Purpose: Difficulties with physical assessment inherent to the helicopter environment have led to suggestion that aeromedical crews may be unable to identify hemo- or pneumothorax (HTX/PTX) while in-flight. This study was conducted to determine the frequency of missed HTX/PTX in trauma patients undergoing air transport.

Methods: One year (1994) of an air medical service's trauma transports to a Level I trauma center were analyzed to identify patients undergoing tube thoracostomy (TT) within 2 hours of trauma center arrival. Patients who had received intra-transport needle thoracostomy were excluded. Records were reviewed to determine how HTX/PTX was diagnosed at the trauma center.

Results: Only 11 patients who had not received aeromedical needle decompression underwent TT at the receiving center. Two of the 11 were trauma arrests and received TT as part of thoracotomy, without air or blood return on TT. None of the remaining 9 patients had TT on clinical suspicion alone. Four had normal physical examination and underwent TT after chest X-ray (CXR). Remaining patients had no HTX/PTX clues on exam or CXR; one had a small HTX identified on chest computed tomography and the other four received intra-operative TT because of rib fractures in the setting of multisystem trauma.