- Longer EMS transport distances or an inability to adequately ventilate a patient with a bag valve mask require a more advanced airway.
- Appropriate intubation is impossible due to patient access or difficult airway anatomy.
- Inability to secure an endotracheal tube in a patient who does not have a gag reflex where at least one failed intubation attempt has occurred.
- Patient must be unconscious.
- WARNING: This airway may not prevent aspiration of stomach contents!
- Pre-oxygenate and hyperventilate the patient.
- Select the appropriate tube size for the patient.
- Lubricate the tube.
- Place patient in sniffing position and gently press down on chin.
- Insert the leading soft tip into the mouth of the patient in a direction towards the hard palate. Guide the device downwards and backwards along the hard palate with a continuous but gentle push until a definitive resistance is felt.
- Incisors should be resting on the integral bite-block.
- Ventilate the patient.
- Auscultate for breath sounds over the lungs and epigastrium and look for the chest to rise and fall.
- Secure the tube to the patient’s face.
- Confirm tube placement using end-tidal CO 2 detector .
- It is required the airway be monitored continuously through waveform capnography and pulse oximetry.
- Complete an airway evaluation form with any BIAD use.