The Head Tilt Chin Lift (HTCL) maneuver is a foundational technique in basic life support (BLS) protocols used to manage an unconscious person’s airway. This simple, non-invasive action counteracts the most common cause of obstruction: the tongue. When consciousness is lost, throat and tongue muscles relax, allowing the tongue to fall backward and block the upper airway. The HTCL repositions the head and jaw to move the tongue away from the back of the throat, creating a clear path for airflow and making rescue breaths effective.
Identifying the Need for Airway Opening
Before attempting any life-saving maneuver, the rescuer must ensure the surrounding area is safe. Once the scene is secure, check the victim for responsiveness by gently tapping the shoulder and shouting, “Are you okay?”. If there is no reaction, activate emergency medical services immediately.
Next, assess the victim’s breathing, taking no more than 10 seconds. The rescuer uses the “Look, Listen, Feel” method, observing the chest for rise and fall, listening for breath sounds, and feeling for airflow. The HTCL should only be performed if the victim is unconscious and not breathing normally, or is only gasping.
Executing the Head Tilt Chin Lift
The rescuer should kneel beside the victim’s head to comfortably reach the forehead and chin. To begin the maneuver, the heel of one hand is placed gently on the victim’s forehead. This hand applies slow, steady, backward pressure to tilt the head back, which extends the neck.
Place the fingers of the other hand under the bony part of the chin, avoiding the soft tissue under the jaw. Pressure on the soft tissue can inadvertently block the airway. Use these two fingers to lift the chin upward and forward, pulling the jaw and tongue away from the throat. This combined action of tilting the head and lifting the chin aligns the oral and pharyngeal axes, opening the airway.
The mouth should open slightly as the chin is lifted, but the rescuer must maintain the head tilt and chin lift position to keep the airway patent. If the victim is not breathing, hold this position while administering rescue breaths. For an adult, the head is tilted to a past-neutral position, which is a full backward tilt.
For infants, a full head tilt is avoided because their anatomical structure can cause the trachea to kink, obstructing the airway. Instead, the infant’s head is moved only to a “neutral” or “sniffing” position, meaning the head is level or slightly extended. This minimal extension achieves the necessary airway alignment without causing potential injury. The technique is otherwise the same, using gentle pressure appropriate for the infant’s size.
Alternative for Potential Spinal Injury
The Head Tilt Chin Lift is contraindicated if a neck or spinal injury is suspected, as this movement could cause further neurological damage. Trauma from a fall, car accident, or significant force indicates the need for an alternative method. The cervical spine must be kept in a neutral, in-line position to reduce the risk of exacerbating a vertebral fracture or spinal cord injury.
In these trauma scenarios, the Jaw Thrust Maneuver is the accepted alternative for airway management. This technique moves the lower jaw forward without causing extension or rotation of the head and neck. The rescuer positions themselves at the victim’s head and places the fingers of both hands under the angles of the lower jaw, near the ears.
The fingers then apply firm, upward, and forward pressure to lift the jaw. This action pulls the tongue and soft palate away from the posterior pharynx, achieving airway patency. While the jaw thrust is more difficult to maintain than the HTCL, it is the only maneuver that prioritizes spinal stabilization. If the jaw thrust is unsuccessful, the rescuer should use the Head Tilt Chin Lift as a final resort, as establishing a patent airway is the priority for survival.