Wang et al. (2001) comes to the conclusion that prehospital RSI can be harmful to patients with TBI. Sloane et al. (2000) found no difference in outcomes between prehospital and intrahospital RSI outcomes, with similar success and complication rates. RSI is an approved skill for Paramedics in certain jurisdictions such as San Diego, and 29 of the states in the US have medication assisted intubation protocols for use by Paramedics (Gausche-Hill, 2004)