 RSI may also be used in prehospital emergency situations when a patient is conscious but respiratory failure is imminent ( such as in extreme trauma ) . This procedure is commonly performed by flight paramedics . Flight paramedics often use RSI to intubate before transport because intubation in a moving fixed @-@ wing or rotary @-@ wing aircraft is extremely difficult to perform due to environmental factors . The patient will be paralyzed and intubated on the ground before transport by aircraft . 
