A patent airway linking the nose and mouth with the lungs is essential to life. In emergency care, individuals may experience airway difficulties for many reasons including major trauma, airway inflammation and altered consciousness. Airway management is therefore a core skill for paramedics and other practitioners working in prehospital care. This article reviews the anatomy and physiology of the airway before moving on to consider causes of airway obstruction. A look-listen-feel approach to airway assessment is described, followed by a discussion of techniques used to clear, open and maintain the airway. Commonly used airway devices including oropharyngeal, nasopharyngeal and supraglottic airways are evaluated, and their indications and insertion techniques discussed. The use of endotracheal intubation by paramedics is also evaluated.