The airway is the anatomical passageway by which air enters the mouth and nose, and travels through the windpipe (trachea) into the lungs. Air is an essential component to the human body. Breathing introduces oxygen into the lungs, which is then transferred into the bloodstream. Oxygen is transported by the bloodstream to feed organs, such as the brain or the heart. Therefore, maintaining an open airway is vital to the human body.

The airway is flexible and is able to move as the neck moves. In persons who are unconscious, the airway can close and restrict the intake of oxygen. Depletion of oxygen causes damage to tissues and organs of the body. Extended oxygen depletion will eventually lead to permanent damage and death to the tissues and organs.

First Responders may now perform a new skill to maintain the airway of an unconscious person. The advanced airway procedure utilizes a device known as a Combi-tube. This device provides the First Responder with a more efficient way of delivering oxygen to a victims lungs, while protecting their airway for aspiration of fluids. The Combi-tube is a dual lumen airway inserted into a victims throat. Ventilation equipment may be attached to the tube, and pure oxygen is forced directly into the lungs.

Insertion of the tube is done blindly, because it does not matter if it is inserted into the trachea or the esophagus, both of which are located nearby each other in the throat. During 90% of the attempts the tube is inserted into the esophagus.

In this situation, the tube has two balloons which are filled and create an air-tight pocket in the throat between the upper portion of the esophagus (blocked by a balloon) and the area behind the tongue and molars (also blocked by the other balloon). These two balloons allow air nowhere to escape, but into the trachea and then to the lungs. Once the Combi-tube is in place, an ambu-bag is used to blow air into the tube, with the outlet between the two balloons.

If the end of the tube is inserted into the trachea, which happens during 10% of the insertion attempts, the second tube is attached to ambu-bag and oxygen is blown out the end of the device. The end of the device is located directly in trachea, so the oxygen has a secured passageway to the lungs.

The skill is monitored by quarterly practice sessions, inserting the tube into mannequins. The quarterly competency refreshes the skill for first responders, and maintains that the first responder is doing a safe and accurate job of insertion.