Anytime an endotracheal tube is placed in an airway in the Emergency Department OR an endotracheal tube is placed by an outside provider (i.e. that patient arrives already intubated (EMS or hospital transfer)) there should be some method (American College of Emergency Physicians guidelines on confirmation of endotracheal tube confirmation recommends either end tidal carbon dioxide, bulb aspiration, or direct laryngoscopy - not physical exam findings) attempted to confirm endotracheal tube placement.