Patient presenting with history, signs, and symptoms of traumatic injuries to the thorax. These signs include dyspnea, hypotension, cyanosis, difficulty speaking in complete sentences, and any signs of trauma to the thorax. Patients presenting with the signs and symptoms of significant chest trauma will be treated as Level I trauma patients by EMS personnel.

1. Perform patient assessment and ABC's. If immediate history/injuries involve thoracic cavity, assess and evaluate the patient for: (Order not important. Thouroughness with speed is).
   1. Unstable vitals
   2. Chest wounds and location
   3. SQ emphysema
   4. Hemoptysis
   5. Jugular venous distension
   6. Abnormal chest movement
   7. Breath sounds
   8. Crepitus
   9. Tracheal deviation/shifting
   10. Presence/Absence of exit wounds

2. Generally, administer high-flow oxygen via NRM. Use ventilatory support if indicated.
3. Apply pulse oximetry device and record O2 saturation levels if time permits.
4. Cover open chest wounds with Vaseline-type gauze occlusive dressing taped on three sides only, to allow air to escape but not enter. Reassess chest frequently as tension pneumothorax may still develop.
5. Stabilize rib fractures with patient positioned on injured side and/or manual stabilization. (Do not compromise c-spine)
6. Impaled objects should be left in place but stabilized.
7. Do not use PASG (MAST).
8. Transport as soon as possible. Evalute and manage other injuries as needed.
9. Monitor vital signs in accordance with S.O.P. protocol.
10. Request ALS Intercept due to trauma to the AIRWAY.

INTERMEDIATE LIFE SUPPORT

1. Establish IV access with 1 or 2 large bore IV's on an isotonic solution. Titrate flow to patient condition and vital signs. Consult with medical control if unsure of appropriate administration rate.

ADVANCED LIFE SUPPORT

1. Decompress suspected tension pneumothorax with largest available catheter in the 2nd intercostal space in the midclavicular line or alternatively the 4th intercostal space in the anterior axillary line. (Refer to the Pleural Decompression protocol for procedure).
2. Apply and monitor ECG as soon as possible. Treat dysrhythmias as necessary.