ObjectivesEmergency intubation in children is an infrequent procedure both in the pre‐hospital and hospital setting. The anatomical, physiological and situational challenges together with limited clinician exposure can make this a difficult procedure with high risk of adverse events. The aim of this collaborative study between a state‐wide ambulance service and a tertiary children's hospital was to describe the characteristics of pre‐hospital paediatric intubations by Intensive Care Paramedics.MethodsWe conducted a retrospective review of state‐wide ambulance service electronic patient care records (ePCRs) in Victoria, Australia, population: 6.5 million. Children aged 0–18 years who were attended by paramedics over a 12‐month period that required advanced airway management were analysed for demographics and first‐pass success rate.ResultsParamedics attended 2674 cases aged 0–18 years over the 12‐month study period who received basic or advanced airway management. A total of 78 cases required advanced airway management. The median age of patients was 12 years (interquartile range 3–16) and most were male (60.2%). Sixty‐eight patients (87.5%) were intubated successfully on the first attempt, first‐pass success was lowest in children <1 year of age. The most common indications for pre‐hospital intubation were closed head injury and cardiac arrest. It was not possible to report complication rates because of incomplete documentation.ConclusionPre‐hospital intubation in children is performed infrequently in an extremely unwell patient group. Continued high‐level paramedic training is required to prevent adverse events and ensure patient safety.