Removing the cervical collar makes the positioning of the laryngoscope easier. Therefore if an assistant is present to hold in line traction that is the method I would use. If sedation is needed propofol is probably prefered as its short duration of action is probably better that a benzodiazapine. I usually give the patient one attempt at an intubation with the collar, but, by the time I am called, someone has usually taken that one try and I do it without the collar, with inline traction. Nasotracheal intubation in a patient with suspected C-spine injury is never performed by our Emergency Team, as these patients may also have undiagnosed skull base fractures.
Orotracheal intubation is preferred.
Midazolam is preffered over propofol as we had a few cases with marked hypotension during induction, which should be avoided in trauma patients, especially in the field. Jan J. De Waele, MD Dept. of Surgery University Hospital Ghent Belgium. If hypotensive without head injury would give ketamine. Might add fentanyl if hypertensive and head injured. Would then deep sedate, topically anesthetize the airway and look with blade, if easy visualization is found, would then administer paralytic and intubate.