Why Airway Is the Top Priority
Airway management is the single most critical skill tested on the NREMT exam. Without a patent airway, no other intervention matters. The NREMT frequently tests your ability to recognize airway compromise, select the correct intervention, and understand the sequence of airway management steps. Every patient contact begins with assessing the airway.
Opening the Airway
The head-tilt chin-lift is the primary technique for opening the airway in patients without suspected spinal injury. For patients with suspected spinal injury, use the jaw-thrust maneuver. If the jaw thrust does not open the airway, the head-tilt chin-lift should be used because establishing an airway takes priority over spinal precautions. This is a frequently tested concept on the NREMT.
Airway Adjuncts: OPA and NPA
The oropharyngeal airway (OPA) is used in unresponsive patients without a gag reflex. It is sized from the corner of the mouth to the earlobe. The nasopharyngeal airway (NPA) can be used in patients with an intact gag reflex and is sized from the tip of the nose to the earlobe. NPAs are contraindicated in patients with suspected basilar skull fractures or significant facial trauma.
Suctioning
Suctioning clears the airway of blood, vomit, and secretions. Suction for no more than 15 seconds in adults and 10 seconds in pediatric patients. Use a rigid (Yankauer) catheter for the oropharynx and a French catheter for the nasopharynx or through an endotracheal tube. Always have suction ready before attempting any advanced airway intervention.
Bag-Valve-Mask Ventilation
BVM ventilation is a core EMT skill. Deliver each ventilation over 1 second with enough volume to produce visible chest rise. Ventilate at a rate of 10 to 12 breaths per minute for adults, 12 to 20 for pediatric patients. The most common error is squeezing the bag too hard and too fast, which causes gastric distension and increases aspiration risk. A two-person BVM technique provides a better mask seal and is preferred when personnel are available.