Outcome measures The primary outcome measure is the incidence of tracheal tube cuff pressure exceeding 30 cm H2O during the cruise portion of flight. This is approximately 10 minutes after the aircraft has taken off. The secondary endpoints include the incidence of tracheal tube cuff pressure exceeding 30 cm H2O on initial inflation of the cuff prior to departure from sending facility, the change in cuff pressure from ground to in flight at cruising altitude, the incidence of cuff leak or other tracheal tube malfunction, and incidence of adverse events related to tracheal tube cuffs, (including those related to use of sterile saline in cuffs) in the transport setting. All outcome measures will be obtained and assessed on day 1, namely during the time period during which the flight paramedics are providing care for the patient. No data will be available after transfer of care takes place at the receiving facility.