MOD-2 is the airway module. Historically this has been the module that has the highest failing rate of any of the seven modules on the National Registry Test. This has many causes, one being that this module is the shortest module but is used indirectly in all subsequent modules. For example, your airway skills are used in the patient assessment modules, trauma modules and pediatric modules yet you are not specifically tested on them. You are just expected to know the skills.

The United States Department of Transportation (US DOT) has recognized that this is a problem and has compiled a supplemental airway curriculum. This is really a merging of objectives from several other modules.

Click here to download a copy of the US DOT 2002 Airway Supplemental document

The MOD-2 module has only one lecture less and then some practice time.

Lesson 2-1 Airway

Teaches airway anatomy and physiology, how to maintain an open airway, pulmonary resuscitation, variations for infants and children and patients with laryngectomies. The use of airways, suction equipment, oxygen equipment and delivery systems, and resuscitation devices will be discussed in this lesson.

Lesson 2-2 Practical Skills Lab: Airway

Provides supervised practice for students to develop the psychomotor skills of airway care. The use of airways, suction equipment, oxygen equipment and delivery systems, and resuscitation devices will be included in this lesson.

Lesson 2-3 Evaluation: Airway Module

Conduct a written and skills evaluation to determine the student's level of achievement of the cognitive, psychomotor and affective objectives from this module of instruction.

The MOD-2 lesson plan is for a total of 7 hours, 4 of which are for lecture. This seems excessive to me, in our program we combine part of the lecture with the practical skills.

The written exam for MOD-2 is difficult in that it covers a small amount of material but it comes very fast after MOD-1. Many students don't have time to read up on the material.

There are several practical skills for MOD-2. These are Mouth-to-mask ventilation, Oral and Nasal pharyngeal airway placement with suctioning, and oxygen administration.

I have my own testing criteria for these skills.

Mouth-to-Mask with supplemental Oxygen

In all practical skills testing we look for proper BSI recognition. In fact it is a mandatory failing criterion for all skills tests, MOD-2 included, if the student fails to mention BSI. I instruct my students to "Make the universal sign for BSI" by waving their hands and saying BSI as they start the test. I also put gloves out on the table for them to use but some institutions try to save money by not using gloves.

This skill is really part of CPR so we don't test as rigorously as some other skills. What I want to see is that the student manages to properly connect the oxygen tubing and gets chest rise. If they manage that then I am satisfied.

Airway Maintenance (Oral, Nasal and Suctioning)

BSI is important of course and for this station I make the students use gloves. I use a rescue manikin for testing purposes (it seems that it's hard to find a live patient who wants a nasal airway shoved up their nose twenty times a night). I usually give the candidate a simple scenario since by this point in their education they do not have a lot of skills. The scenario is usually something like this:

You have come on scene for a 48 year old male who is unresponsive. You have determined that the patient has no spinal trauma and requires you to maintain his airway. What should you do?

I then look to see if the candidate opens the airway with a head-tilt chin-lift and checks to see if the patient is breathing. This is not part of the formal test but it's nice to reinforce basic skills learned in CPR. I want to see the candidate take an appropriately sized oral pharyngeal airway and properly insert it into the patients mouth. When they complete this task I usually add:

The patient begins to gag, what should you do?

The student should promptly remove the oropharyngeal airway. I then add the nasty part:

The patient has vomited clear fluid into the airway and is making gurgling sounds.

I look to see if the student recognizes the fact that they need to suction the patient. I generally provide either a soft tip suction catheter or a hard catheter and allow the student to choose which to use. The student should turn on the suction unit and verify that it works. We use Laerdal suction units, some of which are older than the students, which need to be connected to a power source. The student should check for the presence of vacuum according the the device instructions and then suction the patient appropriately.

Specifically I am looking to see if they suction on the way in (FAIL) or on the way out. Somewhere along the way, some older EMT instructors claim that the hard suction catheter needs to be measured. This is not true, you only insert the hard suction catheter as far as you can see and then suction on the way out. The soft catheter requires measurement.

After suctioning, I usually instruct the student as follows:

The patients airway is now clear but has an intact gag reflex. What should you do?

The student should then size and insert a nasopharyngeal airway. I look to see if they put the beveled edge (the flat side) against the septum of the nose. Since I am using a manikin I actually have the student lubricate the airway.

Oxygen Administration

To complete the MOD-2 testing we need to provide oxygen. Assembling oxygen cylinders is one of my pet peeves on my own ambulance corps. I have been on many calls when the O2 ran out and my fellow crew mates could not change out the cylinder quickly. I run drills on my corps just in O2 management. Ideally you should be able to swap out a cylinder in less than 1 minute (in the dark and upside down - after all the patient needs it more than you do).

This MOD-2 test is quite simple, do it or don't do it. I usually give very simple instructions:

You have arrived on scene of a 22 year old female who requires oxygen. Assemble the tank for use with a non-rebreather mask.

Of course BSI is still important and I make the students perform the skill using gloves. They need to assemble the tank without leaks, verify the current pressure and attach a non-rebreather mask and properly pre fill the reservoir bag at a flow rate of 15 liters per minute. They can then put it on the patients face (in this case a CPR manikin).

We used to ask about hydrostatic testing and the like but this is not part of the EMT test. If you fill your own bottles then this is important to you.

After the mask is applied the student receives additional instructions:

The patient informs you that they can not tolerate a non-rebreather mask. What are your options?

The student should advise the patient that the non-rebreather mask is best for them (again this is not part of the test) but then should properly apply a nasal cannula. I look to see if they remove the non-rebreather mask from the patient before disconnecting the supply tubing. I also check if they lower the flowrate to no more than 6 liters per minute.

After they complete this skill I give the following instructions:

Oxygen service is no longer required. Please, safely return the unit to stand-by mode.

I look to see if they student removes the nasal cannula before shutting down or disconnecting the tubing (both are failing points). I also look to see if the student relieve the pressure in the regulator in a safe manner. After that has been accomplished I ask for the student to remove the regulator for the next candidate.

The MOD-2 practical test is usually well done by the students. They seem to do well with the mechanical skills. It is important that the student practice these skills for the remainder of the course.

Download a free MOD-2 quiz and skills sheets by clicking here
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