Forum Ride Along
Hello all - new EMT and you know what they say about questions. Here is one that never truly was clarified in school.

We are all familiar with that wonderful red bag of OPAs and tags. I don't understand how to utilize OPAs into the system. I understand if someone's is not breathing on their own, re-position the airway and continue with algorithm - however assuming someone does start breathing - and we place an OPA to secure airway (if indicated) - are we then married to that PT, or do we Red tag and move on as common algorithms suggest? Seems to defeat the entire purpose of rapid multi PT triage, however are we not required to still keep the airway manually open while an OPA is inserted? (- this too is something that was never truly clarified in school - like in situations such as CCR with OPA and NRB in place.) What if we are managing bleeding or assessing mental status of another PT while we notice our original PT with OPA inserted begins to gag? - Now OPA is contraindicated and my hand is glued to an arterial spurter.

I am a TEXTBOOK over-thinker. I envy my friends in EMS with more common sense than myself. Obviously any help would be appreciated. Thank you all.


Critical Crazy
Left lateral recumbent (recovery) position is a quick tool to protect the airway that would benefit from OPA or NPA outside of the triage stage of a true MCI. Recovery position will help until follow on crews get to your red patient.

In fact, short obvious signs, I argue that a lot of black tag patients should probably get a breath and recovery position even if opening the airway didn't solve it because it is fast and triage is somewhat inaccurate. I've never had more than one black, one red, and a couple yellows at the same time... but I can tell you as can others that a good algorithm works well until it meets a real MCI... then it might keep working or it might break. Use what you have and do what is best. Hope you never need it...

I appreciate your username.


Forum Deputy Chief
The definition of an MCI is "A demand for resources beyond the capability of resources currently available."

The algorithm is helpful, but be realistic in the mindset that, if the patient requires constant airway manipulation to stay breathing, that you cannot commit yourself to that single patient. If placing an OPA works, great, move on. Realize that they might be a black tag when you come back.

Secondary triage is the most understated key point of any triage, especially start triage.

Initial triage is blunt and quick so you can assess the entire scene quickly.


The fire extinguisher is not just for show
your overthinking it. drop an OPA if they aren't breathing. see what happens. move on. If they start gagging, odds are they are breathing, on their own, maybe they can take it out, or run over and take it out and turn them on their left side.

if you are applying pressure to an arterial bleed your doing it wrong. If it's bleeding a little, have the patient (or someone next to him) apply pressure and move on. if it's bleeding a lot, apply a tourniquet and move on.

remember you are not treating, you are attempting A lifesaving intervention and moving on to assess the rest.


Forum Troll
If they aren’t breathing then reposition the airway. If they still don’t breath they are black tagged. If they do start breathing place an OPA and tag them red and move on to the next patient.

Once you have triaged everyone and no one else needs immediate life saving treatment, then you can stay with this patient as they may be the most critical.