Question: In performing your ABCs on unconscious patients, the BLS has never clarified whether, after checking the airway you should, insert an airway then go to breathing OR go to breathing, insert 2 breaths, then insert an airway. Can you finally put an end to this debate?
Paramedics on-scene should work together as a team in order to complete all the patient care priorities. Much would depend on the other conditions present on the call. Is the patient just unconscious? Or is he apneic and ventilations are required? Is he in cardiac arrest where compressions and defibrillation are the priorities? The BLS Patient Care Standards provide general direction on each case. The "Syncope" standard (p. 2-52), the "Respiratory Arrest" standard (p. 2-41), and the "Airway Obstruction" standard (p. 2-9) all address controlling the airway. The Cardiac Arrest standards for adults and children (p. 2-18 and p. 2-20) also speak to airway control including the possible use of airway adjuncts. Many of the BLS Patient Care Standards include direction for patient management with terms such as "establish/maintain airway patency as required". Your service training manager can also provide further direction on the BLS Patient Care Standards.
Ultimately, the paramedic must determine whether or not airway adjuncts are required, and if so, at what point they are applied. If the airway is being maintained well by manual methods, that may be all that is required. However, if there is difficulty maintaining an adequate airway by manual methods (based on patient condition or lack of additional resources) the paramedic should consider using either an oral or nasal pharyngeal airway (depending on the circumstances), or even advanced airway adjuncts such as a supraglottic airway or intubation if the patient meets the ALS Patient Care Standards medical directives. You will note that the indications for these procedures include "need for ventilatory assistance or airway control AND other airway management is inadequate or ineffective". (p. 2-46, p. 3-7, p. 4-8).