From Gold Standard to Smart Standard: Rethinking Intubation in EMS

Prehospital airway management has undergone a dramatic shift over the past decade, raising an important question: Has endotracheal intubation lost its place as the gold standard in the field? This presentation explores the evolving role of supraglottic airway devices (SGAs) in modern EMS and critical care transport, highlighting why many systems are seeing higher success rates, more reliable ventilation, and improved patient outcomes with second- and third-generation SGAs. Attendees will examine the growing body of evidence showing that SGAs—once considered a backup—are now frontline tools capable of delivering rapid, effective oxygenation with less training variability and fewer procedural complications. With advanced features such as gastric access, high-seal pressures, and optical or fiberoptic compatibility, today’s SGAs not only provide secure airway control but also serve as pathways for intubation when clinically needed. We’ll compare intubation and SGA performance in real-world scenarios, discuss guideline trends, and explore the clinical situations where each approach excels. This session challenges long-standing assumptions and encourages a practical, patient-centered perspective: airway success is not defined by getting a tube—it’s defined by getting oxygen delivered. Join us as we rethink traditional practice and explore what the future of prehospital airway management truly looks like.