Your hospital staff is working its third code in as many days, and, once again, the portable monitor you rely on for pacing and defibrillation has become disconnected. You’ve asked your manager repeatedly for a replacement, and as you fumble with the cord, you decide something must be done.

The extrication has been ongoing for over half an hour, but the crews are still struggling to free the trapped driver. As the medic in charge, you are wedged into the passenger seat, trying to control the blood streaming from the patient’s nose and mouth. The victim is conscious, but his blood pressure is dropping, his pulse is weak and thready, and he’s fighting agonizing pain from his crushed legs. All you can do is continue suctioning his airway, when suddenly your catheter becomes clogged. What do you do?

For any emergency responder who has ever run on a “child choking,” you know it is typically a frantic scenario. Not only is it horrific to witness a child who is unable to breathe, but you have mere seconds to correct the event or face an inevitable pediatric code.

Respiratory emergencies are some of the most critical cases you will encounter. Every second counts, so you had better be ready. Recognizing a patient in distress, treating him or her immediately, and transferring him or her to an appropriate facility are some of the ways you can help improve patient outcomes, but there are other concerns that you as a medic must keep in mind. Here are three of them:

This morning, you glanced at your calendar and realized the quarterly meeting with your paramedic lieutenants was quickly approaching. As an EMS manager, you know these meetings provide a great opportunity for feedback from the field: which treatment strategies are working, and which ones are not; what common problems their personnel encounter on scenes; and if there are any equipment issues that must be addressed.

As an EMS professional, you know that the elderly make up a large percentage of your patients, especially if you work in one of the more common retiree zones (Florida or Arizona, for example). According to the CDC, that number is only increasing. In the last century, our country has seen unprecedented growth in the number of geriatrics. Longer life spans and aging Baby Boomers are the leading factors in this increase, and by 2030, elderly people are expected to account for roughly 20 percent of the U.S. population.¹ Which for you means that the number of geriatric patients you run on each year will only increase.

As a front-line paramedic, you know how important oral and nasal suctioning can be in patient outcome. How else are you going to clear that airway, if not through an effective and efficient portable suction unit? From respiratory emergencies, such as pulmonary edema, to traumatic injuries, there is no better way to clear an airway than through prompt suctioning.

The field of EMS is governed by procedures. Because you work in a fast-paced, high-intensity arena, you don’t have time to contemplate each step in an emergency. Much of your response must be instinctual, based on training, education, and practice. Which is why the use of your portable suction unit should be incorporated into the preparation, response, and post-response phase of respiratory distress emergencies. Here are some considerations when establishing suction procedures:

As a paramedic tasked with performing lifesaving treatments in the field, you know that every procedure you perform has potential complications. The tenuous IV you establish in the geriatric patient may blow; the tube may become dislodged during transport; or the cardiac rhythm may simply refuse to convert, no matter what medication you try. These are just a few of the hurdles you face as a paramedic administering care in emergency situations. And even the simplest of treatments can pose complications under the trying conditions in which you work.

She had only turned her back for a minute—just enough time to run into the house to retrieve her cellphone. As she returned to the backyard, the first thing she noticed was the empty raft, drifting slowly toward the deep end of the pool. The child was nowhere to be seen.