EMS scenario help plz?

Scene safety is always first. Are the police on the scene? Is the weapon secured and in safe hands or a safe place? Then making sure the airway is secure is next, while also protecting the spine. A .45 that entered the lateral chest wall could possibly have hit the spine, and you never know what path a bullet took. A cervical collar (neck brace) would be applied. Breathing at a rate of 32/minute says that they are probably shallow breaths, and he probably needs assistance breathing--I would use a bag-valve-mask with 100% oxygen. The hole in his chest should be covered with an occlusive dressing, like vaseline gauze. That would in turn be covered with bulky dressings to control any external bleeding. He is probably going into shock, so it is a true "load and go" situation. He should be secured to a long spineboard with straps, legs elevated due to the shock, and loaded into an ambulance, which should then hit the road asap. It sounds as if he is developing a tension pneumothorax, however the BP is a little high for a true scenario. Usually below 90 systolic. The chest needs to be decompressed (the right side). That is done with a 14 gauge IV catheter on the front of the chest, midclavicular line, in the 2nd or 3rd intercostal space. A one way valve should be placed on the hub of the catheter when the needle is removed. After that, 2 large-bore IV's should be started and the drip rate should be titrated to keep his blood pressure above 90 systolic. A thorough exam should be done, looking for exit wounds or any other wounds that could have been missed. Early notification of the trauma team at the hospital should be made because emergency surgery is needed and every minute counts. During transport, constant re-assessment of the airway, breathing status, circulation and vital signs should be done. After the chest decompression, the blood pressure should come up some and he should breathe better.