The helicopter medical team of the Basel University Hospital treated and evacuated 710 patients in 1987/88. 484 were trauma patients (68.2%) and the intensive medical care began on the accident scene in 56% of the cases. We treated 90 thoracic injuries. 58.9% of these patients needed a chest tube which was directly inserted at the emergency place in 41.4% of the cases. An endotracheal intubation was necessary for 83.8% of the patients with in-field insertion of a chest tube and for 33.9% of other injured persons. No iatrogenic complications were observed. The clinical follow-up showed less complications for infield treated patients. We conclude that in-field insertion of chest tubes, if correctly performed, is a safe procedure contributing to diminish the lethality and the morbidity of trauma patients.