One-Pager
NREMT BVM Skill: Ventilating an Apneic Patient
Bag-valve-mask ventilation of an apneic adult with a pulse: check, open, suction, airway adjunct, seal, rate and volume
Download one-page PDFLetter landscape, ready to print or keep with your notes
NREMT BVM skill: what it tests
The NREMT BVM station tests bag-valve-mask ventilation of an apneic adult who still has a pulse: you confirm the problem, open and clear the airway, insert an adjunct and ventilate at the right rate and volume with oxygen. The skill is simple; the fails come from slow starts, poor seals and breathing too fast.
Step by step
- Protective equipment on; scene safe.
- Check responsiveness, then breathing and a carotid pulse together, no longer than 10 seconds.
- Open the airway: head tilt and chin lift, or jaw thrust if spine injury is possible.
- Look in the mouth; suction blood, vomit or secretions.
- Size and insert an oral airway (only if there is no gag reflex; otherwise a nasal airway).
- Seal the mask over nose and mouth and start ventilating right away; attach oxygen as soon as you can.
- Turn oxygen to high flow and keep the reservoir full.
- Ventilate: each breath over about 1 second, just enough to see the chest rise, one every 5 to 6 seconds.
- Watch chest rise and recheck the pulse regularly (about every 2 minutes is common teaching); start CPR if it is lost.
Rate and volume
| Patient | Rate | Volume |
|---|---|---|
| Adult with a pulse | 10 to 12 per minute (one every 5 to 6 s) | Just enough for visible chest rise |
| Child or infant with a pulse | 20 to 30 per minute | Just enough for visible chest rise |
| Adult in arrest, no advanced airway | 2 breaths after each 30 compressions | Each over 1 second |
Getting a good seal
- Two rescuers whenever possible: one holds the mask with both hands (thumbs on the mask, fingers lifting the jaw), the other squeezes.
- Alone: C over the mask with thumb and index finger, E of the other three fingers lifting the jaw.
- Bring the jaw up into the mask; do not push the mask down into the face.
- Pad under the head or shoulders to line up the airway; raise the head of the stretcher if allowed.
- No chest rise? Reposition the head, reseal, suction, check the adjunct, then try again.
Critical-fail themes
- Not checking for a pulse, or taking too long to check.
- A long delay before the first breath, or long pauses between breaths.
- Never opening the airway or clearing obvious vomit or blood.
- An oral airway in a patient who gags.
- Rate or volume far too high, or no visible chest rise.
- No oxygen connected by the end of the station.
In depth
The one-page summary above is what the PDF prints. These sections go further.
Oral and nasal airways
- Oral airway: only when the patient has no gag reflex. Size against the face as you were taught; a wrong size can push the tongue back or cause gagging.
- Nasal airway: tolerated with a gag reflex. Lubricate and pass gently along the floor of the nose.
- Avoid a nasal airway with obvious facial injury.
- After any adjunct, confirm chest rise with the next breath.
Why over-ventilation hurts
Positive pressure raises the pressure inside the chest and slows blood return to the heart, so fast or forceful bagging can drop the blood pressure. Air that does not go to the lungs goes to the stomach, which raises the risk of vomiting and aspiration. Small, slow, steady breaths ventilate better.
Exam pearls
- Apneic with a pulse means ventilate; apneic without a pulse means CPR.
- One breath every 6 seconds meets both the national EMS guideline and the BLS guideline for an adult with a pulse.
- Say "chest rising, good seal" so the examiner hears you checking.
- If the patient vomits, roll them with the spine protected, suction, then resume.
Practice free in your browser2,450+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
Related one-pagers
- EMS Patient AssessmentScene to handoff for EMT and paramedic: XABCDE, history, GCS, reassessment, reports
- EMT By-Complaint Quick PagesWhat the EMT looks for, gives and calls ALS for, and where to transport, for common EMT complaints
- EMT: Soft-Tissue and Musculoskeletal TraumaBleeding control, impaled objects, eviscerations, amputations, splinting, traction splints, pelvic binders, crush and mechanism of injury
- EMS OperationsScene hazards, hazmat, infection control, ambulance and air operations, ICS, legal duties and privacy, at EMT scope
- Common EMS MedicationsClass, use, typical adult dose and key cautions for 21 prehospital drugs, with EMT-scope drugs marked
- Prehospital Stroke and STEMIStroke and LVO screens, last known well, destination, 12-lead, STEMI times, and aspirin and nitro cautions for EMT and paramedic
Sources
- National Association of State EMS Officials. National Model EMS Clinical Guidelines, Version 3.0. March 2022. Airway Management; Universal Care; Cardiac Arrest. Link
- Jang YS, Cho GC, Cho Y, et al. 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 3. Adult basic life support. Clin Exp Emerg Med. 2026;13(Suppl 1):S18-S31. Link