It's three a.m., and you have just been dispatched to a "pediatric difficulty breathing." As you rub the sleep from your eyes, you perform a quick mental review of the PALS protocol, just in case. Perhaps the child simply has a cold, and the parent has panicked. It happens all the time. But perhaps it's something more serious. You had better be ready for anything.

Picture this: The storm had knocked out power across three counties, and unfortunately, your zone was situated in the thick of it. Although your station was equipped with an emergency generator, the steady influx of calls had kept you from touching base. And now you're dispatched to an overdose at the nearby homeless shelter.

You are called to a residence in the middle of the night. A frantic father meets you at the door and ushers you upstairs to his son’s room, where you find a four-year-old boy perched anxiously on the side of his bed. He is braced in a tripod position, his small arms rigidly fixed by his side as he leans forward, drooling into a puddle on the floor. The father noticed a fever last night when he put the boy to bed, but is astounded by the child’s rapid deterioration.

Every paramedic knows their equipment is only as good as its upkeep. Drugs go out of date, oxygen tanks become depleted, and batteries lose their charge. Unless you remain vigilant, your equipment will fail you when you need it the most. This is especially true of one of your most basic, yet essential tools: your portable suction unit.

When you think of intubation, you should automatically be thinking "suction." The two treatments go hand in hand; you cannot safely intubate without the aid of suction, which is why you must include the portable suction unit anytime there is the possibility of intubating.

Your BLS engine company is dispatched to a “difficulty breathing” call and your ALS rescue is still in the process of delivering their previous patient to the hospital. Dispatch is sending the next closest rescue, but the responding unit has just notified you that they are held up by a train.

You arrive on scene, grab your O2 bag and jump kit and head inside. You and your fellow EMTs are on your own, at least for the next several minutes. You had better be prepared to assess and initiate treatment for a patient in respiratory distress!

Airway suctioning is a routine part of a first responder’s job. From preventing aspiration pneumonia to clearing the airway of a drowning victim, the right suction machine is an integral part of your EMS toolkit. Yet many paramedics, EMTs, and other first responders avoid suctioning the airway unless they absolutely have to.

Airway obstructions are common and potentially lethal emergencies, especially among vulnerable populations such as children and geriatrics. In 2005, 19,000 children visited emergency rooms for airway obstruction. Obstruction with a foreign body is the most common type of airway obstruction in young children. Among geriatrics, obstructive airway diseases, dysphagia, and aspiration are more prevalent. The odds of airway obstruction increase with age. One study of geriatric patients found that at least 10 percent of seniors who undergo spirometric studies may have an airway obstruction.