Clinical Indications:


  • 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!




  1. Pre-oxygenate and hyperventilate the patient.
  2. Select the appropriate tube size for the patient.
  3. Lubricate the tube.
  4. Place patient in sniffing position and gently press down on chin.
  5. 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.
  6. Incisors should be resting on the integral bite-block.
  7. Ventilate the patient.
  8. Auscultate for breath sounds over the lungs and epigastrium and look for the chest to rise and fall.
  9. Secure the tube to the patient’s face.
  10. Confirm tube placement using end-tidal CO 2 detector .
  11. It is required the airway be monitored continuously through waveform capnography and pulse oximetry.
  12. Complete an airway evaluation form with any BIAD use.