Lesson
Facial Trauma and the Airway
Objective: Keep the facial-trauma airway open with suction and position, and avoid forcing an NPA through a smashed midface.
Why This Is Hard
Le Fort-looking faces bleed into the airway. Crews lie them flat for the collar and they drown. DAS/ATLS: airway first. SMR should not kill the airway.
On this truck
- Suction on and tested. Teeth and blood will keep coming.
- If protocol allows sitting-up SMR, use it so they can drain.
- NPA through a possible cribriform/midface injury is a protocol caution — see OPA/NPA.
Field Rules (Education)
- Position: recovery or sitting if the spine story allows. Flat-on-a-board plus a facial smash is a suction marathon.
- OPA if no gag. SGA can rescue when DL is a bloodbath — still confirm with waveform.
- NPA caution with midface/basilar-skull signs.
- C-spine still matters in the right mechanism — just do not let the board be the cause of death.
Field Pitfalls
- NPA through a floating midface.
- No suction charged.
- Laying them flat “for the collar” while they gurgling-drown.
Practice
60-second drill
Partner: motorcycle, midface smash, gurgling, GCS 8. Position, suction, next airway tool.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- DAS guidelines hub — blood and trauma make a difficult airway — plan B
- AHA 2025 Part 7 — suction and open the airway so ventilation works
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.