Emergency prehospital on-scene thoracotomy: a novel method.

The necessity for prehospital thoracotomy is rare, but can be lifesaving. Occasionally an emergency practitioner or surgeon coincidentally arrives at a trauma scene before the arrival of emergency medical teams. In such a circumstance, even when thoracotomy may be indicated, it is not usually performed in view of the lack of equipment (e.g., dissecting tools or rib retractor). We present a novel technique of "L" shape thoracotomy, or Thoraco-sterno-costochondrotomy, whereby in a prehospital setting, and with minimal equipment (such as a penknife) a thoracotomy can be performed with adequate exposure of the heart and great vessels. The similarities of this pragmatic procedure are considered within the context of ancient Aztec and Mesoamerican thoracotomies.