The call was to a shooting; no other information was provided. You arrive to find a gunshot wound to the mouth, self-inflicted, the shotgun still warm, the patient still conscious. A last minute flinch sent the blast careening through the patient’s cheek – a survivable wound, if you can keep the airway clear. But with heavy bleeding and massive tissue destruction, maintaining a patent airway is going to be tricky. You better have your suction ready.

From a large metropolitan teaching hospital to a rural medical center with less than 100 beds, it is clear that resources can vary greatly between patient care facilities. Small hospitals often face extra challenging circumstances, including limited workforce, physician shortages and decreased available funding to make infrastructure and equipment improvements. Yet despite these challenges, according to the American Hospital Association, 51 million Americans still rely on small, rural hospitals for their care.  What are some things small hospitals can do to ensure delivery of vital services on a modest budget?

Patients are routinely transported to various locations within the hospital, but that doesn’t mean it is without risk.  Regardless of whether a transport is emergent or non-emergent, careful thought should be given to the process, so that the patient is provided with a consistent and safe level of care.

Pediatric emergencies are some of the most challenging calls to which paramedics respond. And when the emergency involves the respiratory system - whether medical, traumatic, or obstructive - literally every second counts. The first step in pediatric airway management is securing a clear passageway. Therefore, medical suction is a crucial link in the treatment chain. But clearing a child’s airway is not the same as clearing that of an adult. Smaller jaws, larger tongues, shorter necks, and more anterior tracheas dictate extra care when suctioning the pediatric airway and the equipment you choose makes a difference.

You are transporting your 78-year-old patient for a CT scan. She has a history of COPD and has had a tracheostomy for several months. She normally has an effective cough to clear any secretions, but mid-transport you notice that she starts seeming restless and agitated. Her pulse oximeter begins to alarm, and on auscultation you hear rhonchi bilaterally. You suspect that she may need to be suctioned to remove a mucus plug. You flip the switch on the portable suction machine attached to the transport bed, and you hear... nothing. Even though the battery was charging for hours, your portable suction machine won’t operate.