1. Roll the casualty onto his or her back, if necessary.

2. Open the airway using the head-tilt/chin-lift method.

NOTE: If foreign material or vomitus is seen in the mouth, remove it as quickly as possible.

a. Kneel at the level of the casualty's shoulders.


b. Place one hand on the casualty's forehead and apply firm, backward pressure with the palm to tilt the head back.


c. Place the fingertips of your other hand under the bony part of the lower jaw and lift, bringing the chin forward.





NOTE: Do not use the thumb to lift and do not press deeply into the soft tissue under the chin with the fingers.

3. Check for breathing within 3 to 5 seconds by placing an ear over the casualty's mouth and looking toward his or her chest.

a. Look for the chest to rise and fall.


b. Listen for sounds of breathing.


c. Feel for breath on your cheek.





NOTE: If the casualty resumes breathing at any time during this procedure, the airway should be maintained open and the casualty should be monitored. If the casualty continues to breathe, he or she should be transported to medical aid. Otherwise, the procedure should be continued.

4. Give breaths to ensure an open airway.

NOTE: When mouth-to-mouth rescue breathing cannot be performed because the casualty has jaw injuries or spasms, the mouth-to-nose method may be more effective. The mouth-to-nose is similar to mouth-to-mouth except that the rescuer blows into the nose while holding the lips closed with the hand at the chin. The rescuer then removes his or her mouth to allow air to escape. In some cases, it may be necessary to separate the casualty's lips to allow the air to escape.

a. Maintain the airway and gently pinch the nose closed using the hand on the casualty's forehead.


b. Take a deep breath and place your mouth, in an airtight seal, around the casualty's mouth.


c. Give two full breaths (1 1/2 to 2 seconds each), taking a breath between them, while watching for the chest to rise and fall and listening and/or feeling for air to escape during exhalation.


d. If the chest rises, continue with step 8.


e. If the chest does not rise, proceed to the next step.

5. Reposition the casualty's head slightly farther backward and repeat the breaths.

a. If the chest rises, continue with step 8.


b. If the chest does not rise, proceed to the next step.

6. Perform abdominal or chest thrusts.

NOTE: Use abdominal thrusts unless the casualty is in the advanced stages of pregnancy, is very obese, or has a significant abdominal wound.

a. Abdominal thrusts.





(1) Kneel astride the casualty's thighs.


(2) Place the heel of one hand against the casualty's abdomen, slightly above the navel but well below the tip of the breastbone, with the fingers pointing toward the casualty's head.


(3) Place your other hand on top of the first.


(4) Press into the abdomen with a quick forward and upward thrust.





NOTE: Give each thrust as a separate, distinct movement.


(5) Give several thrusts (up to five).





b. Chest thrusts.





(1) Kneel close to the side of the casualty's body.


(2) Locate the lower edge of the casualty's ribs and run your fingers up along the rib cage to the notch where the ribs meet the breastbone.


(3) Place the middle finger on the notch with the index finger just above it on the lower end of the breastbone.


(4) Place the heel of your other hand on the lower half of the breastbone next to the two fingers.


(5) Remove your fingers from the notch and place that hand on top of your other hand, extending or interlacing the fingers.


(6) Straighten and lock your elbows with your shoulders directly above your hands.


(7) Without bending your elbows, rocking, or allowing your shoulders to sag, apply enough pressure to depress the breastbone 1 1/2 to 2 inches.





NOTE: Give each thrust slowly, distinctly, and with the intent of relieving the obstruction.


(8) Give several thrusts (up to five).

7. Perform a finger sweep and repeat the breaths.

a. Open the casualty's mouth by grasping the tongue and lower jaw to lift the jaw open or crossing the fingers and thumb to push the teeth apart.


b. Insert the index finger of your other hand down along the cheek to the base of the tongue.





WARNING TAKE CARE NOT TO FORCE THE OBJECT DEEPER INTO THE AIRWAY.


c. Use a hooking motion from the side of the mouth toward the center to dislodge the object.


d. Reopen the airway and repeat the breaths.


e. If the chest rises, proceed to the next step.


f. If the chest does not rise, repeat steps 6 and 7 until the airway is clear.

8. Check for a pulse, for 5 to 10 seconds, using your first two fingers, in the groove in the casualty's throat beside the Adam's apple.

NOTE: Do not use your thumb.

a. If a pulse is found but the casualty is not breathing, continue with step 9.


b. If no pulse is found, CPR must be performed by qualified personnel.

9. Continue mouth-to-mouth resuscitation, at the rate of about 10 to 12 breaths per minute.

10. Recheck for pulse and breathing for 3 to 5 seconds after every 12 breaths.

11. Perform all necessary steps in the correct sequence.

12. Continue mouth-to-mouth resuscitation as stated in the task standard. When breathing is restored, watch the casualty closely, maintain an open airway, and check for other injuries, if necessary. (See the task Evaluate A Casualty, task number 081-831-1000.)