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Darren Braude discusses the concept of Rapid Sequence Airway (RSA). The evolution of this concept goes back to the start of the 21st century. Here, the practise of ‘archaic’ airway management was common. This involved getting that plastic tube down the patient’s trachea no matter what. However, gradually, the risks of hypoxaemia during airway management become evident. This led to a movement towards extraglottic airways. If the oxygen saturation was dropping and there had been two failed attempts. This movement continued to involve towards operators deciding to move to other methods when only one attempt had failed. This was largely due to the increased training and skill of clinicians. The thinking being if they could not get it in one shot, they probably weren’t going to get it at all. This evolution was the catalyst for the movement towards faster airways, and less emphasis on intubation. Rapid Sequence Airway is pharmacology and preparation as in RSI, with the planned placement of an extraglottic device,