How to ventilate with a bag-valve mask

Bag-valve-mask ventilation is the airway skill that saves the most lives in an emergency. The hard part is the seal, so two rescuers work better than one.

What you need

• Bag-valve mask with reservoir
• Oxygen at 15 L/min
• Oral or nasal airway
• Suction

Step by step

1. Protect yourself and open the airway

   Gloves on. Head tilt and chin lift, or jaw thrust only if a spine injury is possible. [1]

2. Clear and size an airway

   Suction if needed. Size an oral airway from the corner of the mouth to the angle of the jaw and insert it if there is no gag reflex. [1]

3. Connect oxygen

   Oxygen at 15 L/min with the reservoir attached and filling. [1]

4. Seal the mask

   Right mask size over nose and mouth. One hand in an E-C clamp: thumb and index finger press the mask, other fingers lift the jaw into the mask. With two rescuers, one holds the seal with both hands and the other squeezes. [1]

5. Ventilate

   Squeeze over about one second, just enough to see the chest rise. For an adult with a pulse, one breath every 6 seconds. [2]

6. Check it works

   Chest rises and falls, saturation improves, and capnography shows a waveform if available. [1]

7. Avoid air in the stomach

   Too much volume or speed fills the stomach and causes vomiting. Watch the abdomen. [1]

Common errors

• Poor seal (the most common reason it fails).
• Breathing too fast or too much volume.
• Forgetting to connect the oxygen.

Sources

1. NREMT psychomotor skill sheets (EMT and Paramedic)
2. AHA Guidelines for CPR and ECC

Facts and steps follow NREMT psychomotor skill sheets (EMT and Paramedic). Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.