Thoracic Trauma in the Field

Thoracic trauma is a critical cause of battlefield mortality, often resulting from high-velocity penetrating injuries and blunt force trauma sustained during combat operations. In austere and resource-limited environments, timely recognition and rapid field management are essential for survival. This chapter outlines the types, mechanisms, clinical features, and frontline treatment of thoracic injuries in the context of combat trauma. Penetrating injuries, such as gunshot wounds and shrapnel lacerations, commonly lead to pneumothorax, hemothorax, or cardiac tamponade, while blunt injuries from blasts or falls cause rib fractures, pulmonary contusions, and diaphragmatic rupture. Using the MARCH framework and TCCC phases, providers prioritize massive hemorrhage control, airway management, chest decompression, and hypothermia prevention before evacuation. Real-world case scenarios demonstrate successful use of field interventions including chest seals, needle decompression, portable oxygen, and pain control. When surgical care is delayed, stabilizing chest trauma in the field becomes the linchpin to improved outcomes. Advancements in prehospital technologies—like portable ultrasound and hemostatic agents—now support earlier diagnosis and better triage. By reinforcing combat-specific protocols, this chapter equips providers with the knowledge and tools to manage thoracic trauma under fire.