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A 7-year-old boy in Samoa required surgical intervention for airway obstruction by a live fish in the oropharynx. Traditional fishing practices in our country involve killing the fish by biting off the head. This young boy is still learning his craft, and an unsuccessful attempt resulted in his presentation for medical care with a wriggling live fish lodged in the oropharynx. We describe our management of the case, including recommendations. The case was a catalyst for the successful implementation of improved signage directing patients to the Emergency Department of the hospital, as well as development of an emergency airway ‘grab-bag.’