To ensure effective ventilation with a bag-mask device, what is required?

Using proper head positioning and creating an effective seal are crucial for ensuring effective ventilation with a bag-mask device. When the head is positioned appropriately, such as in the "sniffing" position, it helps to align the airway and open it more effectively, which facilitates the passage of air into the lungs.

Additionally, achieving a good seal between the mask and the patient's face is essential; this prevents air from escaping around the mask and ensures that the delivered breaths enter the patient’s lungs instead of escaping into the environment. An ineffective seal can lead to inadequate ventilation, reducing the effectiveness of the intervention in emergency situations.

Other options, such as counting breaths aloud while ventilating, using a protective mask, or timing the ventilation every 6 seconds, do not address the fundamental requirements of creating proper positioning and a seal, which are vital for successful bag-mask ventilation.