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 Drugs go out of date, oxygen tanks become depleted, and batteries lose their charge.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!

When you think about treating patients with head injuries, using an emergency suction pump may not be the first thing that comes to mind. Certainly, airway is your main priority, but we tend to focus more on level of consciousness, spinal immobilization, and assessing for additional trauma than we do on portable suction.

If you serve in an administrative position within your department, you have a lot on your plate. Certifications must be kept up, training requirements must be met, and your personnel must be prepared to respond to an ever-changing EMS landscape, from biological attacks to mass-casualty incidents.

When was the last time you worked a code? If you serve a busy, urban area, or a population heavy on retirees, you probably remain proficient in advanced cardiac life support (ACLS). Drug therapies and dosages, intubation procedures, and post-resuscitation care are part and parcel to busy EMS systems. But what if you work in a slow-paced, rural setting, where the calls are few and far between? What happens to your ACLS skills if you rarely use them? Most likely, you lose them.

As you approached the patient, you could see instantly that he had multi-system trauma. While darting across a busy interstate, the young man had been struck by a pickup truck, which was now parked farther up the roadway, its windshield and front bumper exhibiting the damage of a high-speed impact. The patient was unconscious, his limbs splayed. He had massive head and facial trauma and deformity to both legs. Each gasping exhalation produced a bloody froth. Your mind immediately inventoried the injuries and you set to work.