EMS providers play a critical role in the care of patients with COPD and CHF exacerbations. But what happens when you have a patient with history of both and they happen simultaneously? This is a challenge for us as providers because treatments vary and in fact can cause more complications for one or the other disease process. Signs and symptoms can be similar and present with worsening of your patient, making the situation difficult to differentiate because of common issues like shortness of breath and coughing. The severity of these exacerbations can vary greatly and can be very difficult to manage. By understanding the disease, its complications, and the appropriate treatment options, EMS providers can help to improve the outcomes for these patients. Core: Respiratory