What Steps Should You Follow To Open The Airway?

If someone cannot breathe, the first thing to do is call 911 or direct someone else to call. Then open the airway using a head-tilt, chin-lift: place one hand on the forehead and gently tilt the head back, while lifting the chin with two fingers of your other hand. If you suspect a neck or spinal injury, use a jaw-thrust instead: place your fingers behind the angles of the jaw and lift it forward without tilting the head. After opening the airway, check for normal breathing and begin CPR if the person is not breathing normally.

Airway opening is one of the most basic and most important skills in first aid. It is also one of the most misunderstood. What follows is a step-by-step guide to opening an airway in an adult, what to do if you think the person has a spinal injury, and how to tell the difference between an airway problem and a choking emergency.

What Steps Should You Follow To Open The Airway?

The steps are straightforward. The skill is in doing them in the right order and knowing when to stop and move on to CPR.

Step 1: Check the scene and the person. Make sure the area is safe for you. Tap the person and shout to see if they respond. If they do not respond and are not breathing normally, call 911 immediately or have someone else call while you begin.

Step 2: Position the person. Lay the person flat on their back on a firm surface. If they are face down, roll them as a unit — supporting the head and neck — to avoid twisting the spine.

Step 3: Open the airway. Use the head-tilt, chin-lift maneuver. Place one hand on the forehead and tilt the head back. Place two fingers of your other hand under the bony part of the chin and lift it upward. This lifts the tongue away from the back of the throat, which is the most common cause of a blocked airway in an unconscious person.

Step 4: Check for breathing. Look for chest movement, listen for breath sounds, and feel for air on your cheek. Do this for no more than 10 seconds. Gasping is not normal breathing — treat gasping as a sign the person needs CPR.

Step 5: Act on what you find. If the person is breathing normally, place them in the recovery position (on their side) to keep the airway open while you wait for help. If they are not breathing normally, begin CPR starting with chest compressions.

Why Does Tilting the Head Open the Airway?

In an unconscious person, the tongue falls back and blocks the throat. This is the single most common cause of an obstructed airway in someone who is unresponsive.

The tongue is attached to the lower jaw. When you tilt the head back and lift the chin, you pull the jaw and tongue forward, away from the back of the throat. The airway opens because you are physically moving the tissue that was blocking it.

This is why the head-tilt, chin-lift works reliably in most unconscious adults. It is a mechanical fix for a mechanical problem. It does not require any equipment, and it can be done by almost anyone with minimal training.

What If You Suspect a Neck or Spinal Injury?

Use the jaw-thrust maneuver instead of the head-tilt, chin-lift. The jaw-thrust opens the airway without tilting the head back, which reduces movement of the neck.

To do a jaw-thrust: kneel at the person’s head, place one hand on each side of the head, and put your fingers behind the angles of the lower jaw. Lift the jaw forward and up. If the jaw-thrust does not open the airway, the standard guidance is to use the head-tilt, chin-lift anyway — a blocked airway is an immediate threat to life, and opening it takes priority.

Spinal injury is a real concern after falls, diving accidents, and car crashes. But it is less common than many people assume. The current approach in CPR training is to open the airway with the standard maneuver unless the mechanism of injury clearly suggests a spinal problem. Some training programs have moved toward teaching the head-tilt, chin-lift as the default even in trauma, because the risk of a blocked airway outweighs the risk of spinal movement in most cases.

How Do You Tell the Difference Between an Airway Problem and Choking?

An unresponsive person with a blocked airway needs the airway opened and CPR. A conscious person who is choking needs a different response entirely.

If the person is conscious and clutching their throat, cannot speak, and has a silent or weak cough, they are choking on a foreign object. In that case, the response is back blows and abdominal thrusts (the Heimlich maneuver), not a head-tilt. The head-tilt, chin-lift is for an unresponsive person whose airway is blocked by their own tongue.

If the person is coughing forcefully, leave them alone and encourage them to keep coughing. A strong cough means air is still moving. Intervening too early can turn a partial blockage into a full one.

