Perform Mouth-to-mouth Resuscitation

Conditions: You see an adult casualty who is unconscious and does not appear to be breathing. You are not in a chemical environment.

Standards: Gave mouth-to-mouth resuscitation correctly, in the correct sequence. Continued mouth-to-mouth resuscitation at the rate of about 10 to 12 breaths per minute until the casualty started to breathe on his own, the soldier was relieved by a qualified person, or the soldier was too tired to go on.

Note: The standard is based on American Heart Association information.

Performance Steps

1. Roll the casualty onto his back if necessary.

WARNING: The casualty should be carefully rolled as a whole, so the body does not twist.

2. Open the airway.

Note. If foreign material or vomit is in the mouth, it should be removed as quickly as possible (see step 7).

   a. Head-tilt/chin-lift method.

       (1)  Kneel at the level of the casualty's shoulders.

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

       (3)  Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward.

Note. Do not use the thumb to lift.

Note. Do not press deeply into the soft tissue under the chin with the fingers.

   b. Jaw-thrust method.

Note. This method is usually used for casualties with a neck or severe head injury.

       (1)  Kneel above the casualty's head (looking toward the casualty's feet).

       (2)  Rest your elbows on the ground or floor.

       (3)  Place one hand on each side of the casualty's head and place the tips of the index and middle fingers under the angles of the casualty's lower jaw.  Place your thumbs on the jaw just below the level of the teeth.

       (4)  Raise your fingertips to lift the jaw forward (upward).  This action will also cause the casualty's head to tilt backward somewhat.

Note. If the casualty's lips are still closed after the jaw has been moved forward, use your thumbs to retract the lower lip and allow air to enter the casualty's mouth.

3. Check for breathing.

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

   b. Look for the chest to rise and fall.

   c. Listen for sounds of breathing.

   d. Feel for breath on your cheek.

Note. If the casualty resumes breathing at any time during this procedure, the airway should be kept open and the casualty should be monitored. If the casualty continues to breathe, he 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 resuscitation breathing cannot be performed because the casualty has jaw injuries or spasms, the mouth-to-nose method may be more effective.

Note. Perform the mouth-to-nose method by blowing into the nose while holding the lips closed. Let air escape by removing your mouth and, in some cases, removing your mouth and separating the casualty's lips.

   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 ½ 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.

Note. If chest rises, go to step 8.

Note. If chest does not rise, continue with step 5.

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

Note. If chest rises, go to step 8.

Note. If chest does not rise, continue with step 6.

6. Perform abdominal or chest thrusts.

Note. Abdominal thrusts should be used 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 the other hand on top of the first.

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

Note. Each thrust should be 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 the 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 the other hand on the lower half of the breastbone next to the two fingers.

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

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

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

Note. Each thrust should be given slowly, distinctly, and with the intent of relieving the obstruction.

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

7. Perform a finger sweep and repeat breaths.

   a. Open the 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 the other hand down along the cheek to the base of the tongue.

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

WARNING: Take care not to force the object deeper into the airway

   d. Reopen the airway and repeat the breaths.

Note. If chest rises, go to step 8.

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

8. Check for a pulse for 5 to 10 seconds.

Note. Use the first two fingers in the groove in the casualty's throat beside the Adam's apple. Do not use the thumb.

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

   b. If no pulse is found, cardiopulmonary resuscitation (CPR) must be performed by qualified personnel.  Send for qualified medical 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.

Note. Once breathing is restored, watch the casualty closely, maintain an open airway, and check for other injuries.