Endotracheal intubation and cricothyrotomy are Paramedic-only. Nobody below you carries them. Nobody below you can fix a failed one either.
A cuffed tube through the cords seals off the trachea. Air only goes where you push it, and stomach contents can't come up and in. That's why it beats a supraglottic device or a BVM on paper. It protects the airway completely, and no other tool in your bag does that.
It's also the intervention with the most ways to go wrong. The tube can go into the esophagus instead of the trachea. It can go too deep and end up in one lung. Repeated attempts turn a manageable airway into a bloody, swollen one. That's why the exam is not really testing whether you can place a tube. It's testing whether you know when to try, when to stop trying, and how you prove, over and over, that the tube is still where you put it.
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