EMS Facilitated Intubation Without Paralytics

Facilitated intubation, also known as medication-facilitated intubation (MFI) or sedation-facilitated intubation, refers to intubation performed using a sedative or anesthetic drug as an induction agent without the use of a paralytic (neuromuscular blocking agent). In comparison, rapid sequence intubation (RSI) employs both an induction agent and a paralytic drug. Both procedures are performed to varying degrees by emergency medical service agencies across the nation.

Geographic Variation

Drug-facilitated intubation protocols, including regulations for both medication-facilitated intubation and rapid sequence intubation, vary between states and, in many cases, between regional and local emergency medical service agencies. One recent study found that 18 states (35.3%) have statewide drug-facilitated intubation protocols. Of those states, only 1 (5.6%) has a protocol for sedation-facilitated intubation. The remaining 17 states (94.4%) with drug-facilitated intubation protocols use intubation with sedation and a neuromuscular blocking agent. Regional and local use of medication-facilitated intubation and rapid sequence intubation is harder to ascertain, as there are no published studies regarding the extent of drug-facilitated intubation other than on a statewide level. The utilization of medication-facilitated intubation compared to rapid sequence intubation also varies based on the patient's needs and the procedure's safety.