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Duke University’s (Durham, NC) Respiratory Care Department provides an airway management service that responds, on average, to 845 intubations per year. Airway procedures are performed by registered respiratory therapists who must complete a three-step training curriculum. This includes basic airway competencies, airway certification, and advanced standing. Requirements include advanced cardiac life support, written examination, laboratory demonstration, supervised clinical performance, and annual skills maintenance. The goals of our service are to provide (1) competent persons for performing the service, (2) a rapid response time, and (3) a cost-effective delivery. Results of an analysis of our service indicate that airways are successfully placed in less than 3 attempts in 93% of intubations performed. Additionally, recognized complication rates have dropped from 12% to 3% consecutively for the past 8 years. Response time has remained at less than 1 minute on average. Cost savings are realized by centralizing equipment and using nonphysician providers. By centralizing an airway management service in respiratory care departments, the following can be achieved: (1) response by a strategically located specialized team is ensured; (2) all necessary equipment arrives with the provider; (3) portable equipment is cost-effective, avoids loss, and ensures optimal function; (4) utilization of nonphysicians allows physicians to remain at their primary duties; and (5) a centralized airway service provides accurate records and data. Respiratory care departments can provide an effective and safe airway service.