Just an NP and former ED nurse.Marbles,
I'm trying to remember if you're a medic or M.D.?
Knife beats a needle in my opinion (of course you need something for blunt dissection), though my opinion is based on learning from others, not personal experience.You're correct. I do greater than 10:1 but I don't work in the city where people get stabbed and shot. I see very few sucking chest wounds but I've needle decompressed dozens.
I carry a couple 14g 3" for that purpose when snowmobiling. I do not carry those while hunting but I do have knife.