The approach to airway management in the multiple trauma patient has changed significantly over the past decade. A number of central controversies have been identified, and the debates continue. This article identifies the major controversies in trauma airway management, reviews and summarizes relevant literature, and presents specific recommendations and supporting arguments. Particular emphasis is placed upon the role of endotracheal intubation, use of neuromuscular blocking agents, and the issue of neuromuscular blockade versus rapid tranquilization of the combative trauma patient.