As an emergency responder, you know what a vital role training plays in job preparedness. You can’t predict what the next call will be, so you had better be ready for anything your community throws at you. Some calls are standard: the unresponsive patient, the elderly person having chest pain, or the child who fell off his bike, breaking his arm. These types of calls come in with such frequency, that training for them can seem redundant and unnecessary.

The man had been mowing the lawn when he collapsed under the intense, midday sun. You arrive on scene to find an elderly man, pulseless and apneic, in the front yard of a small house. The neighbors have gathered in a worried huddle, dogs are barking from behind a nearby fence, and all eyes are on you to immediately remedy the situation.

The patient was practically comatose by the time you arrived on scene. A gastric cancer patient, he had lost his ability to effectively swallow and had regurgitated once he arrived home from his chemotherapy treatment. As your partner flips open the airway bag, you attach the monitor and note a bradycardic rate of fifty-four. You set up for an IV while your partner cranks on the O2, only to realize the tank is empty. He dashes out to the truck for a replacement while you attempt the IV. Valuable seconds tick by. The patient is breathing on his own, yet gasping, and you fail to notice the remnants of vomit and bile rimming his mouth. With each passing minute, he inhales more of the acidic stomach contents lodged in his airway. His prognosis is quickly devolving.

When was the last time you intubated a patient? If you work in a busy metropolitan area, with high trauma rates or a large elderly population, intubations may be a regular occurrence. But for many emergency personnel, especially those assigned to slower stations, intubations are few and far between. Which makes it all the more critical to stay on top of your skills. And if you aren’t getting tubes in the field, the only other place to hone your technique is through training.

The call comes in as a “gunshot wound to the head,” and you arrive on scene to find a middle-aged male with what appears to be a self-inflicted, small caliber entry wound to the right temple. He is sitting in a recliner and bleeding profusely from the nose and mouth. You carefully place him on a backboard, but once he is supine, his airway quickly fills with blood. Things are not looking good.

The call comes in as an “asthma attack” and you arrive on scene to find a ten-year-old asthmatic on the verge of respiratory arrest. You quickly set up oxygen and a breathing treatment while your partner hooks him up to the monitor and starts an IV. You load the patient for transport, whisk him down the street to the trauma center, which happens to have a specialized pediatric emergency center, and deliver him into the hands of specialists within a matter of minutes.

Whoever said “children are just small adults” never had to work on one in an emergency setting. Calls involving pediatric patients can be some of the most challenging you as a paramedic may encounter. Pediatric calls occur with less frequency than those involving adults, resulting in rusty skills and lack of confidence when treating juvenile patients.

You are dispatched to a “patient unconscious” and arrive on scene to find an obese man in his mid-50s, unresponsive and apneic. As his wife is describing his extensive cardiac history, the man goes into cardiac arrest and you initiate resuscitation. He is asystolic, so you immediately turn to drug therapy, only he has no veins to speak of. Your only option for drug therapy is through the endotracheal tube, which is also the best means of securing his airway, so you set up your equipment, have the suction unit close by, and position yourself for intubation. It’s not going to be easy.

Airway management is one of the most vital aspects of patient care and can range from basic adjuncts to complex interventions. Whether the patient is an overdose, in cardiac arrest, or the victim of multisystem trauma, the first step in treatment and stabilization is securing a patent airway. And fortunately, there are an array of choices for paramedics in the prehospital setting.