COURSE SUMMARY
ANNEX: B
COURSE: MEDICAL
PHASE: 1 VER: D
PREPARATION DATE: 2012/01/23
COURSE TITLE :TREAT UNIT CASUALTIES
REFERENCES: ANA-STP-8-86C-E4-5-SM-TG / (U.S. DOCTRINE STP 8-68W13-SM-TG)
ACADEMIC TITLE
CLEAR AN UPPER AIRWAY OBSTRUCTION
HOURS
081-86A-0019
2 HRS
Terminal Learning Objective:
Understand how to complete, in order, all the steps necessary to clear an object from a casualty's
upper airway. Continue the procedures until the casualty can talk and breathe normally or until
you are relieved by a qualified person.
Enabling Learning Objectives:
1. Soldier will understand how to determine whether the casualty needs help.
2. Soldier will understand correct positioning for type of situation.
3. Soldier will understand procedure for clearing the airway without force a foreign body
deeper into the airway.
4. Soldier will demonstrate correct performance of thrust and number to be performed.
5. Soldier will understand the actions necessary if the casualty becomes unconscious:
a. How to reposition the casualty.
b. How to perform a finger sweep.
c. How to open the airway.
d. How to perform rescue breathing procedures.
6. Soldier will understand how to complete all necessary steps in order.
CLEAR AN UPPER AIRWAY OBSTRUCTION
081-86A-0019
Conditions: You are evaluating a casualty, who is not breathing or is having difficulty breathing,
and you suspect the presence of an upper airway obstruction.
Standards: Complete, in order, all the steps necessary to clear an object from a casualty's upper
airway. Continue the procedure until the casualty is able to speak and breathe normally or until
relieved by a qualified person.
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. Determine whether the casualty needs your assistance.
a. Conscious casualty.
(1) Ask the casualty if he is choking and if he can speak.
(a) If the casualty has adequate air exchange (is able to speak, coughs forcefully or
wheezes between coughs), do not interfere except to encourage the casualty to continue
coughing.
NOTE: Abdominal thrusts are usually not effective for dislodging a partial obstruction; attempts
to remove the object manually could cause a complete obstruction.
(b) If the casualty has poor air exchange (weak, ineffective cough; high-pitched noise
while inhaling; increased respiratory difficulty; and possible cyanosis), continue with step
1a(2).
(c) If the casualty has a complete airway obstruction (is unable to speak, breathe or cough
and may clutch the neck between the thumb and fingers), continue with step 1a(2).
2. If the casualty is lying down, bring him to a sitting or standing position.
3. Apply 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) Stand behind the casualty and wrap your arms around his waist.
(2) Make a fist with one hand and place the thumb side of your fist against the casualty's
abdomen in the midline, slightly above the navel and well below the tip of the xiphoid
process.
(3) Grasp your fist with your other hand and press your fist into the casualty's abdomen
with quick inward and upward thrusts.
(4) Continue abdominal thrusts until the blockage is expelled or the casualty becomes
unconscious.
NOTE: Make each thrust a separate, distinct movement given with the intent of relieving the
obstruction.
b. Chest thrusts.
(1) Stand behind the casualty and encircle his chest with your arms just under the armpits.
(2) Make a fist with one hand and place the thumb side of the fist against the middle of
the casualty's sternum.
(3) Grasp your fist with your other hand and give backward thrusts, pressing your fist into
the casualty's chest.
(4) Continue giving thrusts until the blockage is expelled or the casualty becomes
unconscious.
CAUTION: Do not position your hand on the xiphoid process or the lower margins on the rib
cage.
NOTES:
1). Administer each thrust with the intent of relieving the obstruction.
2). If the casualty becomes unconscious, position the casualty on his back, open the airway,
observe the airway to look for the obstruction, and begin the steps of cardiopulmonary
resuscitation (CPR).
4. Take appropriate action if the casualty becomes unconscious. Begin the steps of CPR.
a. Determine unresponsiveness.
b. Open the airway.
NOTE: Perform the head-tilt/chin-lift maneuver to clear an obstruction that is caused by the
tongue and throat muscles relaxing back into the airway in any person who is found unconscious.
c. Observe the airway to look for the obstruction.
NOTE: If the obstruction is visible, you may attempt to remove the object.
d. Attempt ventilation.
e. If the first ventilation does not produce visible chest rise, reposition the head and reattempt
to ventilate.
f. If both breaths fail to produce visible chest rise, perform 30 chest compressions and then
open the airway and look into the mouth for the obstruction.
g. Reattempt ventilation.
5. When the object is dislodged, check for breathing. Perform rescue breathing, if necessary or
continue to evaluate the casualty for other injuries.
Evaluation Preparation:
NOTE: Only the procedure for clearing an airway obstruction in a conscious casualty will be
evaluated. The procedure for an unconscious casualty can be evaluated as a part of task 08186A-0048.
Setup: You will need another Soldier to play the part of the casualty. Instruct the casualty how to
appear as though he has an obstructed airway; with consciousness progressing to
unconsciousness. Instruct the casualty not to assist the Soldier in any way.
Brief Soldier: Describe the signs and symptoms of a casualty with good air exchange, poor air
exchange, or a complete airway obstruction. Ask the Soldier what should be done and score step
1 based on the answer. Then tell the Soldier to clear an upper airway obstruction. Tell the Soldier
to demonstrate how to position the casualty, where to stand and how to position his hands for the
thrusts. The Soldier must tell you how they should be done and how many thrusts should be
performed. Ensure that the Soldier understands that he must not actually perform the thrusts.
After completion of step 5, ask the Soldier what must be done if the casualty becomes
unconscious.
Performance Measures
PASS
1. Determined whether the casualty needed your assistance.
——
2. Moved the casualty to a sitting or standing position, if necessary.
——
3. Applied abdominal or chest thrusts.
——
4. Took appropriate action if the casualty became unconscious.
Began the steps of CPR.
——
a. Repositioned the casualty.
b. Opened the airway.
c. Observed the airway looking for the obstruction, and removed it if
seen.
d. Attempted ventilation.
e. If the first ventilation did not produce visible chest rise, repositioned
the head and reattempted to ventilate.
f. If both breaths failed to produce visible chest rise, performed 30 chest
compressions, and then opened the airway and looked into the mouth
for the obstruction.
g. Attempted ventilation.
h. Performed rescue breathing procedures, if necessary.
5. When the object was dislodged, checked for breathing. Performed rescue
breathing, if necessary.
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FAIL
——
——
——
——
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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.