If a choking person becomes unresponsive, lower them to the ground and begin CPR. Each time you open the airway to give breaths, look in the mouth for the object and remove it only if you can see it. Never do a blind finger sweep — it can push the object deeper.

What Is the Recovery Position and When Should You Use It?

The recovery position keeps an unconscious but breathing person on their side so the airway stays open and fluids can drain. Use it when the person is breathing normally but is not fully awake.

To place someone in the recovery position: kneel beside them, place the arm nearest you at a right angle to their body, bring the far arm across their chest, and bend the far knee. Roll them toward you onto their side, tilt the head back slightly, and make sure the airway is not blocked by the ground or their own arm.

Do not use the recovery position if you suspect a spinal injury and the person is breathing — keep them still and wait for emergency services. Do not use it for a person who is not breathing. That person needs CPR.

What Should You Do If the Airway Is Blocked by Fluid or Vomit?

Roll the person onto their side to let the fluid drain, then return them to their back and reopen the airway. If they are not breathing normally after the airway is clear, start CPR.

Vomit and blood are common causes of airway obstruction in unconscious people. Clearing the mouth with a finger sweep — only if you can see the material — and turning the person to the side are the standard steps. Do not put your fingers blindly into the mouth.

If the person is drowning, the priority is to get them out of the water and start rescue breathing and CPR as soon as possible. Do not attempt to drain water from the lungs by pressing on the abdomen — this does not help and can cause vomiting and further airway problems.

How Do You Open a Baby’s Airway?

Use a gentler version of the head-tilt, chin-lift. Place one hand on the baby’s forehead and tilt the head back only slightly — the head should not be tilted as far back as an adult’s. Use one finger to lift the chin.

For an infant, the airway is smaller and more easily compressed. Over-tilting the head can actually close the airway rather than open it. The goal is a neutral or slightly extended position, not a full tilt.

If you suspect a spinal injury in an infant, use a jaw-thrust. If that does not open the airway, use the head-tilt, chin-lift. The same principle applies: a blocked airway is the more immediate threat.

For children over the age of one, use the adult head-tilt, chin-lift but with less force. The technique is the same; the pressure is lighter.

What Equipment Do Trained Responders Use to Open an Airway?

Trained responders and healthcare professionals use airway adjuncts — simple plastic devices that hold the tongue away from the back of the throat. The oropharyngeal airway (OPA) is inserted into the mouth, and the nasopharyngeal airway (NPA) is inserted into the nose.

These devices are not for untrained use. Inserting an OPA in a person who is not deeply unconscious can trigger gagging, vomiting, and further airway obstruction. The head-tilt, chin-lift remains the first-line maneuver for lay rescuers because it is safe, effective, and requires no equipment.

Bag-valve-mask ventilation and advanced airway devices like supraglottic airways and endotracheal tubes are used by emergency medical personnel. These require training and are outside the scope of basic first aid.

What Mistakes Should You Avoid When Opening an Airway?

The most common mistakes are easy to correct once you know them.

• Not calling 911 first. Opening the airway buys time, but the person needs emergency care. Call before you start if you can.
• Tilting the head too far back in an infant. Over-extension can close a baby’s airway. Use a gentle tilt.
• Doing a blind finger sweep. If you cannot see the object, do not reach for it. You can push it deeper.
• Confusing gasping with normal breathing. Gasping is not breathing. Treat it as a sign to start CPR.
• Delaying CPR to keep opening the airway. If the person is not breathing normally after the airway is opened, start chest compressions immediately. Do not spend more than 10 seconds checking for breathing.

One clarification worth knowing: the head-tilt, chin-lift is not the same as the Heimlich maneuver. They solve different problems. The head-tilt opens an airway blocked by the tongue. The Heimlich maneuver forces air out of the lungs to dislodge a foreign object from a conscious choking person. Using one when the other is needed can waste time in an emergency.