When I first started as an EMT in Newark, N.J., I had the opportunity to work with a more experienced partner who had started working on the ambulance in the mid 1960s, pre-EMT training in the state. He said to me, “Kid, blood pressure, tire pressure it’s all the same.” While this statement gave me a chuckle, I soon realized a cavalier approach to blood pressure and the tools we use to measure it does not serve us well as clinicians. BP is an essential cardiovascular variable. Its monitoring is mandatory in any EMS patient, and it has a significant impact on patient management. BP is essential for us to determine when a patient is decompensating and proceeding into shock or is in extremis due to congestive heart failure or hypertensive crisis.