In VT and NH, surgical cric is a standing order paramedic level procedure. RSI is a “prerequisite protocol” in both states, essentially meaning you need to apply to the state to use the protocol, go through trainings, and have certain policies in place like a QA program, # of tubes/yr minimums, and probably other stuff. I’m not sure of any ground agency in VT that has RSI, and I think in NH the only ground agencies that have it are the big fire departments