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The degree to which EMS clinicians participate in airway management is determined by their scope of practice and the discretion of their medical directors. EMS protocols for airway management may vary based on the qualifications of available personnel and the system architecture. While all clinicians should be adept at basic airway management, invasive airway management may be limited to advanced personnel. The EMS medical director must choose which clinicians receive advanced airway training, taking into account the ability to acquire and maintain airway skills, as well as distance to the hospital and the availability of backup personnel.

Tiered response systems may offer options for organizing airway management. The additional clinician may be a supervisor or a more experienced person capable of a wider range of airway management techniques. For example, some systems limit RSI to supervisor units. Limiting ETI to supervisors or a specific cohort of clinicians has the benefit of concentrating field experience for the procedure and decreasing the resources necessary for training and competency verification. The ideal airway management paradigm for a given service may vary based on the qualifications of EMS clinicians, available resources, coverage area, and volume of calls requiring airway management.