Page 38 - PJ MED OPS Handbook 8th Ed

Airway
Guidelines and Considerations:
• Indicated when airway is (or a significant potential exists to become) partially or completely
obstructed or compromised.
• Cervical spine injury is assumed with deceleration trauma, blast injury and unconscious pa-
tients. Spinal immobilization is not required for penetrating trauma alone in the absence of
other spinal precaution indications.
• Airway management options are often driven by the tactical situation and phase of patient
care. In general, airway options during each phase of patient care/evacuation will be limited
to the following:
○ Chin-lift or jaw-thrust
○ Nasopharyngeal airway (NPA) – Indicated for unresponsive casualties without evidence of
basilar skull fracture or significant mid-face trauma
○ Recovery position – Utilize in mass casualty incident if NPA not available or working
○ Sit up and lean forward for conscious patients
○ Supraglottic Airway Device (e.g., Laryngeal Mask Airway, I-gel)
○ Endotracheal intubation –direct/video assisted laryngoscopy
○ Cricothyroidotomy

Recovery position
For use in unconscious patients in dynamic situations
and mass casualty scenarios where time, tactics and Hand Supports
Head
resources do not allow other treatments.
1. Lay patient prone.
2. If on left side, extend left arm overhead, right
arm bent at elbow in front on ground, left leg
extended, right leg flexed at hip and knee. Knee Stops Body From
Rolling Onto Stomach

Sit up and lean forward position
For all patients who are conscious and bleeding from the mouth or throat and can maintain their
own airway. If they can do this, never force them to lie down. Monitor clinical status and O2 sat
closely and be prepared to perform surgical airway if they deteriorate (refer to Oro-pharyngeal
Hemorrhage Protocol in the PJ MTPs). Patient will determine best position of comfort. It is import-
ant to treat and transport the patient in this position if able and avoid surgical airway.

36 n Pararescue Medical Operations Handbook / 8th Edition