Airway management in EMS is often reflexive - secure the tube, control the airway. In austere and resource-limited environments, that reflex can do more harm than good. This lecture challenges traditional airway dogma and reframes airway decisions around environment, resources, and patient physiology rather than just procedural skill. Through high-risk, field-based scenarios, participants will explore when airway intervention helps and when it harms, with a focus on high-performance BVM ventilation, supraglottic airways as practical definitive tools, and early recognition of the truly failing airway. Built for "high acuity, low resources" settings, this session delivers practical, street-ready strategies that translate directly to the next shift.