Objective: To prospectively evaluate the effectiveness of the endotracheal tube introducer (ETTI) versus standard orotracheal intubation (SOTI) in the prehospital air medical setting. Methods: Critically ill patients were randomized to ETTI versus SOTI based on an odd/even day regimen. Data were collected on initial intubation attempt used, success using initial approach, number of intubation attempts until success, and laryngeal view encountered. The 2 approaches then were compared and statistically analyzed. Results: Fifty-one patients were entered into the 10-month study; 20 patients were randomized to the ETTI group and 31 to SOTI. Overall success rate for first intubation attempt was 70% for the ETTI and 65% SOTI (P = .67). Total intubation time was 62 seconds (95% CI = 16-108) for the ETTI versus 62 seconds (95% CI = 38-86) for SOTI (P = .4). The ETTI group had a higher percentage of intubating difficult laryngeal views (grade 3 and 4) on first attempts than SOTI. Conclusion: In this study, the authors found the ETTI to be a safe airway adjunct with results equal to SOTI. The ETTI may have a useful role in prehospital airway management.