MARCH Module 02 of 05
A — Airway Management
Once catastrophic bleeding is controlled, the airway is the next immediate threat. The question is simple: can air move between the environment and the lungs? An unconscious casualty cannot protect their own airway — that job passes to you.
The Physiology
Why A Comes Second
A blocked airway kills through hypoxia — silent, fast, and unforgiving of delay.
Minutes To Brain Injury
Brain tissue begins to suffer irreversible injury after roughly three minutes without oxygen. A complete airway obstruction is one of the fastest kills in trauma.
Unconscious = Unprotected
An awake casualty coughs, swallows, and adjusts their own airway. An unconscious one cannot. Level of consciousness is your airway barometer.
Positions That Work
Position of comfort for the awake casualty; recovery position for the unconscious breather. Simple body positioning is the highest-value airway skill at every level.
Speaking = Open (Now)
Normal speech proves the airway is patent at this moment. It proves nothing about the next five minutes. Trauma changes — reassess.
Recognize — The Quick Airway Check
Can they speak clearly? If yes, they have a patent airway right now. Not forever.
- Listen for noisy, gurgling, snoring, or labored breathing — obstructed airflow has a sound.
- Watch chest rise: asymmetric, absent, or paradoxical movement is a red flag.
- Check responsiveness — a dropping level of consciousness is often the first airway sign.
- Look for facial trauma, blood, vomit, or foreign material in the mouth.
- Consider the mechanism: head and neck injury raise airway risk before symptoms appear.
"He's talking" does not mean "airway problem solved." It means the airway is open at this moment. Trauma changes.
Act — Positioning First, Devices Second
Conscious casualty
If breathing spontaneously and maintaining their own airway: allow a position of comfort. Don't reflexively force everyone flat — a conscious casualty sitting up is managing their own airway better than you can from outside.
Unconscious but breathing
Clear obvious material and use appropriate positioning / the recovery position within the situation. C-TECC active-bystander guidance recommends position of comfort for an awake patient and recovery position for an unconscious breathing patient.
Positioning, clearing obvious obstruction with a gloved hand, recovery position, continuous monitoring. No device beats hands-on positioning done early.
NPA where trained and authorized under applicable TECC / local protocols; suction and advanced adjuncts for medical professionals operating under medical oversight.
Check — Reassess Every Cycle
- Re-check speaking, breathing, and responsiveness at every reassessment cycle.
- A deteriorating airway announces itself gradually — monitor continuously rather than checking once.
- Any change in voice, increasing noise, or dropping consciousness = re-run A immediately.
Don't — The Failure Patterns
- Treating equipment instead of the patient — inserting a device because you carry it, not because the casualty needs it.
- Forcing a conscious casualty flat when they were breathing fine sitting up.
- Failing to recognize gradual deterioration because "they were talking earlier."
- Blending TCCC and TECC airway pathways into one algorithm — they are intentionally different.
If the patient is talking to you normally, resist the urge to put something in their airway just because you own it.
The May 2026 TCCC update simplified Tactical Field Care airway management and changed parts of its airway pathway; civilian TECC retains its own scope-dependent recommendations. Don't silently blend them into one universal algorithm.
What This Looks Like At Your Level
Switch roles to compare scope
Civilian / Prepared Citizen
Position of comfort, recovery position, clear what you can see, and monitor. Your most powerful airway tool is your hands and your eyes — and calling 911 early for any casualty whose consciousness drops.
Position · Clear obvious obstruction · Recovery position · Monitor continuously
Law Enforcement / First Responder
The same basics, plus airway adjuncts where your training and agency policy authorize them. Think about positioning during handcuffing, drags, and vehicle extrication — an airway dies quietly during transport decisions.
Same basics · NPA where trained and authorized · Casualty positioning during movement
Medic / EMS / Clinician
You own the full airway stack: suction, BVM, adjuncts under protocol, advanced airway strategies, capnography to confirm and monitor, and surgical airway where authorized and indicated.
Suction · BVM · Airway adjuncts under protocol · Advanced airway strategies · Capnography · Surgical airway where authorized
Module Self-Check
Test Your A Knowledge
1. A casualty is talking to you clearly after a motor vehicle collision. Airway handled?
2. An unconscious casualty is breathing on their own. What is the single best bystander intervention?
3. A conscious casualty insists on sitting upright and leaning forward. Do you force them flat?
4. You hear gurgling respirations in a semi-conscious casualty. What does that mean?
5. Do civilians and combat medics use the same airway algorithm?
Equipment
Build Your A Capability
Airway adjuncts and tools, live from the store's airway catalog.
ProCric™ Cricothyrotomy Kit
SurSecur Nasopharyngeal Airway, – 28Fr
King Airway - LTS-D Supraglottic Airways
MARCH Pre-Lubricated Nasal Airway - 28 Fr
4.9 / 5 · 10 reviews
Continue The Sequence
Next MARCH Modules
TCCC content reviewed against CoTCCC Guidelines — 1 May 2026 · Civilian / LE content reviewed against current C-TECC guidance
Guidelines evolve. Agency protocols and scope of practice control. Educational alignment — not a certification.