NREMT Airway, Breathing, and Ventilation

There is no current “Airway 18–22%” silo

Airway and ventilation tasks sit inside Primary Assessment and Patient Treatment and Transport on the current blueprint, not in a retired “Airway 18–22%” silo. For broader next-best-action reasoning, see primary assessment items; the sections below stay on airway and ventilation.

The specification’s related tasks include assessing the patient’s airway and breathing, then managing airway, ventilation, and oxygenation. Pediatric anatomy changes the technique; it does not create a separate official domain. See pediatric patients.

The National Registry points candidates to current AHA CPR/ECC guidelines and the National EMS Education Standards through the education-program page. Follow those and local protocol, including for device settings.

Read arrest and breathing problems as different stems

The 2025 AHA Adult Basic Life Support guidance distinguishes an adult in cardiac arrest from an adult who has a pulse and is not breathing normally. After cardiac arrest is identified, it says to begin CPR. For an adult who is not breathing normally but has a pulse, it says rescue breathing is reasonable, about one breath every six seconds. A single airway-then-breathing-then-circulation list does not cover both.

On an exam item, use the facts the stem already gives:

• No pulse, or the stem says cardiac arrest: stay in the arrest context. Do not import a breathing-only sequence.
• A pulse is present and breathing is the problem: ventilation belongs only when the stem’s rate, depth, or oxygen problem supports it.
• Blood, vomit, or secretions are in the airway: suction is relevant because the stem supplied that cue. A gurgling sound is not, by itself, an order to ventilate.
• The patient is talking: speech is a clue the airway is open. Oxygen still depends on whether the stem made hypoxia the problem.

Scene safety is a separate size-up task. Size-up is 15–19%. Your local protocol sets the field sequence.

Practice airway and breathing scenarios in the Passy NREMT EMT prep app →, paying attention to whether a pulse and normal breathing are present.

Adjuncts, suction, and oxygen at EMT level

Most airway treatment items turn on a small set of EMT tools. Know what each one is for and when the stem rules it out:

• Oropharyngeal airway (OPA): for an unresponsive patient with no gag reflex. Courses size it from the corner of the mouth to the earlobe or the angle of the jaw.
• Nasopharyngeal airway (NPA): often tolerated by a patient who still has a gag reflex. Courses teach caution when the stem describes severe facial or head trauma.
• Suction: clears blood, vomit, or secretions so that ventilation can work. Keep each attempt brief, because the patient is not being ventilated while you suction.
• Oxygen versus assisted ventilation: oxygen helps a patient who is breathing adequately but is hypoxic. A patient whose breathing rate or depth is inadequate needs ventilation, usually with a bag-valve mask, and oxygen alone will not fix that.

Inadequate breathing usually shows up in the stem as a rate that is too slow or too fast, shallow chest rise, increased work of breathing, cyanosis, or a falling level of consciousness. When those cues appear, the question is usually whether to ventilate now.

Treatment domain versus assessment domain

If the item is “what do you assess next,” you are still in primary assessment.

If the item is “what do you do for this breathing problem,” you are in treatment—and later transport may ask whether the patient needs ALS intercept or a closer hospital while you keep ventilating.

Circulation is part of primary assessment when the stem asks for it. It is not automatically the step after breathing, and it is not skipped in an arrest stem because the page is about airway.

What not to import from old outlines

Do not allocate 20% of your calendar to a vanished domain label. Do allocate enough reps that medical, trauma, and pediatric airways feel different.

The what-to-study map lists the current domain percentages. Spend airway time on the decisions items test, such as recognizing inadequate breathing, choosing between oxygen and assisted ventilation, and knowing when suction has to come first, rather than on device brand names.