ExpatMedic0
MS, NRP
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They are BLS skill here, along with CBG testing. Some services carry the combi and some carry the king.
combi/kingairway BLS or ALS?
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mct601
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This.
https://www.nremt.org/nremt/about/exam_coord_man.asp#BSkillSheets
Advanced airway is supposed to be included on BLS skill practicals, but I was actually not tested on it. Reason being, many states don't allow basics to perform advanced airway procedures.
I was introduced to Combi about two weeks ago. It seems to be stupid proof. I like it and I think it should be BLS with what I have learned about it so far. In my area, it's an ALS skill, and it doesn't seem like anybody likes it so maybe I am missing something here. 
TransportJockey
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I was introduced to Combi about two weeks ago. It seems to be stupid proof. I like it and I think it should be BLS with what I have learned about it so far. In my area, it's an ALS skill, and it doesn't seem like anybody likes it so maybe I am missing something here.
For a lot of medics it's a pride thing. They feel they have to get that ETT. Some of the best medics I worked with would take one look and if they didn't think they could get it in 1 or two attempts would just drop an MLA and go from there.
I was introduced to Combi about two weeks ago. It seems to be stupid proof. I like it and I think it should be BLS with what I have learned about it so far. In my area, it's an ALS skill, and it doesn't seem like anybody likes it so maybe I am missing something here.
Because some believe the Combitube is "stupid proof", it has higher incidence of complications which has had some bad consequences for patients. Just the design alone can cause problems due to its size. Then, in the hands of those who feel it is "stupid proof", it becomes deadly.
If you make something idiot proof, someone WILL build a better idiot.
In my class we were taught the use of several different tubes. We practiced with the combitube but not the kind. The service that I will be working at has them on the trucks but we only have ALS trucks but it's still a bls skill but has never been used I don't think.
Establishing airways should not be viewed in terms of "BLS skill". The King and Combitube are both advanced airways meaning they are more than the NPA or OPA and should be treated as such regardless of the level of the provider. By no means should it be thought of as a lesser skill because of some BLS label. If you can not think in terms of "advanced" vs BLS and ALS, then this airway device and skill is probably more than one should be attempting.
Sometimes it seems that rather than building a new piece of stupid proof technology, wouldn't it be easier to just build a better provider?
Of course then I couldn't market my giant reflective star of life in Gals so all the new people could buy one and make me insanely wealthy. (No idea what the thing would do, but who cares as long as it sells right?)
Why not have the goal of having better providers and better stupid proof technology? 
It's not like (most) of the instructors are the ones designing these utilities so we aren't taking away from the production of better technology or better providers.
VentMedic, can you provide us with examples of where the combi tube can fail? I can only think of somebody not paying attention to gastric distention (so they continue to use the wrong lumen), maybe too forcefully put it in causing damage to the pt. airway instead, don't have a good seal with the balloons, maybe one of the balloons block both the trachea and esophgas..? Just trying to think of what could go wrong the combi tube.
It's not like (most) of the instructors are the ones designing these utilities so we aren't taking away from the production of better technology or better providers.VentMedic, can you provide us with examples of where the combi tube can fail? I can only think of somebody not paying attention to gastric distention (so they continue to use the wrong lumen), maybe too forcefully put it in causing damage to the pt. airway instead, don't have a good seal with the balloons, maybe one of the balloons block both the trachea and esophgas..? Just trying to think of what could go wrong the combi tube.
Look at the pictures I posted earlier. The size of the tube by diameter and the 85 ml cuff can do some damage.
Also, if you (not you specifically but in general) are using the Combitube, the potential complications should have been thoroughly discussed or your training was very inadequate.
Esophageal tears
Serious cord damage - the Combitube is much larger than any ETT you will commonly use.
Hematoma
Ischemia-reperfusion injury or compression of glossal blood vessels including the lingual veins which can cause the tongue to become engorged - this may require a tracheotomy as will some of the other complications.
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Eh, that's what I was guessing was that the size and being too wreckless with it could cause damage as I mentioned earlier (I mentioned being too forceful). In my area, I was only introduced to the combi tube on how to use a BVM on it (along with other ALS airway), not how to insert or the whole thing behind it. Our instructors briefly described how it worked (about a 15 minute total lecture for every ALS airway), which is where I got the idea that it was stupid proof, but that's it. I also heard rumor in Santa Clara County and Alameda County (around the Bay Area), they tried letting EMT-b using it, but it was a disaster and they stopped it so I was curious with what was so wrong with it. Thank-you very much for the explanation. 
I would say ALS.
Im assuming the BLS crew would be using it in a caridiac arrest?
Im more then happy to drop an OPA, ventilate and transport if ALS isnt available rather then risking a injury to the airway and complicating matters by intruducing blood and swelling.
If you do ROSC the patient the ER can place and advanced airway in their nice controlled enviorment when you arrive.
If I had a crystal ball and could predict future I would say the treatment for cardiac arrest patients is headed towards passive ventilation even at the ALS level.
EMTinNEPA
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Careful... as soon as something is declared "idiot-proof", they build a better idiot.
I advocate the King LT as a BLS skill. The combi-tube, while amazing in its simplicity, can be confusing to new providers simply because it has two ports to connect the BVM.
As for BLS providers performing endotracheal intubation, absolutely not. BLS providers do not get nearly enough education on airway anatomy and physiology to be performing such an invasive, and potentially life-threatening if performed incorrectly, procedure.
Besides, everybody from EMT-B up to emergency physician should be able to manage an airway without an endotracheal tube.
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swindlman
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Truly what is confusing about the Combi? If you connect the BVM on Port 1 and you see no chest rise and negative lung sounds switch to the other port. If the problem continues, pull it and use an OPA and BVM.
AngelEyes
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Combitube/King ALS vs. BLS
In Oregon we are able to do it as a BLS skill.
In Oregon we are able to do it as a BLS skill.