All patients with tension pneumothoraces or hemothoraces have a chest drain inserted at
the roadside. In addition, chest drains are inserted in all patients with small uncomplicated
pneumothoraces, because a pneumothorax secondary to trauma often converts to a lifethreatening
tension pneumothorax which is difficult to treat within the confined space of a
helicopter cabin. Chest drains are also required in patients with a simple pneumothorax who
are intubated because intermittent positive pressure ventilation may rapidly convert a simple
pneumothorax to a tension pneumothorax.