The employment of a systematic approach is required to identify immediate and potentially life threatening thoracic trauma. The assessment of the breathing apparatus is key: in the field of play; respiratory rate, expansion and chest wall tenderness. In the medical room a more thorough examination including respiratory rate, expansion, percussion and auscultation with the possible assistance of monitoring oxygen saturations with a pulse oximeter. Such an approach will allow the practitioner to identify the conditions highlighted in this chapter and to either treat them appropriately or facilitate rapid, safe transfer to definitive care for treatment. Transfer to the emergency department to specialist care should be undertaken at the earliest opportunity once safe to do so with trained personnel and equipment.