In this first episode, Dr Alan Garner and Dr Andrew Weatherall chat about decompressing the chest in the setting of prehospital pneumothorax. It's a chat to go over the reasons a clinician might choose to act, the role of ultrasound in the process, and a walk through the evidence (or what little evidence there is) on the pros and cons of various techniques for chest decompression and maintaining the effect of that first chosen technique. No one technique is perfect because they all have complications that matter. It might be that what we really need is better evidence.