Tension pneumothorax is commonly unidentified and undertreated by EMS. There has been an expansion of scope-of-practice across the nation, allowing paramedics to perform finger thoracostomy for suspected tension pneumothorax. However, few paramedics have hands-on training. In this workshop, we will discuss identification and practice hands-on treatment of pneumothorax in both patients who are conscious as well as those who are in cardiac arrest or peri-arrest. Students will review updated literature that has modified the techniques commonly used for pleural needle decompression. We will discuss the indications and contraindications for finger thoracostomy as well as two techniques for chest tube insertion in the EMS setting. Students will have the opportunity to practice all skills.