Don't get me wrong, RSI can be neccesary in the field. I think that it should be a last resort because of the complications involved, but advanced airway procedures can be neccesary. For example, the madison medics are trained to do surgial airways, and though there use is vanishingly small, I've seen them save people who would've died prior to arrival at the ED without that intervention. Still, it shouldn't be the first club out of the bag, and should be reserved only for those cases where no other treatment is effective.