An open airway is the foundation of Basic Life Support (BLS) for any unresponsive person. When consciousness is lost, muscles relax, causing the tongue to fall back against the pharynx. This soft tissue obstruction is the most common cause of a blocked airway, preventing air from reaching the lungs. As a single rescuer, rapidly opening the airway is essential before administering rescue breaths and providing life-saving oxygenation until emergency medical services arrive.
Initial Assessment Before Intervention
Before touching an unresponsive person, ensure the safety of the scene. After confirming the environment is safe, the rescuer should check for responsiveness by gently tapping the person’s shoulder and shouting a question, such as, “Are you okay?” If there is no response, immediately activate the emergency response system by calling 911 or a local emergency number. If the rescuer is alone, using a mobile phone on speakerphone allows communication with the dispatcher while proceeding with the assessment.
The rescuer must then quickly assess the person for breathing and pulse, taking no more than ten seconds. Look for chest rise and fall, listen for air movement, and feel for a pulse, often at the carotid artery in the neck. If the person is not breathing normally, or is only gasping, immediate intervention is necessary to open the airway. Abnormal, infrequent gasps, known as agonal breathing, are not considered effective breathing and require the same immediate action.
The Standard Approach Head-Tilt Chin-Lift
The Head-Tilt Chin-Lift (HTCL) maneuver is the standard technique for opening the airway when no head or neck injury is suspected. This maneuver works by moving the tongue away from the back of the throat, effectively reversing the soft-tissue obstruction caused by muscle relaxation. The rescuer should kneel beside the person’s head, placing one hand on their forehead. Apply gentle, firm pressure with the palm to tilt the head back, which extends the neck.
Place the tips of two fingers from the other hand under the bony part of the chin. Lift the chin upward and forward to bring the jaw with it, which pulls the tongue away from the airway entrance. Avoid pressing on the soft tissues under the chin, as this could compress the airway and counteract the maneuver. The combination of tilting the head and lifting the chin ensures the oral and pharyngeal axes are aligned for optimal airflow.
This technique is straightforward, requires no equipment, and is highly effective for a single rescuer in non-trauma situations. If the initial attempt does not result in an open airway, the rescuer should slightly reposition the head and chin and try the maneuver again. Maintaining the head tilt and chin lift position is mandatory for successful delivery of rescue breaths.
Modifying the Airway Open for Suspected Trauma
If a neck or spinal injury is suspected (e.g., from a fall or car accident), the Head-Tilt Chin-Lift maneuver is avoided. Tilting the head back in these cases could cause movement of an unstable cervical spine, potentially leading to further neurological damage. The alternative technique is the Jaw Thrust Maneuver, which is designed to open the airway while keeping the head and neck in a neutral, stabilized position.
To perform the Jaw Thrust, position yourself at the top of the person’s head, placing hands on either side of the jaw. Position fingers under the angles of the lower jawbone, near the ears. The jaw is then grasped and gently lifted straight upward and forward without tilting the head back at all. This forward movement of the jaw achieves the goal of pulling the tongue away from the back of the throat.
The Jaw Thrust is technically more difficult to perform while simultaneously giving rescue breaths, and it may not fully open the airway in every case. If the Jaw Thrust is attempted and the airway remains blocked, the rescuer must prioritize oxygenation over spinal stabilization. In this instance, the rescuer should cautiously revert to the Head-Tilt Chin-Lift technique, as maintaining an open airway is paramount to survival.
Administering Rescue Breaths as a Single Rescuer
Once the airway is successfully opened using either the Head-Tilt Chin-Lift or the Jaw Thrust, the single rescuer can deliver rescue breaths. The person’s nostrils must be pinched closed with the thumb and index finger of the hand that was on the forehead to prevent air leakage. The rescuer then takes a normal breath, seals their mouth completely over the person’s mouth, and delivers a breath lasting approximately one second.
The primary sign of an effective rescue breath is visible chest rise, indicating that air has entered the lungs. If the chest does not rise, the rescuer should quickly reposition the head and chin to ensure the airway is fully open before attempting the second breath. Deliver two effective breaths in a row before proceeding with chest compressions, if necessary, or continuing rescue breathing if the person has a pulse but is not breathing.
If the person has a pulse but is not breathing, provide one rescue breath every five to six seconds for an adult, aiming for a rate of ten to twelve breaths per minute. Each breath should be delivered smoothly over one second, just enough to cause the chest to rise. This controlled rate prevents hyperventilation and minimizes the risk of air entering the stomach, which can lead to complications.