The Center for Disaster and Emergency Medicine at NIPSTA has developed a 4 - hour course for the practicing paramedic to wants to enhance his/her airway management skills. The Difficult Airway Manangement curriculum relies heavily upon placing patient care providers into simulated but extremely challenging environments that is the result of sometimes limited patient access. The paramedic will be required to perform “hands on” advanced airway management skills.  This course will be conducted in “live” disaster environments where providers can expect challenging scenarios and where medical care is brought directly to the patient.  These specialized environments include concrete structural collapse, confined space and motor vehicle crash/entrapment.  Advanced airway management will be expected prior to victim removal with the goal of improving patient outcome.