A pocket mask is a portable barrier device used to deliver breaths to a patient during an emergency. This tool features a dome shape that fits over the patient’s mouth and nose, with a one-way valve to divert exhaled air and body fluids away from the rescuer. Proper use requires correct positioning to maximize the mechanical advantage needed for successful rescue breathing. Effective ventilation depends on maintaining both an open airway and a tight seal between the patient’s face and the mask.
The Primary Rescuer Position
The optimal placement for a single rescuer administering breaths with a pocket mask is directly behind the patient’s head. This positioning, often referred to as the apex position, is achieved by kneeling or standing immediately above the patient’s head while they are lying supine on a firm surface. This overhead placement grants the rescuer the best possible leverage and control over the patient’s head and neck. It also provides a clear view of the chest to monitor for adequate rise and fall during ventilation. Positioning to the side makes it difficult to apply the necessary pressure evenly with both hands to maintain a tight seal and an open airway simultaneously.
Securing the Airway and Mask Seal
The primary position facilitates the use of both hands to secure the mask and maintain an open airway, which is the most effective method for single-rescuer ventilation. The crucial technique used here is the C-E clamp, which directly addresses the twin goals of opening the airway and preventing air leakage. The rescuer uses the thumb and index finger of their non-dominant hand to form a “C” shape, pressing the mask firmly against the face to ensure a secure seal.
The remaining three fingers of that same hand form an “E” shape, which is used to perform the head-tilt/chin-lift maneuver. This “E” portion lifts the jaw upward, a movement that pulls the tongue away from the back of the throat to open the airway. The overhead position allows the rescuer to apply this upward force directly and symmetrically, minimizing the risk of inadvertently pushing the head out of alignment or breaking the mask seal.
Achieving this two-handed seal is important because even minor air leaks can significantly reduce the volume of air delivered to the lungs, making the rescue breaths ineffective. By positioning themselves above the head, the rescuer is able to exert consistent, downward pressure with the “C” fingers and upward force with the “E” fingers. This stability ensures that the air travels into the lungs and is not forced into the stomach, which can cause complications.
Positioning for Specialized Scenarios
While the overhead position is optimal for a single rescuer, certain situations require a different approach. In a two-rescuer scenario, the primary rescuer maintaining the airway and mask seal remains positioned at the patient’s head, utilizing the C-E clamp technique. The second rescuer, responsible for delivering the breaths, is typically positioned to the side of the patient’s chest. This division of labor allows the rescuer at the head to dedicate both hands to maintaining the seal and airway, while the second rescuer focuses on ventilation delivery.
A different adaptation is required if a spinal injury is suspected, which necessitates the use of the jaw-thrust maneuver instead of the head-tilt/chin-lift. In this technique, the rescuer still kneels at the patient’s head to maintain the cervical spine in a neutral position. The rescuer places their fingers under the angles of the jaw and lifts the jaw forward to open the airway without tilting the head back.
In confined spaces, such as inside an ambulance or on a stretcher, the rescuer may be forced to position themselves to the side of the patient. This lateral positioning compromises the two-handed C-E clamp, often requiring the rescuer to use one hand to hold the mask and the other to attempt the head-tilt/chin-lift. While necessary due to circumstance, this side position provides less leverage and makes maintaining a perfect seal more challenging.