Every day, hundreds of thousands of patients seek care in the emergency department, and between 10 and 12 percent of these patients arrive by ambulance. Of these, only a few present with life-threatening emergencies that result in immediate or eventual endotracheal intubation. This is not to say that intubation is an unimportant skill, quite the contrary. Without a clear airway, most humans will succumb to anoxia within 4 to 6 minutes. Why then has pre-hospital endotracheal intubation become so controversial? In the 1850s, doctors developed methods to visualize the vocal cords of living patients and then intubate the windpipe with a metal tube. Before these developments, securing a patient's airway involved surgical techniques such as tracheotomy, a procedure dating back to 3,600 BC (1). Since then, several advances have been made, including better techniques, improved laryngoscope blade design, and, more recently, video laryngoscopy. Every improvement should promote better performance, but healthcare professionals continue to struggle with this skill. Over forty years ago, largely as part of Accidental Death and Disability: The Neglected Disease of Modern Society, the role of the first aider was created. This publication, also known as the “White Paper,” documented the lack of training and standardization in the area of ​​public safety. “This standardization led to the first nationally recognized curriculum for EMS – Emergency Medical Technician – Ambulance (EMT-A) – which was published in 1969. Many consider this document the birth of EMS modern” (2). Several years later, convinced that more could be done in the area of ​​pre-hospital emergency care, the paramedic curriculum was born...... middle of document ...... evidence scientists against the prehospital ETI who are chasing it from EMS practice. It's simply the failure to properly educate students on the use of the [endotracheal] airway. Although mannequin practice and human simulation are improving, there remains a need to acquire this skill on human subjects” (6). If prehospital endotracheal intubation is to remain a viable skill, paramedics must learn, practice, and maintain proficiency in this rarely used skill. but a very valuable skill. Certainly, alternative airways are a viable answer, but there are still situations in which the endotracheal tube will remain superior. “A survey of paramedics ranked ETI as the most important [skill]. Thus, attempts to limit or remove this skill often elicit an emotional response” (6). Paramedics must remain objective and embrace positive change for our profession to thrive.