Airway management in the ED and other acute care settings has followed the ‘ABC’ priority paradigm. Open the airway, apply oxygen then support oxygenation and ventilation with a ‘definitive’ airway A.K.A a tracheal tube. The challenge and focus of airway management in emergencies has been on the technical imperative of laryngoscopy and intubation and therefor success is usually referenced by correct placement of the tube. First pass success (FPS) has been the primary outcome in a majority of publications examining airway management. This reverse rationalization is supported by numerous publications in every setting demonstrating an association between increasing number of attempts and patient morbidity and mortality. The focus of airway management is to support oxygenation and ventilation while maintaining physiologic homeostasis. The tube provides neither benefit nor harm airway management and success should therefor, be defined by a broader contextual surrogate for patient outcomes. Clinicians should strive for FPS rates >90%, without critical hypoxemia or hypotension performed in a timely manner.