Mechanical ventilation is increasingly popular in EMS due to its ability to provide consistent and guideline-compliant ventilation, enhancing patient safety compared to manual methods like bag-valve-mask ventilation. Mechanical ventilation offers advantages such as reducing the risk of hyperventilation, aspiration, and overinflation of the stomach. It also improves workflow by freeing up personnel for other tasks during patient transport. Despite its benefits, mechanical ventilation requires trained personnel to manage ventilator parameters safely. We will review non invasive and invasive ventilation, basic settings, alarms and troubleshooting for those who currently use or interested in using Mechanical Ventilation in their practice. Its adoption in EMS is encouraged to improve outcomes in patients with respiratory failure