Ketamine and rocuronium should become the first-line choices for RSI in critically ill patients.

What is PHARM? Its the area of clinical medicine involved with the assessment and stabilisation of acutely ill or injured patients in the prehospital setting, who require transport to definitive care. It requires a wide range of skills and knowledge including emergency medicine, paramedicine, critical care and aeromedicine. The working environments span the entire range of those on our planet and challenges placed on prehospital providers are both demanding, mentally and physically. There is no backup, you are the backup and what you bring with you is all you have. We who work in the area and face these challenges in hostile and austere settings choose to, with the belief that a patient's location should not dictate the level of emergency care they deserve and we can provide. This is the discipline.

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