The pre-hospital setting provides unique challenges to management of the airway including tight spaces, neck immobilization, poor lighting, and often the added complexity of attempting procedures during transport. When possible, basic airway management should be prioritized including head-tilt-chin-lift maneuvers, and bag-valve masking. If ineffective, a supraglottic airway can be utilized to aid in oxygenation and maintenance of a patent airway. An oropharyngeal airway is acceptable, however nasopharyngeal airways should be avoided in trauma, particularly if a basilar skull fracture is suspected. Endotracheal intubation carries with it many risks, particularly when paralytics are used, as maintenance of the airway becomes a challenge if intubation fails. It should therefore be attempted by experienced personnel, only when less invasive methods fail or when it is deemed necessary for safe transport of the patient, to reduce risk of failure and the associated increase in morbidity and mortality due to hypoxia.