We conducted a retrospective review of all adult trauma patients who underwent prehospital field rapid sequence intubation (RSI) by aeromedical crews from 1988 through 1995 and compared them to all trauma patients who arrived by ground transportation and underwent RSI in the trauma suite from 1992 through 1995 at a University hospital. Of the 47 field RSI patients, 46 (97.9%) were successfully intubated, whereas 263 of the 267 (98.5%) hospital RSI patients were successfully intubated. There were no statistical differences in success rates, number of attempts, or immediate intubation events in the procedure between the two groups. There were no differences in delayed events with the exception of pneumonia, which occurred more frequently in the field RSI group (28% vs. 6%, respectively). We performed a subgroup analysis on isolated head injury patients to evaluate outcome. There was no difference in total hospital days, length of ICU stay, mortality or final disposition in the two head injury groups. Though this study is limited by small sample size, we conclude that field RSI is equally successful and safe as hospital RSI.