Bilateral thoracostomies are where an incision into the chest wall either side of the patient is made to gain access to the lungs therein.  Usually done as a ‘prophylactic’ treatment of a tension pneumothorax or a haemothorax  Best performed under clean hospital conditions but done “on the road” in emergencies when the patient has suffered a traumatic cardiac arrest.  This is the time when a doctor to “loses” their keys.