A new April 2026 cadaveric study put another dent in needle decompression — 76% success in ideal lab conditions. A 2024 retrospective had finger thoracostomy at 93% versus 47%. The evidence has stacked up for a decade. Civilian ground EMS still won't pick up the scalpel.

The 2020 AHA guidelines say firm surface, and every EMS crew has been arguing about backboards and floor transfers ever since. A 2024 ILCOR meta-analysis and new June 2026 research quietly show the argument is aimed at the wrong variable — and the real fix has nothing to do with the mattress.