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.

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.