The objective of the summary document is to provide a reference for management, shared at the regional level, of patients with Acute Respiratory Failure by Prehospital Emergency Systems. The specific aim is to reduce the therapy free interval with the highest standards of care in the early stages of the emergency and continuity of care during both pre- and in-hospital management. Acute Respiratory Failure (ARF) is one of the conditions for which the Emergency System is activated more frequently. Its most frequent clinical presentations are Acute Pulmonary Edema, acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD), and an overlap of the two. In all these clinical presentations, through the optimization of oxygen therapy and the early ventilation can prevent and/or reduce the rapid and progressive patient’s worsening.