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Yes, Spen. As AZCEP noted above, I anticipate a difficult airway on any prehospital tube I place. I don't know if it will present as a difficult airway until I look (I may suspect one way or another but have been surprised either way much too often). So, when I go to place a tube, I will have the bougie ready with a tube loaded. During visualization, if it turns out I didn't need it then oh well. It just means I have good practice for all those times when I *DO* need it. But if it turns out I do need it, then I don't have to withdraw the laryngoscope, grab the bougie, load the tube and try again all of which delays getting that patient's airway secure and can cause extra trauma to the patient's airway. -be safe