Advanced Paramedic Delivered Finger Thoracostomy

David Menzies, Stephen O'Neill, Jim Leonard, Paul Butcher, Paul Creevy, Dave Irwin



Introduction & Aims

Tension pneumothorax is a potentially fatal but reversible injury encountered in major trauma and traumatic cardiac arrest. Needle decompression has been the standard treatment approach pre hospital in Ireland and internationally. However, concerns exist regarding the effectiveness of this approach due to anatomy and body habitus. We aim to describe the training, introduction and experience of finger thoracostomy by advanced paramedics within a pre hospital service in Ireland.


Finger thoracostomy has been advocated as an alternative pre hospital treatment which is both diagnostic and therapeutic. Paramedic delivered thoracostomy is commonplace in pre hospital critical care services internationally. The MCI Medical Team (as part of Motorsport Rescue Services) is a PHECC-registered multidisciplinary team which provides medical cover at motorcycle road racing events in Ireland. The MCI Medical Team has significant experience of major trauma and routinely performs pre hospital anaesthesia for trauma patients. We introduced a training module on finger thoracostomy, comprising: theory, practical instruction and assessment for advanced paramedic members of the team.

Results & Conclusions

Advanced paramedic members of the team we trained to deliver finger thoracostomy in predefined circumstances when operating as part of the MCI medical team. To date, advanced paramedic delivered finger thoracostomy has been utilised on three occasions. Introduction of advanced paramedic delivered thoracostomy is a feasible and effective technique for the treatment of tension pneumothorax within a closely governed system.


Trauma; Pneumothorax; Thoracostomy

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London HEMS SOPs

PHECC Clinical Practice Guidelines, 2017

ATACC manual, 2014

MCI Medical Team SOPs, 2018

Dickson RL et al. EMS Simple Thoracosotmy for a Traumatic Cardiac Arrest. J Emergency med 2018. Jun 26.



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Copyright (c) 2018 David Menzies, Stephen O'Neill, Jim Leonard, Paul Butcher, Paul Creevy, Dave Irwin

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