When disaster strikes—an earthquake collapses a building, a car crash traps occupants, or an industrial accident pins a victim—urban search and rescue (USAR) teams are often the first line of response. For medical specialists embedded within these teams, one of the most critical and complex tasks is airway management during the extrication of trapped victims. In confined, unstable urban environments, this process is fraught with challenges: limited access, potential spinal injuries, environmental hazards, time pressures, and the need for seamless coordination with rescue personnel. Below, we explore these difficulties in depth and outline evidence-based best practices, equipment recommendations, and U.S.-specific protocols to ensure patient survival and team safety.