Ok...My 2c... Quick resume:30 plus years (over 20 as a Medic) field provider for NYC EMS and Florida EMS.

In all those years I have NEVER needed to do a needle or surgical cric. I have only had ONE spontaneous Tension Pneumothorax (collapsed lung) patient. All others were trauma related and penetrating injuries. Maybe all of my 'blunt force' tramuas were lucky in that they never presented with a Tension Pneumothorax. Any lung collapses were self limiting on my patients (again-lucky for them?)

We were instructed that the Thoracentesis (needle decompression) was to relieve the TENSION Pneumo. We did not and do not do it for a simple pneumothorax. Granted a long term 'bug out' type scenario would present with other concerns maybe over days the simple will become tension- I (or really my patient) only had to make it to the ER. I do know that 'my' simple pneumos did not progress because I followed up on them to be sure I didn't miss anything.