a.  Assess for unobstructed airway.

b.  If there is a traumatic airway obstruction or impending traumatic obstruction, prepare for possible direct airway intervention.

c.  Allow a conscious casualty to assume any position that best protects the airway, to include sitting up and/or leaning forward.

d.  Place unconscious casualty in the recovery position, head tilted back; chin away from chest.

e. Use suction if available and appropriate.

f.  If the previous measures are unsuccessful, and the casualty’s airway obstruction (e.g. facial fractures, direct airway injury, blood, deformation or burns) is unmanageable, perform a surgical cricothyroidotomy using one of the following:

    1. Bougie-aided open surgical technique using a flanged and cuffed airway cannula of less than 10 mm outer diameter, 6-7 mm internal diameter, and 5-8 cm of intratracheal length.
    2. Standard open surgical technique using a flanged and cuffed airway cannula of less than 10mm outer diameter, 6-7 mm internal diameter, and 5-8 cm of intra-tracheal length.
    3. Verify placement with continuous EtCO2 capnography.
    4. Use lidocaine if the casualty is conscious.

g.  Frequently reassess SpO2, EtCO2, and airway patency as airway status may change over time.

h.  Cervical spine stabilization is not necessary for casualties who have sustained only penetrating trauma.