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MEDICAL: Safety Pin Airway

The Safety pin airway – Iraqi style! (Sweet unibrow dude!)

Read THIS so you can’t sue us

Treating a trauma casualty was briefly mentioned in Andrew R.’s First Aid Kit article, and we’ll make sure to post more thorough discussions here in the future on how to treat all things trauma.

In Andrew’s article he introduced EABC (exsanguinations, airway, breathing, circulation), and briefly discussed treating life-threatening bleeding. The next step in the trauma assessment is ensuring the patient has a patent airway.

Unless the airway is blocked due to a foreign object (debris, broken teeth etc), the main cause of an airway blockage is the tongue relaxing and blocking the airway. So opening an airway simply involves removing any object that is blocking the airway and making sure the tongue is out of the way.

Oral pharyngeal airways are designed to pull the tongue up and towards the front of the mouth, ensuring it doesn’t slip back and obstruct the airway. The downside with oral pharyngeal airways is that they have to be sized correctly to the patient, so you have to carry a half-dozen or so.  In addition, if the patient should regain consciousness or is semi-conscious, they can trigger the gag reflex.

Oral Pharyngeal Airway

And while they are fairly light, relatively inexpensive and simple to use, they take up a lot of precious space, and should, in my opinion, be reserved for an ambulance or in a dedicated medical or squad trauma bag.

Nasal Pharyngeal Airway

The other standard airway is the nasal pharyngeal airway, which, while should be sized in the ideal world, you can get away with only having one in your kit (preferably sized for you), and they don’t trigger the gag reflex.  You should absolutely have one of these in your FAK (First Aid Kit) and know how to use it.  I’ll dedicate a future article to their use because of how important they are.

But sticking with the theme of ditch medicine, if you don’t have a well-thought out FAK (so no purpose built airway) on you and you need to secure the airway of a casualty, here’s how you can do it.  Most off-the-shelf first aid kits come with a triangular bandage (cravat) in them.

The triangular bandage is a piece of thin cloth that is triangular shaped and typically comes packaged in a plastic bag with 2 safety pins. It has many uses including making a sling or sling and swath (if you have two) for a broken arm or some other arm/shoulder injury that you want to immobilize, as a hasty tourniquet, or to tie splints to broken limbs.

Cravat – handy for splints and airways

You can take one of the safety pins that come with a triangular bandage and use it to pin the tongue to the lower lip.  This will pull the tongue forward and secure it from blocking the airway.

Obviously, this isn’t the preferred method, and you’ll have to be careful that the bleeding from the now pierced tongue doesn’t obstruct the airway (a gauze pad should do the trick).  But it will free up your hands to take care of any other tasks that you need to accomplish.

Replace the safety pin with a stud and you’ll have given a perfectly cool tongue piercing.  If you’ve got a buddy who snores, pinning his tongue to his lip will help solve that too.

I will say that the safety pins that come with the triangular bandage are about the perfect size for someone with the hands of a 5 year old girl, so I replace them with some bigger ones.  But safety pins are pretty handy things to have around, so I always keep a couple of extras in my kit anyway.


~John B
Cheif Medical and S&R Correspondent

John B has been an EMT for 18 years and is currently a Field Team Leader for a Search and Rescue Team, he also holds a Master’s degree in Neuroscience.

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  1. If you can justify this procedure; do it. Just be prepared to vigorously back-up your justification. Airway generally trumps all other concerns.

    Before I did this procedure though, I would place the pt in the “recovery” or “rescue” position first, again, airway trumps all other concerns.

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  2. I agree with the above statement. The tongue has a large blood supply, piercing one of the two or three veins on the inferior aspect would result in a large amount of blood NOW obstructing airway. I would also be careful placing a gauze pad to soak up this blood, now you have a foreign body obstruction.

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  3. When it hit me what direction this was heading towards did I have one of those OH Shit laughs!

    I have to admit that before I would resort to this I would be more inclined to roll the patient into the “recovery” position. I would really save this for the last resort (but that’s just me).

    It does show what one can come up with, with a bit of ingenuity.

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  4. Lol! This would absolutely be a last resort, which is part of the reason that James puts a disclaimer on my articles.

    It would be way easier to just roll the patient into the recovery position, or (if no c-spine injury suspected) a head tilt/chin lift, just like they taught us in CPR.

    But that wouldn’t be very interesting to read about. Just trying to put different stuff out there for you to think about.

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  5. I think this ditch medical stuff like this is good to add to the old brain-bank and file it away as “well, nothing left to do but this”

    Also I think it is a good tip for contractors and military guys that may have to hastily throw an unconscious wounded person in the back of a car and book ass

    ~James G

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  6. In the ditch, massive haemorrhage trumps everything. If the Claret is flowing, then you’re just fucking about dealing occluded airways

    Unless the method of injury is witnessed, ALWAYS assume C-spine damage, in which case jaw thrust is the preferred method of opening the airway.

    One of the best treatments for any casualty is to talk to them especially the dead and/or dying. Even if their number is up, the last sense to go is hearing and you really don’t want to hear how half your body is now just a pile of jam before saddling up for your final journey.

    Now where did I put that broken bottle and piece of coolant hose, I got a cric to carry out.


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  7. Stevie – too true, too true. I think a lot of times, we medical types forget that the pt is a person too. Got to treat them like a person, not just another procedure.

    You bring another good point up; what mind-set should the medic be in? The civilian v. the combat focus is totally different. In the civy world we always assume c-spine compromise until proven different. In combat, the studies show significantly less than 1% of injuries have s-spine damage. How do we “blend” the two opposing views? Should we?

    Go ahead; discuss.

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  8. In the civilian world we have to worry about every asshole out there that wants an insurance pay off for that fender bender that “broke his neck”. The military doesn’t have that issue & is able to be more realistic about c-spine issues.
    This still gets bantered around at conferences as far as having EMS being able to clear c-spine patients. Personally from a civilian stance, if people want to complain about their neck then they deserve a hard backboard, bondage & a rough ride to the hospital. Who says health care is broken. :>)

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  9. In Search and Rescue, we don’t work off of the EMS protocols. Most injuries incurred in the wilderness (falling down) would require c-spine stabilization and a back board if the protocols were used. This would require a huge process for extrication; a Stokes basket team of 12-20 to move the patient at a blistering 1/4-1/2 mile per hour. Instead the medical teams will, within all reasonable certainty, try to clear the c-spine in the field. For legal reasons, we have a physician on call to give us direct command, and if any uncertainty is present we will error on the side of caution. But having a patient walk out is preferable, and in many cases much safer, then calling in a Stokes team.

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  10. Sorry to be a pedant, but a triangular bandage is only a cravat when it’s folded into a strip (they are usually packaged this way when you purcase them).


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