The provider must be extra cautious with the trauma patient. If there is any concern for spinal cord or vertebral injury, responders must do their best to limit excessive movement of the neck. Whenever there is reason to suspect a spinal injury, from either the mechanism of injury (e.g., involvement in a major motor vehicle accident or high fall) or evidence of predisposing injuries (e.g., facial injuries, multiple injuries), the patient should be immobilized until a spinal evaluation can be completed.

It is best to use spinal precautions when managing the airway instead of immobilization devices such as C-spine collars that can cause an obstruction and make it difficult to provide airway management.

Steps 

Responders should be well versed in spinal precautions and:

• Always use the jaw thrust maneuver (instead of head tilt/chin lift)
• Only use slow and careful head tilt if the airway is obstructed 
• Maintain the head in the neutral position. One responder should be responsible for maintaining this positioning and ensuring there is no movement of the head while airway management is ongoing.
• Never place a nasopharyngeal airway or intubate nasally in patients with facial trauma or basilar skull fractures. Instead, one responder should intubate via the oropharynx while the other responder maintains neck immobilization.