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Since the very first publication on rapid sequence induction and intubation (RSII) [1], the controversy surrounding the practice has far outpaced the available evidence. This imbalance is one reason the Project for Universal Management of Airways (PUMA) group felt compelled to issue a preview of its forthcoming universal airway guidelines [2]. The Ship of Theseus analogy, cited in the insightful editorial by Lyons and Wiles [3], is an apt metaphor for the evolution of RSII. However, an alternative interpretation, offered by philosopher Thomas Hobbes, might be even more fitting. Hobbes envisioned a scenario in which a custodian reassembles a second ship using all of the original parts discarded by the Athenians, thereby creating a paradox: which of the two is the true Ship of Theseus? This thought experiment raises profound questions about identity, continuity and function. The proposed RSII algorithm from PUMA cited by Lyons and Wiles [3] reflects this paradox. It integrates both the ‘original’ and ‘reassembled’ elements of RSII as conceived by pioneers like Safar and Stept, while also incorporating essential modern updates: continuous oxygen delivery throughout the procedure; strategies to maximise first-pass tracheal intubation success; and the reframing of cricoid force as an optional, operator-dependent manoeuvre. Certain legacy elements of the original RSII have rightly been set aside. Modern anaesthesiology is increasingly data-informed, leveraging audits, observational studies, non-inferiority trials and randomised controlled trials. In the 1970s, the predominant fear during induction in patients with full stomachs was aspiration. Today, the scientific community broadly recognises the concept of the ‘physiologically difficult airway’ [4] and our primary concerns have shifted, recognising the pressing challenges of physiological derangement, including hypoxia and cardiovascular collapse, as emphasised by recent literature [4]. Modern RSII should focus on maximising tracheal intubation first-pass success, most often using videolaryngoscopy paired with the ideal adjunct (yet to be definitively identified). Simultaneously, continuous oxygenation – potentially via high-flow nasal oxygen – should be prioritised, alongside the confirmation of tracheal tube placement using best practice standards [4]. Moreover, RSII should be ‘rapid’ only in the narrow window between the loss of airway reflexes and inflation of the tracheal tube cuff. Every other phase should be deliberate and meticulous: thorough airway management planning; point-of-care gastric ultrasound; tailored drug selection for induction and haemodynamic optimisation (including, at times, the decision to use no induction drugs and proceed with an awake tracheal intubation); and, role and task assignments using a structured checklist-based approach [5]. The absence of conclusive evidence does not imply the absence of value. The RSII may never be wholly evidence-based, but sufficient data now exists to support a consensus-driven, evidence-informed framework. Should future research allow us to systematise RSII fully, clinical judgement will always be essential. A prudent and skilled clinician must still assess the specific risks and benefits for each individual patient. And, as Lyons and Wiles remind us through their editorial and daily practice, this principle applies to all elective, emergency and rapid sequence inductions. This guiding principle must also underlie any medico-legal review or coroner's report. Perhaps the components of RSII have changed and the ships are no longer the same, but the destination of patient safety is unchanged.