Respiratory emergencies are some of the most critical calls to which you will respond. If the airway is impeded or the patient is unable to exchange oxygen, you could be heading straight toward respiratory arrest. Your job is to prevent the arrest and ensure a patent airway with good air exchange—which is why a thorough understanding of thoracic anatomy is fundamental to correcting respiratory insufficiency.

On October 2, 2017, we woke up to the grim news of another mass shooting. The night before, a man in Las Vegas had opened fire on a crowd of concert fans, discharging high-powered weapons from the 32nd floor of the Mandalay Bay hotel, killing 58 people and injuring over 800. Police stormed the hotel but found the gunman had already committed suicide, thus ending the siege after leaving a morbid path in his wake.

As we kick off the new year, and make plans for emergency preparedness, it behooves us to take a glimpse in the rearview. The prior year, 2017, was not pretty; we saw a plethora of natural disasters, from earthquakes in Mexico, to flooding in Bangladesh, to a hurricane leaving thousands without power on Puerto Rico, months after the rains have moved on.

Ask any paramedic and they’ll tell you one of the most critical pieces of equipment in their EMS arsenal is their portable suction unit. Nothing takes the place of a suction unit. There is no other means of removing blood, vomit, or secretions from an airway, except through immediate, aggressive suction. This is why the maintenance of your unit is vital to airway management.

As an emergency medical professional, you know the critical role that speed plays in your daily duties. Lights and sirens expedite your response, prefilled syringes provide immediate medication administration, and pre-gelled pads allow safe, instantaneous defibrillation.

The same can be said for suctioning: It must be performed the instant you recognize the need for it. Fortunately, today’s modern suction units provide immediate, powerful suction capabilities to clear clogged airways and restore patency. And whether you’re suctioning the oral or nasal cavity, or an advanced airway, expediency is key.

Let’s discuss the necessity of expedient nasotracheal suctioning.

Trauma patients can be some of the most complex challenges you will encounter as a paramedic. Traumatic injury can take many forms, from penetration, to blunt trauma, to amputation. Assessing the trauma patient involves triaging any life-threatening injuries, and correcting or stabilizing your patient until you can turn them over to a trauma team. When trauma involves the trachea, your patient may be at serious risk.

With the onslaught of winter and frigid temperatures spreading across the country, now is a good time to think about one of our most vulnerable populations: the elderly. Although geriatrics make up a clear majority of our patients, winter weather can pose additional challenges for these high-risk individuals.

As winter approaches, so too does cold and flu season. This time of year usually marks an uptick in emergency room visits and EMS responses, many of which involve a respiratory disorder. And any respiratory emergency can lead to a critical suction scenario. So, to prepare for the long winter ahead, let’s examine some potential winter suction scenarios you may encounter as we await the coming of Spring.

Oropharyngeal suctioning is a critical step in maintaining airway patency. This simple treatment can mean the difference between life and death for your patient, so proficiency is key. Identifying a tenuous airway, correcting the problem, and maintaining patency will improve patient outcomes and reduce length of hospital stays by preventing complications from aspiration and hypoxia.

One of the scariest calls you will run into is a child in respiratory distress. Children are challenging, with their inability to articulate symptoms; their small veins and airways; and the fact that when they crash, they crash with a vengeance.