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In the case of a tension pneumothorax, the priority intervention is immediate needle decompression followed by chest tube placement. This response is crucial because a tension pneumothorax occurs when air accumulates in the pleural space and creates increased pressure that can compromise cardiovascular and respiratory function. The pressure buildup can lead to lung collapse and severe mediastinal shift, which can quickly become life-threatening.

Needle decompression involves inserting a large-bore needle into the second intercostal space at the midclavicular line, allowing trapped air to escape and alleviating the pressure. This rapid intervention stabilizes the patient and provides the necessary time to arrange further treatment, such as chest tube placement, which establishes continuous drainage of air or fluid from the pleural space.

Other options such as oxygen therapy and monitoring are important for overall management but do not address the acute life-threatening nature of a tension pneumothorax. Pain relief medication is supportive but not a critical intervention in this emergency scenario. Merely assessing vital signs, while important for monitoring, does not treat the underlying condition and delays essential lifesaving procedures.