Scene Safety, Standard Precautions, and Infection Control for Airway Procedures

Why Scene Safety and Infection Control Come First

Before you open an airway kit or reach toward a patient, you must protect yourself and your crew. Airway procedures — bag-valve-mask ventilation, suctioning, supraglottic airway insertion, endotracheal intubation — place you inches from a patient's mouth and airway. Respiratory secretions, blood, and vomit can spray, splash, or aerosolize in an instant. A provider who becomes infected or injured cannot help the next patient, and may spread illness to colleagues and family. OSHA's Bloodborne Pathogen Standard (29 CFR 1910.1030) and Respiratory Protection Standard require employers to provide and require employees to use appropriate personal protective equipment (PPE). As a student and future EMT or paramedic, you are expected to follow these rules from your very first skills lab session.

Standard Precautions

Standard precautions treat every patient's blood, body fluids, secretions, and mucous membranes as potentially infectious — regardless of known diagnosis. This approach replaced the older "universal precautions" concept and now includes both bloodborne and droplet/airborne pathogen protections. For airway procedures, assume every patient may carry bloodborne pathogens (such as HIV and hepatitis B and C) as well as airborne or droplet pathogens (such as tuberculosis, influenza, or COVID-19). You will not always know what a patient has. Standard precautions remove the guesswork.

Required PPE for Airway Procedures

Gloves are the minimum for any patient contact, but airway work demands more. Select the correct glove size — a glove that is too loose can slip during a procedure and expose your skin. Nitrile gloves are preferred when latex allergy is a concern for patient or provider.

Eye protection (safety glasses, goggles, or face shield) guards against splash of blood, vomit, or secretions. During intubation and suctioning, a full face shield is strongly recommended because it also protects the nose and mouth.

Mask selection depends on the risk level:

• A standard surgical/procedure mask protects against large respiratory droplets and splatter.
• An N-95 respirator (or higher) is required when an airborne-transmitted disease (e.g., suspected tuberculosis or other aerosol-generating procedures) is possible. N-95 respirators must be fit-tested before use — a mask that does not seal to your face offers far less protection.

Isolation gown protects your clothing and skin from large-volume splatter during suctioning or active vomiting. Tie it securely at the neck and waist.

Donning Sequence

Put on PPE before patient contact, using this sequence:

1. Gown

2. Mask or respirator

3. Eye protection

4. Gloves (last, so gloves cover gown cuffs)

Inspect each item before use. A glove with a pinhole tear must be replaced immediately.

Doffing Sequence (Removing PPE Safely)

Doffing is where many exposures actually happen. Contaminated PPE must not touch your face or clean skin.

1. Gloves — peel the first glove off by grasping the outside, then use the bare hand to peel the second glove from the inside out. Dispose immediately.

2. Eye protection — remove by grasping the earpieces or headband, not the front lens (which may be contaminated).

3. Gown — untie, pull away from neck and shoulders, roll the gown inward (contaminated side in), and discard.

4. Mask or respirator — remove by the ties or ear loops; never touch the front of the mask.

5. Perform hand hygiene immediately after each major step, and always as the final step.

Hand Hygiene

Alcohol-based hand rub is effective for most situations and is faster in the field. Soap and water is required when hands are visibly soiled or when caring for patients with certain gastrointestinal illnesses. Hand hygiene after doffing is not optional — it is the final barrier between potential contamination and your safety.

Sharps Safety

Airway procedures sometimes involve needles (e.g., medication administration adjuncts, surgical airway kits). Never recap a needle with two hands. Use a one-hand scoop technique or a mechanical recapper, and dispose of sharps immediately in an approved sharps container. Needle-stick injuries are a leading cause of occupational bloodborne pathogen exposure in EMS.

After an Exposure Event

If a splash to eyes, nose, or mouth occurs, or a needle-stick happens, act immediately:

1. Flush the affected area with water or eyewash for at least 15 minutes.

2. Report the exposure to your supervisor without delay.

3. Follow your agency's exposure-control plan — this plan, required by OSHA, outlines the exact steps for post-exposure evaluation and follow-up, including medical evaluation and possible post-exposure prophylaxis.

4. Document the incident accurately.

Time matters: post-exposure prophylaxis for certain bloodborne pathogens is most effective when started quickly. Never downplay or delay reporting an exposure.

Connecting PPE to Airway Skill Performance

Properly donned PPE should not prevent you from performing airway skills. Practice in lab with full PPE so that gloves and face shields feel normal during intubation attempts. Instructors will evaluate your PPE technique separately from your airway technique — both must be correct to reflect real field standards. Arrive at every lab session ready to don PPE before the first mannequin touch.