Heres my two cents:
You should differenciate between penetrating and blunt trauma, but still keep it simple.
Penetrating trauma to the chest and increased respiratoru distress - needle the side of the penetration and hope for the best, if that didnt work then trouble shoot it. Was it a bad needle or the wrong side? Careful about bi-lateral needles, you've just commited them to bi-lateral chest tubes which is not fun to manage.
Blunt trauma to the chest, increased respiratory distress AND disappearing radial pulse on inspiration, or altogether - then they get the needle on the affected side. Check carefully for asymetrical expansion and go for the side that isnt expanding.
In a tensio pneumo, it is not the collapsed lung that kills, it is the increased intrathoracic pressure that occludes the vena cava (big vein that returns all the bodies blood to the heart then lungs then heart then back to the rest of the body, for those less medically inclined). It's that decreased preload to the heart that causes the PEA (pulseless electrical activity) that casues death.
Beleive it or not its a blood issue, not a breathing issue.
Pericardial tamponade can mimic this, or any mediastinal pneumo or hemo. Here a needle wont do much, but nothing less than an ER really will. Same as a hemothorax, they need the surgeon.