You quickly insert another needle thoracostomy, and then insert a chest drain on the right side to provide secure drainage during transport. Even had he not developed a tension pneumothorax now, he had a high likelihood of developing one, given those rib fractures and positive pressure ventilation. (Obviously you were going to put one up before taking off anyway - just checking).

He remains tachycardic at 110 and hypotensive with a BP of 90/30. Your two litres of Ringer's have gone through and you replace them with new warmed bags. The patient is loaded onto the helicopter and you give the OK to take off.