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The triad of respiratory distress, unilateral absent or markedly diminished breath sounds, and signs of obstructive shock (e.g., hypotension, jugular venous distension) strongly indicates tension pneumothorax. Air trapped under pressure in the pleural space compresses the ipsilateral lung, shifts mediastinal structures, impedes venous return to the heart, and rapidly degrades perfusion. Massive hemothorax (A) would present with hypovolemia and dullness to percussion; neck veins are often flat due to blood loss. Flail chest (C) produces paradoxical chest wall motion with underlying pulmonary contusion, but typically breath sounds are still present bilaterally unless a pneumothorax coexists. Pulmonary contusion (D) causes worsening hypoxia over time with crackles, not immediate profound unilateral silence with obstructive physiology. AEMT priorities are rapid recognition, high-flow oxygen, support of ventilation, and immediate transport to a facility capable of definitive care. Depending on local scope, AEMTs may prepare for or assist with needle decompression performed by authorized providers. Continuous reassessment is crucial due to the condition’s potential to deteriorate rapidly.