Expired Air Resuscitation (EAR)

Source: Close, A. "Emergency Care", 2001.

EAR is used by the First Aider when the patient is either not breathing or not breathing adequately (only 6-8 times per minute, or very shallow - poor volume). The First Aider uses his or her own expired air or breath to provide air to the patient. EAR includes mouth to mouth, mouth to mouth and nose, and mouth to stoma.

Technique - EAR - Adults
- Use a protective mask or face shield if available
- Place the patient on their back
- Apply head tilt and jaw support according to age and size
- Take a breath in and place your mouth over the patient's open mouth
- Seal the patient's nostril with your cheeck or by pinching with your thumb and forefinger
- Give 5 breaths in 10 seconds
- Check for the chest falling and feel air exhale from the mouth between breaths
- Check for a pulse and signs of perfusion (nutritive delivery to arterial blood)
If a pulse is present, then continue to:
- Deliver 15 breaths per minute, this is one breath every 4 seconds
- Watch for the chest rise and fall with each breath
- Check for return of breathing and/or pulse after 1 minute and then 2 minutely intervals after that
- Lift your mouth away to avoid the patient's exhale of stale air
- Breathing too hard into the patient may force air into the stomach, causing it to swell
- Do not apply pressure to the stomach, this will cause regurgitation.

If there is no chest movement, check the airway, head tilt and your EAR technique.
If there is still no air entry, then treat for airway obstruction (chocking).
If an unconscious patient is breathing, check for pulse.
If a pulse is not present, commence Cardio-Pulmonary Resusciation (CPR)
If an unconscious patient stops breathing at any time roll them onto their back and administer 5 full quick breaths, then continue EAR at 15 breaths per minute. If there is no pulse, commence CPR.

If the patient is breathing inadequately: match patient's breath with your breath to improve the volume of air inhaled into the lungs.

*EAR on infants and children must be modified: gentle breaths (puffs) - only enough to make their chest rise. Do not apply head tilt for infants (keep it straight, unless there is any resistance to first puffs). As children grow older and larger, more head tilt may be needed.

EAR RATES:

Adult: Maximum or slight head tilt, jaw support, 5 breaths to start, 1 full breath every 4 seconds, 15 breaths per minute.

Child: Slight head tilt, slight jaw support, 5 small breaths to start, 1 gentle breath each 3 seconds, 20 breaths per minute.

Infant: No head tilt, slight jaw support, 5 puffs to start, 1 puff each 3 seconds, 20 breaths per minute.