OBJECTIVES: The indications for emergency thoracotomy are controversial for blunt trauma. The best results were seen in those patients who were stable enough to undergo thoracotomy in the operating theatre and survived the operation. METHODS: The hospital records of 29 patients who underwent emergency thoracotomy for blunt thoracic trauma were reviewed. RESULTS: Of 964 patients with thoracic trauma, 745 (77.3%) sustained blunt injury and 29 of these patients (3.9%) required emergency thoracotomy. Six patients underwent emergency department thoracotomy for blunt cardiac trauma and only one of them survived (16.7%). Of the 23 patients who had emergency thoracotomy at the operating theatre, 2 died in the early postoperative period due to pulmonary embolism (8.7%) and 21 of them survived (91.3%). CONCLUSION: The results of emergency department thoracotomy in our series were extremely poor compared with the results of other reports, mainly due to rapid deterioration of hemodynamic condition caused by severe cardiac injury. The outcome from emergency thoracotomy in the operating theatre was encouraging, due particularly to the patients' status being stable enough to be transferred to a fully equipped operating theatre. We emphasize the importance of emergency medicine education programmes on rapid diagnosis of traumatic injuries with early intervention, and adequate hemodynamic and respiratory support.