Intermediate Airway Management for SHTF

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What you will learn here is information that is meant for Emergency Medical Technicians. If however you are in a tactical or wilderness situation where help may be long in coming… or a SHTF situation where help might not come at all this is an easy skill set that can save lives. Basic airway adjuncts like an NPA should be in every IFAK. Now let me say DO NOT ATTEMPT any of these if you can avoid it.

You know the Jaw Trust and the Head Tilt Chin lift right? Well for the purposes of this I will assume that you do. If you don’t stop reading right now and learn these two manuvers. They are the number one way to secure a patent airway. If you have other shit to do you might want to become familiar with an Airway Adjunct.

Airway Adjuncts:

There are two very easy to use they are the Oral Pharyngeal (fair-en-G-al) Airway (OPA) and the Nasal Pharyngeal Airway NPA). You use both of these to secure the airway when you cannot waste time with the head tilt chin lift.

Oral Pharyngeal Airway

OPA. The OPA is for an UNCONCIOUS PATIENT!!! It physically keeps the tongue from occluding the airway. So OPAs are easy to use and they are cheap. You can order an entire set of them for like $6 on Amazon. The OPA is a “?” shaped piece of equipment.

How to use it. You first need to size the appropriate OPA. You do this by checking it from the corner of the mouth to the edge of the jaw. You insert it into the mouth sideways and then turn it down like you do a key.

Knowing when NOT to use an OPA is equally important. If there is any burns to the airway, there is trauma to the face or airway. Do NOT use this on anyone who is awake. Unless you are dealing with a deep throating champ who ever you do this on will gag.

Nasal Pharyngeal Airway

The NPA is a bit sluttier than the OPA. You can use it on anyone who will tolerate it and doesn’t have head or face trauma. It is sized similarly except you measure from the nose to the edge of the jaw. You can throw an NPA into a friend. The only thing is like any good slut you might need a little lube. You want to use a water based surgical lubricant although you can use the patients spit. All you have to do is spread the lube evenly but not excessively accross the NPA. Push on the patient’s nose to make a piggy face. point the bevel (angled) end towards the septum (middle part of the nose) and push straight down.

Now to critique this video. The Navy Doc made shit way more complicated than it needed to be. You don’t have to twist and rotate. All you need to do is push up on the nose make the piggy face. Then push straight down. Problem solved.

You can improvise an NPA by taking clean tubing from hydration bladders, other medical tubing such as Oxygen tubing or IV tubing cutting them to the appropriate size and sending a safety pin through the end of the tubing.


Suctioning an Airway is important. At most you should only suction for 10 seconds at a time. Since we are talking about situations that exist away from the support of ambulances please let me state that this will focus on mechanical suction devices.

Bulb Syringe.

If you have infants or little children… who are sick. Suctioning of the nose is kinda important. Most young children use their nose as their primary way to breath. Keeping it clear of slime is hugely important. This is a pretty basic skill. You put it in the nose depressed and release pressure once you are in.

Hand Pump.

Hand pump are for adults. They should be place in the mouth. Do not suction more than 10 seconds at a time… The rest is self explanatory.

King LT.

The King LT is a supraglottic airway. It works like a combination of the OPA and NPA. You have to lube it like the NPA. You can only use in the situations of an OPA. The advantage of the King LT over the OPA is that you can hook up a BVM to it and you can do CPR and ventilate at the same time. You can also use it to insert an ET tube… but that is an advance skill. It’s insertion is a little different. You are going to do what is called the jaw lift. Use a OPA as a bite block by placing it on the corner of the mouth between the teeth. You pull the jaw directly up. you push the King LT straight in. You inflate the tube with the syringe.

The syringe you can use as the suctioning device in conjunction with an OPA in the field.

Bag Valve Mask.

a BVM is simple device. You can hook it up to a CPR mask, and O2 tank, or a King LT.

The BVM is super easy to use. You just press and deflate it every 5 seconds.

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About David Black

Trained and Certified: National Registry EMT, Wilderness EMT, US Army 68W, Tactical Combat Causality Care (TCCC), Basic Life Support for Healthcare Workers, Advanced Cardiac Life Support, Pediatric Advanced Life Support, US Coast Guard Medical Person In-Charge, Pre-Hospital Trauma Life Support. International Trauma Life Support. HAM Radio Technician. Trained and Certified to Instruct: Combat Life Saver Instructor and Community Emergency Response Team Trainer. CPR, AED, First Aid.

2 thoughts on “Intermediate Airway Management for SHTF

  1. The debate between the use of NPA/OPA is a heavily debated topic in prehospital settings. Both protect the tongue from blocking the pharynx hence the P in both their names. NPAs have fewer counter indications. They are easier to carry a wide variety of sizes to fit most patients. OPAs many be more effective… However they are less effective than say a King LT, LMA, Combitube, or ET tube. I have never used an OPA by itself. It was always an adjunct to buy me time to put in an advanced airway. I have never carried OPAs in an IFAK or CLS bag. The thing is that both are tools. They both have uses. It is all situationally dependent. The thing is that I am not trying to get embroiled in endless debates. I am putting the info out there. It is up to the individual medic to decide in their best clinical judgement what is best for them. If an OPA is your go to device then cool. It works for you. All that I care about is that lives are saved.

  2. G’day. Good article you wrote for the most part, however i would like to mention a correction to the npa usage. Npa’s do not actually maintain an airway like an opa does. This is because the npa is usually a soft flexible tube that can be crushed and the fact that most do not reach the tounge, which in unconscious patients it goes limp and blocks the airway. Overall i would advise the opa as the “go-to” device. Also with the suction, only suction where you can see. Otherwise its a great article for use in emergency situations.

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