This is a non-blinded, prospective, randomized laboratory time trial comparing time to insertion of an endotracheal tube against the King LTS-D airway with a simulated patient. Paramedics from 7 EMS agencies attending a monthly critical thinking lab were recruited and consented to participate. All providers completed a brief training session with the King LTS-D device. Each provider completed four advanced airway management scenarios in a randomized order: 1) ETI standard scenario 2) King LTS-D standard scenario, 3) ETI difficult scenario and 4) King LTS-D difficult scenario. Insertions were performed on the SimMan® mannequin, and insertion times were measured by two experimenters. The difficult scenario entailed inflation of the mannequin’s tongue. Provider characteristics were examined as potential factors affecting insertion time. From February 2009 to June 2009, 57 providers completed 228 insertions. The mean King insertion time was significantly faster than the ETI insertion time in both the standard and difficult scenarios. There was no difference in time to insertion for the King LTS-D between the standard and difficult scenario. Time to insertion in the difficult ETI scenario was significantly longer than insertion time for the standard scenario. Provider age was only predictive of insertion time for the ETI standard scenario. Years as a paramedic were not predictive of time to insertion in any of the 4 scenarios. In a simulated training environment, providers were able to successfully place the King LTS-D airway faster, regardless of scenario. This data should be compared to similar data obtained in the field.