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Respiratory distress is a very common complaint in the prehospital setting. The initial evaluation should be focused on identifying immediate threats to life and determining needs for immediate intervention, such as NIPPV, bag‐valve‐mask ventilation, or advanced airway management (supraglottic airway or endotracheal intubation). Once this evaluation is completed, efforts should be focused on attempting to determine the underlying cause of the problem. Respiratory distress may be caused by a primary pulmonary, cardiovascular, or infectious problem issue, or as part of the compensation for another nonpulmonary problem.

In general, treatment should include titrated oxygen with cardiac rhythm, pulse oximetry, and waveform capnography monitoring while ensuring timely transport. In stable situations, the emphasis should focus on avoiding overtreatment and resisting the urge to give multiple medications in an undirected fashion. However, short‐acting inhaled bronchodilators should be initiated if there is a concern for bronchospasm, and nitrates should be considered as first‐line therapy in the patient with findings consistent with ADHF or SCAPE.