The incidence of preventable death resulting from tension pneumothorax has been reduced in the recent Middle Eastern conflicts. One reason for the decrease is that U.S. combatants now use personal protective equipment that provides significant protection for the chest and back, though it should be noted that chest wounds may still result from bullets or shrapnel impacting near the edge of the body armor and traveling into the chest.

Despite the use of modern body armor, tension pneumothorax remains one of the leading causes of death on the battlefield and can be managed in the field. Like hemorrhage, tension pneumothorax is treatable.

These signs may be difficult to assess in a combat situation. You must be alert to the possibility of tension pneumothorax whenever a casualty has penetrating or other chest wounds. Therefore, the sole criterion for suspecting a tension pneumothorax is significant torso trauma or primary blast injury and one or more of the following:

- Severe or progressive respiratory distress
- Severe or progressive tachypnea
- Absent or markedly decreased breath sounds on one side of the chest
- Hemoglobin oxygen saturation < 90% on pulse oximetry
- Shock
- Traumatic cardiac arrest without obviously fatal wounds

It is important to evaluate casualties during TFC for early and late signs of tension pneumothorax. Left untreated, tension pneumothorax can cause severe respiratory distress, shock, and death. The treatment for a tension pneumothorax is to let the air trapped under pressure escape by performing a needle decompression of the chest.