If the casualty has impaired ventilation and uncorrectable hypoxia with decreasing oxygen saturation below 90%, consider insertion of a properly sized Nasopharyngeal Airway, and ventilate using a 1000ml resuscitator Bag-Valve-Mask.

An NPA is better tolerated than an oropharyngeal airway if the casualty regains consciousness and is unlikely to stimulate their gag reflex. Also, a nasopharyngeal airway is less likely to be dislodged during transport.

The NPA should be inserted into the right nostril, if not obstructed, with the bevel towards the nasal septum. If unable to insert into the right nostril, insert into the left nostril. Ensure a water-based lubrication is used (like the one contained within the Joint First Aid Kit, or JFAK). The correct angle for insertion is 90 degrees to the frontal plane of the face – NOT along the long axis of the nose. Although intracranial insertion of NPAs has been rarely reported in the literature, it has not been reported in any casualties from recent operations; nevertheless, the proper angle of insertion will help prevent potential injuries.

Do not use an NPA if there is clear fluid coming from the ears or nose. This may be cerebrospinal fluid (CSF), an indication of a possible skull fracture.

Facial burns, singeing of the nasal hairs, or carbonaceous sputum.

Any obvious deformities to the nose due to trauma is a clear indication to not attempt an NPA insertion.

Allow the conscious casualty to assume whatever position allows them to breathe most comfortably.