Prehospital Management of Tension Pneumothorax by Nurses on Non-Physician-Staffed Advanced Life Support Units: A Scoping Review Protocol

Background: Tension pneumothorax (TPX) constitutes a time-critical medical emergency requiring immediate intervention to avert patient decompensation and potential fatality. Within the prehospital environment, non-physician-staffed advanced life support (ALS) units often represent the initial point of clinical contact, rendering the role of registered nurses deployed on such units—exemplified by the Lombardy region—of paramount significance. Nevertheless, the marked international heterogeneity in scopes of practice, clinical guidelines, and procedural frameworks necessitates an examination of optimal nursing management strategies for TPX and their respective effectiveness. Objective: This scoping review aims to systematically map the extant scientific literature regarding the prehospital management of tension pneumothorax performed by nurses operating within non-physician-staffed ALS units. The review endeavors to identify existing practices, protocols, and empirical evidence, drawing comparative insights from international paramedical models such as those involving paramedics and Emergency Medical Technicians (EMTs). Methods: This review will be conducted in accordance with the methodological framework delineated by Arksey and O'Malley, enhanced by the recommendations of Levac et al. and the Joanna Briggs Institute (JBI) guidelines. A comprehensive search was conducted across five primary biomedical databases: PubMed, Cochrane Library, CINAHL, Scopus, and Embase. An initial pool of 143 articles was identified; following the removal of 56 duplicates, 87 articles remain. These will be screened independently by two reviewers, with adjudication by a third reviewer in case of discrepancies. Data will be synthesized narratively and qualitatively, with visual representations prepared according to the PRISMA-ScR framework. Expected Results: The review anticipates delineating the principal clinical evaluation and management techniques for TPX, elucidating cross-national disparities and convergences in practice, and generating actionable insights pertinent to the potential integration of effective international methodologies into the Italian prehospital care framework. Implications: Findings are expected to provide a global overview of nursing-led TPX management techniques and a preliminary analysis of their medico-legal implications within the Italian legislative context. These results may inform clinical training, policy development, and further empirical investigations.