COURSE SUMMARY
ANNEX: B
COURSE: MEDICAL
PHASE: 1 VER: D
PREPARATION DATE: 2012/01/24
COURSE TITLE:TREAT UNIT CASUALTIES
REFERENCES: ANA-STP-8-86C-E4-5-SM-TG / (U.S. DOCTRINE STP 8-68W13-SM-TG)
ACADEMIC TITLE
VENTILATE A PATIENT WITH A BAG-VALVE-MASK
(BVM) SYSTEM
HOURS
081-86A-0017
4 HRS
Terminal Learning Objective:
Understand how to effectively use a Bag-Valve-Mask System.
Enabling Learning Objectives:
1. Soldier understands the principles and concepts for implementation of a BVM.
2. Soldier understands tasks required leading up to use of BVM (size of mask, J-tube, etc)
3. Soldier demonstrates proper application and use of BVM, using the one man method.
4. Soldier understands how to record the care provided on the appropriate form.
5. Soldier understands how to evacuate the casualty.
6. Soldier understands how to prevent further injury to the casualty.
VENTILATE A PATIENT WITH A BAG-VALVE-MASK SYSTEM
081-86A-0017
Conditions: You encounter an unconscious patient. The patient has signs of difficulty
breathing. You must ventilate the patient with a bag-valve-mask (BVM) system. You will need
an ANA Form 1380 (Field Medical Card), oropharyngeal airway (OPA), BVM system, and
supplemental oxygen (if available).
Standards: Ventilate the patient with a BVM system until spontaneous breathing returns, until a
normal rate and depth of respiration is achieved, or until directed to stop by a medical officer.
Perform the procedure without causing further injury to the casualty.
Performance Steps
CAUTION: All body fluids should be considered potentially infectious. Always observe body
substance isolation (BSI) precautions by wearing gloves and eye protection as a minimal
standard of protection.
1. Insert an OPA if the patient is unconscious.
WARNING: Do not attempt to use an OPA on a conscious or semiconscious patient.
2. Assemble the BVM system, selecting the correct size of mask for the patient.
3. Ensure the bag is operational.
NOTE: An operational BVM should have a self-refilling bag, a non-rebreathing outlet valve,
oxygen reservoir, a one-way inlet valve, and a transparent face mask.
4. Kneel above the patient's head facing the patient's feet.
5. Place the patient's head in an extended position unless you suspect a spinal injury.
6. Fit the mask to the patient.
a. Stretch the mask with the thumb and index finger on both sides of the mask.
b. Place the mask over the patient's face with the apex of the mask over the bridge of the
patient's nose and the base of the mask in the groove between the lower lip and the chin to
form a tight seal.
NOTE: As the stretched mask resumes its original shape, pull the patient's skin taut to help
form a leak proof seal.
7. Ventilate the patient using the one-rescuer method, if appropriate.
a. Hold the mask in place with one hand.
(1) Place your little, ring, and middle fingers along the mandible.
(2) Place your thumb on the upper portion of the mask above the valve connection.
(3) Place your index finger on the lower portion of the mask under the valve connection.
NOTE: This is known as the "C-clamp" method and will maintain the seal.
b. Maintain a leak proof mask seal with one hand. Use firm pressure to hold the mask in
position and to maintain a seal on the patient's face.
c. Continue squeezing the bag once every 5 seconds for an adult, once every 3 seconds for
infants and children.
8. Ventilate the patient using the two-rescuer method, if appropriate.
a. Hold the mask in place with two hands.
(1) Place your little, ring, and middle fingers along the mandible.
(2) Place your thumb on the upper portion of the mask above the valve connection.
(3) Place your index finger on the lower portion of the mask under the valve connection.
(4) With your other hand, duplicate the above steps (mirror image) to achieve a leak proof
seal.
b. Have your assistant continue squeezing the bag with two hands until the chest rises;
squeeze once every 5 seconds for an adult, once every 3 seconds for infants and children.
9. Observe for rise and fall of the patient's chest.
a. If the chest does not rise, reposition the airway.
b. If the chest rises and falls, continue with step 10.
10. Continue ventilations.
a. Observe for spontaneous respirations.
b. Periodically check the pulse.
c. Observe for vomiting or secretions in or around the mouth or mask.
NOTE: If an oxygen source is available, it should be attached to the oxygen reservoir (at 10 to 15
L/min to increase the percentage of oxygen from 55% to approaching 90-100%).
11. Continue ventilations until spontaneous breathing returns, until a more normal rate and depth
of respiration is achieved, or until directed to stop by a medical officer.
12. Document all medical care and procedures on the FMC.
13. Evacuate the patient.
Evaluation Preparation:
Setup: For training and evaluation, use a cardiopulmonary resuscitation (CPR) mannequin
capable of accepting an OPA. Have another Soldier act as an assistant. If oxygen will be used,
prepare the oxygen source. Tell the Soldier if oxygen is to be used and whether the patient is
conscious or unconscious. Have the Soldier insert an OPA, and ventilate the patient with a BVM
using the one-rescuer and two-rescuer methods. After 2 minutes of ventilation, tell the Soldier
that the patient has resumed normal breathing. Tell the assisting Soldier to only perform those
actions the Soldier being evaluated directs.
Brief Soldier: Tell the Soldier to ventilate the patient with a BVM system.
Performance Measures
1. Inserted an OPA if the patient was unconscious.
2. Assembled the BVM, selecting the correct size of mask for the patient.
3. Ensured that the bag was operational.
4. Knelt above the patient's head facing the patient's feet.
5. Placed the patient's head in an extended position
(if no spinal injury is suspected).
6. Fit the mask to the patient.
7. Ventilated the patient using the one-rescuer method, if appropriate.
8. Ventilated the patient using the two-rescuer method, if appropriate.
9. Observed for rise and fall of the patient's chest.
a. If the chest did not rise, repositioned the airway.
b. If the chest rose and fell, continued with step 10.
10. Continued ventilations.
PASS
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FAIL
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11. Continued ventilations until spontaneous breathing returned, until a more
normal rate and depth of respiration was achieved or until directed to stop by a
medical officer.
12. Recorded the procedure on a FMC.
13. Evacuated the patient.
14. Did not cause further injury to the patient.
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Evaluation Guidance: Score each Soldier according to the performance measures. Unless
otherwise stated in the task summary, the Soldier must pass all performance measures to be
scored PASS. If the Soldier fails any steps, show what was done wrong and how to do it
correctly.
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