Airway Management

A majority of preventable deaths occur because of obstructions to the airway. These obstructions can take place at any point within the respiratory system. One of the basic topics taught on a first aid course is ‘Airway Management’ – this topic can make you aware of airway problems and show you how to deal with them.

When unconscious you lose muscle tone; your tongue or any foreign body such as food, vomit or even saliva can become a hazard to the upper airway. If DRAB is followed by the first aider there is a chance to save a life.

Airway Management

D    –       Danger; the first person on scene must first protect themselves. Often, when I was in the fire service, we would attend incidents where one casualty had been reported, by the time we arrived there were several. It’s human nature to help someone in distress and, in the heat-of-the-moment it can be easy for rescuers to get caught up in the moment and do something at the cost of their own safety. If it is too dangerous do not attempt any first aid but, do make an emergency call to the emergency services.

               Tip: if you have access to a pair of protective rubber gloves put them on before commencing any first aid. This helps protect you from cross infection but it also gives you time to compose yourself, see any possible dangers, observe the mechanics-of-injury and look at the Vital signs of the casualty.

R    –       Response; while approaching the patient their conscious level should be challenged by using the Alert, Voice, Pain, Unresponsive (AVPU) Scale.

               Alert – Someone with an airway and breathing can communicate. Try to strike up a conversation, “Hello, I’m Tony, a first aider; can I help you?”  – You’re hoping to have a two-way-conversation.

               Voice – If the patient does not converse try to get them to respond to a voice command; “Can you open your eyes? Open your eyes?” – You want to see them open their eyes or if they are already open you want to see them tracking you.

               Pain – if they continue to falter, by administering controlled pain you will confirm the conscious level of the patient; Tap both shoulders and ask, “Can you feel this?” – If that fails, squeeze and dig your finger-nails into the top of the ears and ask the patient, “Can you feel this?” – The normal reaction is move away or defend yourself from pain; if there is no reaction then you can diagnose your patient as being;

               Unresponsive – if your patient has failed to show they are alert; or able to respond to a voice command; or not shown any reaction to pain stimuli, then they are not responding and classed as Unresponsive. If you are the only one at scene shout, “HELP!! Can someone help; we need some help over here please!!” – It’s not time to call the emergency services yet but the patient has a problem and you may need the help of a passerby.

A   –        Airway – an airway can easily become compromised when the patient has lost consciousness. If you can see, quite clearly that the patient is breathing do not move them just monitor them; moving them could make any injuries to their ‘C’ Spine worse (area of spine in the neck). If you have any doubts about the normality of the patients breathing you must first Check and then make the airway.

If you swam under water for any distance, the first thing you do when resurfacing would be to take a deep breath.  Likewise, if a patient has lain for a while with a compromised airway the first thing they would do when their airway is opened is take a deep breath to get air into their oxygen starved bodies. Any foreign objects in the mouth or airway would travel inwards with a 50/50 chance entering either, the stomach or entering and blocking the airway. To take away this 50% chance of blocking the airway it is best practice to move the head to the neutral position (Bruce Forsythe position – head slightly back with chin raised) and open the mouth by pulling the jaw down. Take a visual look inside and remove anything you may see – do not blind sweep the mouth with your fingers as you could force any foreign object down the throat.

Once you’re happy the airway is clear you can then open the airway by performing the HEAD-TILT-CHIN-LIFT movement. Your tongue can become a foreign object when you are unresponsive and fall back over the airway to alleviate this you need to put the palm of your hand on their forehead and tilt the head back as far as it will slide (HEAD-TILT) and then grab hold of the chin with your other hand and pull it up (CHIN-LIFT).

               Tip: Move your own jaw forward to make your bottom set of teeth more prominent of your top set of teeth – hold your chin while you do this and feel how your jaw is moving – this is how you should move the patients jaw. The back of the jaw (the mandible) is connected to the tongue and by pulling the jaw forward in this way the tongue is physically moved away from the airway.

B    –    Breathing; the final part of the HEAD-TILT-CHIN-LIFT manoeuvre is to put your head in a position where you can LOOK down the chest of the patient. Ideally your ear needs to be near their nose and mouth so you can LISTEN for breathing and your cheek should be close enough to FEEL their breath; known as Look, Listen and Feel.

In this position and continuing the Head-tilt-chin-lift, you ‘Look, Listen and Feel’ for a maximum of 10-seconds; you want to register two to three normal breaths. If you have any doubts about the normality of the breathing and you have previously diagnosed your patient has being ‘Unresponsive’ you would now need someone to call for an ambulance; if there is no one else then you have to abandon the patient and do this yourself.

If the patient can breathe normally during the head-tilt-chin-lift assisted 10-second observation you need to know if they can breathe ‘unassisted’ – keep their head tilted back but release the chin and observe them again for a further 10-seconds, asking yourself, “Can the casualty breathe normally?”

If they continue to breathe normally then continue to check for any severe bleeds; treating any you find and then do a head-to-toe survey to see if you can find any other injuries that may need your attention.


Any unresponsive patient you have to leave on their own or, if their airway becomes compromised at any stage put them into the ‘Recovery’ position; sometimes known as the SODA position (Safe/Open/Draining/Airway). They need to be rolled onto their side with their head slightly tilted downwards and mouth opened to give them a draining airway – to stop saliva, vomit or even the tongue compromising the airway. Attending a first aid course will show you a simple easy method how to do this.

DRAB is known as the ‘Primary Survey’ – it is the basic knowledge and skill everyone should learn and practice in any first aid situation. If you can keep yourself safe, and find out whether the casualty has an airway, and are able to breathe, and you know how to open and protect airways; this will help prevent many deaths.

Tony Clough