A pocket mask is a specialized barrier device used to deliver ventilations to a person who is not breathing or is breathing inadequately. It features a one-way valve that protects the rescuer from the patient’s breath and bodily fluids, making rescue breathing safer and more hygienic. Delivering effective rescue breaths requires a precise technique that begins with the proper positioning of the rescuer. Optimal positioning ensures the rescuer can maintain an open airway and create an airtight seal over the patient’s face, which directly influences the success of ventilation. The goal is to maximize the volume of air entering the lungs while minimizing rescuer fatigue during a prolonged event.
The Ideal Rescuer Position
The most mechanically advantageous location for a single rescuer using a pocket mask is kneeling directly behind and above the patient’s head. This position, with the rescuer facing the patient’s feet, aligns the body axis with the patient’s head, providing the best leverage for airway control. Positioning at the top of the head provides an unobstructed view of the mask placement and the patient’s chest rise, confirming effective ventilation.
This placement allows the rescuer to use their forearms and body weight to stabilize the patient’s head, which is helpful during the two-handed sealing technique. The superior position makes it easier to sustain the pressure required to open the airway and secure the mask. Positioning behind the head also ensures the rescuer does not interfere with chest compressions during two-rescuer cardiopulmonary resuscitation (CPR).
Securing the Mask and Airway
Once positioned above the head, the rescuer must simultaneously secure the mask and open the patient’s airway using the two-handed “C-E clamp” technique. This method is the standard for single rescuers because it maximizes the airtight seal, which is necessary for delivering the appropriate volume of air. To execute the “C,” the thumb and index finger of both hands are placed on the rim of the mask, pressing it firmly against the face. This downward pressure prevents air leaks around the nose and mouth.
The remaining three fingers of each hand form the “E” component, used to lift the patient’s jaw and open the airway. For a patient without suspected spinal trauma, this is combined with the head-tilt/chin-lift maneuver, gently extending the neck to move the tongue away from the back of the throat. This displacement is necessary because the tongue often obstructs the airway in an unconscious person. Force must be applied through the bony part of the jawline, not the soft tissue beneath the chin, to prevent further airway obstruction and maintain the seal.
If a head or neck injury is suspected, the rescuer must avoid the head-tilt maneuver and use the modified jaw thrust technique instead. This involves grasping the angles of the patient’s lower jaw and lifting it forward, opening the airway while maintaining the neck in a neutral, in-line position. From the optimal position behind the head, the rescuer can use both hands for the jaw thrust, dedicating one hand to each side of the jaw for superior control and stability. A tight seal is confirmed by observing the patient’s chest visibly rise with each delivered breath.
Adapting Position for Practical Scenarios
While kneeling behind the head is ideal, real-world emergencies often require adapting the rescuer’s position. If the patient is confined in a small space (such as against a wall, in a vehicle, or on a narrow stretcher), the rescuer may need to kneel beside the patient’s head or upper chest. This side-positioning compromises the mechanical advantage and makes the two-handed C-E clamp significantly more challenging.
From the side, the rescuer typically must use a one-handed technique to hold the mask, which often leads to an ineffective seal and air leakage. Maintaining the necessary head-tilt or jaw-thrust with only the remaining fingers requires greater muscular effort and may not sustain the open airway effectively. In these compromised positions, the rescuer must prioritize achieving the best possible alignment between their mouth and the mask’s valve. The fundamental goal remains to create a tight seal and an open airway, even when optimal body mechanics are unavailable due to environmental constraints.