Harm Reduction Resources

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Basic Life Support Skills for First Responders and Harm Reduction Workers

This video is intended for professionals who are already trained on these devices and are seeking a review or further tips on performing these skills effectively. This video does not take the place of professional training and should be used as a review of these skills. Do not use Oropharyngeal Airways (OPAs) or Nasopharyngeal Airways (NPAs) devices outside of your scope of practice. Do not use OPAs or NPAs as a lay-person or first-aider. Generally, these devices are used by specifically trained healthcare professionals in the context of a medical emergency (paramedics, nurses, firefighters, harm reduction workers, overdose prevention sites, and other delegated emergency/medical professionals).

They are NOT to be used by the lay person or first-aider whom are not specifically trained with them, as harm may occur if they are used outside of professional standards. In this training video I use a “Difficult Airway” simulator head that is meant to realistically represent a hard-to-manage-airway that healthcare providers and first responders may encounter in the field. An Oropharyngeal Airway (OPA) is used when the person is unresponsive, can not protect their own airway, and does not have an active gag reflex. This is mostly when manual airway maneuvers fail (head-tilt/chin-lift, jaw-thrust, etc.), and/or Bag-valve Mask (BVM) is required. OPAs are sized by measuring it from the corner of the mouth to the curvature in the jaw. If too big or too small, try another size or it will not be effective.

Start by inserting the OPA with the inward curve facing upwards. As you advance the OPA along the roof of the mouth start to passively rotate the OPA as it passes over the tongue, so the curve turns 180 degrees downward and sits behind the tongue. If the OPA pops back out or meets resistance assure you are using the appropriate size or re-assess the casualty’s consciousness, in case they have regained their gag reflex and can no longer accept an OPA.

A Nasopharyngeal Airway (NPA) is used when a person is semi-responsive and unable to protect their own airway. NPAs can also be used when the unresponsive person is in trismus (clenched jaw) or who cannot accept an OPA. Never use an NPA in the context of facial trauma or potential basal skull fracture, as it can cause serious harm or death. Signs of basal skull fracture include but are not limited to: bruising behind the ears, bruising around both eyes, and fluid drainage from ears or nose.

Start by sizing the NPA, measuring from tip of the person’s nose to the curvature in their jaw. Make sure it is the appropriate size. Then generously lubricate the NPA and start by attempting the right nostril. Point the NPA’s bevel to the septum of the nose and slide the NPA in, advancing it as it follows the natural curve of the nasopharynx. If you meet resistance try the other nostril or assure the NPA is sized correctly. Some individuals have anatomical anomalies such as “deviated septum” that may affect their ability to receive an NPA. If not done correctly and with care it can result in damage to the tissues and structures of the nares/nasopharynx (this can include bleeding).