Flail chest happens when several ribs are broken in more than one place, so that a section of the chest wall becomes loose and no longer moves with the rest. This loose segment moves in the opposite direction to the chest when the person breathes, which is called paradoxical breathing. It makes each breath less effective, and the bruised lung underneath adds to the problem. Flail chest is a serious injury that follows crush, fall or vehicle injuries, and it needs hospital care.
Recognising Flail Chest
- Severe chest pain, worse on breathing
- Rapid, shallow, laboured breathing
- A section of chest that sinks in when the person breathes in and bulges out when they breathe out
- Bruising and swelling over the ribs, sometimes with a grating feeling
- Blue lips, pale clammy skin and signs of shock
Flail Chest First Aid Steps for a Conscious Person
- Call the emergency number and tell them you suspect broken ribs with abnormal breathing.
- Position them comfortably. Most people breathe best half sitting and leaning toward the injured side, with head and shoulders supported.
- Support the injured area gently. Place a thick pad or folded cloth over the loose segment and ask the person to hold it in place with their hand or arm, or support the arm on the injured side with a sling. Do not tie anything tightly around the chest.
- Reassure and keep them warm, avoiding movement.
- Monitor breathing rate, pulse, skin colour and alertness regularly. See vital signs observations.
- Give oxygen if trained and permitted by your protocol, and prepare to assist breathing if it fails.
If the Person Is Unconscious
Open the airway and follow the DRABC primary survey. If breathing normally, place them in the recovery position lying on the injured side so the stronger lung is free to expand. Seek urgent help and begin CPR if breathing stops.
Why Flail Chest Is Dangerous
The lung under the loose segment is often bruised, which reduces oxygen uptake. Pain makes the person take shallow breaths, and broken ribs can puncture the lung or cause bleeding inside the chest. Hospital care may include oxygen, strong pain relief, regional anaesthetic blocks and, in severe cases, a breathing machine.
Flail Chest Compared With Other Chest Injuries
A person with a penetrating wound and a sound of air entering needs the steps in sucking chest wound first aid. A person with deep tenderness, pain on breathing and no loose segment may have a simple rib fracture, but should still be assessed.
Pain Control and Breathing After Chest Injury
Pain is a major reason people with chest wall injuries breathe poorly, and shallow breathing leads to lung collapse and chest infection. First aiders should not give strong medicines but can keep the person still, reassure them and ask them to breathe as deeply as they can bear. In hospital, good pain relief is central to recovery, and some patients need regional nerve blocks. Recovery from a flail segment takes weeks, and people are advised to stop smoking and attend follow-up physiotherapy to prevent complications.
Frequently Asked Questions
Should I strap the ribs tightly?
No. Tight bandaging restricts breathing. Support gently with a pad and the person’s own arm.
Can a flail chest heal?
Yes, with medical care, but recovery takes weeks and pain control and breathing exercises are important.
References and Further Reading
Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team
This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.
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