  1. Steve Owens says:

    THANK YOU. As a fellow medic with plenty of field trauma experience I applaud you for finally saying it out loud! Needle decompression isn’t nothing. It is an invasive procedure with significant consequences if not indicated. When teaching civilians I suggest thinking more about chest seals than decompression.

  2. Al T. says:

    Good article. Using the needle was covered in an Army Combat Lifesaver Class I took in 2008. Couple of Medics in class were just shaking their heads at the cavalier way using the needle was covered.

  3. Chris says:

    Thank you so much for posting this! As an EMT and an RN (also the training officer for my local EMS service) I can’t begin to tell you how much dread I feel every time I see some joker whipping out a 14-ga. angiocath when discussing trauma care for the average Joe. I’ve worked in a large level one trauma center and I’ve only seen a patient come in with a needled chest a few times–each time performed by a flight doc or nurse. It’s silly to cover the material in a first aid class.

    We live in an era where states (and medical directors) are beginning to consider eliminating many of these low-occurrence treatments and procedures from EMS protocols. Why teach it to the average Joe?

  4. SWATdoc says:

    Very nice overview. If you think you are going to be like George Clooney in “Three Kings” and decompress Marky Mark I say: guess again. That scene was a bunch of baloney. A few additional points:

    1. In my 17 years of emergency physician experience (hey Jonathan, we’re tied!) the only tension pneumos I have seen have either developed from popped blebs in COPD patients, or in blunt or penetrating trauma patients AFTER they have been intubated (positive pressure ventilation is troublesome when you have an air-leak somewhere in your pulmonary system.)

    2. A dedicated decompression needle can be useful in those cases, but better to vent the chest with a scalpel and clamp and pop in a chest tube (if you are qualified; not trying to give the tacticool crowd something else to gun for.)

    3. In my experience with patients coming in needled from the field, and in review of field needle decompression by TRAINED MEDICS in our EMS region, the success rate of the procedure is pretty dismal. And yes, I have seen it done when not indicated. Not a good thing.

    4. We (yes, I work with Jonathan’s above-mentioned doc…taught him everything he knows 🙂 )do not teach needle decompression as a skill to LEOs, be they patrol or SWAT. But we do have SWAT operators carry a needle in their kit so that WE can use it ON THEM should it be necessary.

    5. An open chest wound will not kill you (more likely that rapidly expanding hemothorax will) but will leave you huffing and puffing. Chest seals will improve respiratory dynamics, but be aware you now have a closed system. Should the casualty develop respiratory distress at that point, do not needle them unless you are a qualified medic. Instead, try burping the chest seal.

    Sorry to ramble. My more than two cents.

  5. Tierlieb says:

    I am the typical user. I went to some rather high level TCCC courses and was taught how to use the needle for chest decompression. That use was covered in quite a bit of detail with a bunch of practical exercises. But I was not taught indications and counter-indications to the level where I feel comfortable using them as I found out during an excellent scenario training. That is why I decided I am not going to use it until I get some explicit training in that regard.

    Yet I still carry a needle for the simple reason that I might encounter someone who knows how to use it – mainly on me (where I come from, we use the patient’s medical kit on them whenever possible) but also on others (the case of being on a shooting range with a bunch of medical doctors who do not carry kit because “an ambulance is only 10mins away” – which is true for my country most of the time). “Better have it and not need it” applies to a little needle the size of a ballpoint pen, I think.

    After this article, I think I may forego looking for more training in regards to chest decompression and concentrate on easier issues like recommended.

    P.S.: I’d love to read a similar treatment to coniotomies – the time devoted to it in most TCCC curricula is similar to chest decomp, the necessary tools are more complex (and too bulky to carry in anything but a dedicated emergency bag) but to me it seems indications and counter indications are much more obvious. Personally, I would feel much more confident in a coniotomy than in chest decompression.

    P.P.S.: To be fair to all those that taught me: Those courses had a noticeable amount of SOF and PMC who might have to deal with issues of extended care. It does make a lot more sense there.

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