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Tension pneumothorax causes obstructive shock and requires immediate decompression. Needle decompression at the 4th/5th intercostal space, anterior axillary line, with a long catheter relieves pressure and restores circulation. Oxygen and pain meds may help but do not correct physiology. Upright positioning does not relieve pressure. Early recognition and rapid intervention save lives, with reassessment for recurrence and preparation for chest tube placement at higher care.

Alternate CCPs provide redundancy if the primary site is unsafe or insufficient. Preplanned alternates with rehearsed displacement routes ensure smooth transitions, minimizing confusion under fire. They do not reduce medic needs or HLZs. Including alternates in medical annexes reflects realistic battlefield planning and improves survivability.

The medical annex formalizes evacuation routes, CCPs, HLZ criteria, casualty collection flow, resupply, and medical tasks within the operational plan. Admin annex covers personnel/admin issues; communications plan covers nets and encryption. Commander’s intent provides overall mission purpose, not specific medical details. The medical annex ensures medics, leaders, and evacuation assets integrate seamlessly into tactical maneuvers, preventing delays and confusion in high-stress situations. It is a core planning tool for mission medical success.

Effective plans include explicit triggers for CCP displacement (e.g., enemy proximity, mass-casualty overflow), designated alternate locations, and rehearsed routes. When a trigger is met, execute the displacement plan: notify via brevity codes, maintain 360° security, move casualty staging and supplies by bounds, and re-establish triage/treatment zones quickly at the alternate site. Improvisation under fire increases friction and risk; abandoning casualties is unacceptable. Waiting for higher wastes critical time. Well-rehearsed displacement preserves medical capability and survivability while maintaining alignment with the scheme of maneuver and airspace/fires deconfliction.

Tension pneumothorax is rapidly fatal without decompression. Needle decompression at the 4th/5th intercostal space anterior axillary line, using a long catheter, relieves the pressure. Oxygen, pain meds, or fluids do not resolve obstructive shock. Immediate recognition and decompression save lives. Reassess for recurrence, manage chest wounds with seals, and expedite evacuation for definitive chest tube placement. Continual monitoring during movement is essential.