The potential for cervical spine injury makes airway management more complex in the trauma patient. A cervical spine injury should be suspected in all injury mechanisms involving blunt trauma. Cervical spinal injury occurs in 2% of victims of blunt trauma. Cervical spine injury is often occult, and secondary injury to the spinal cord must be avoided. Immobilization of the cervical spine has been instituted until a complete clinical and radiological evaluation has excluded injury as all airway interventions cause spinal movement. The urgency of airway intubation is the most important factor in planning which technique of securing the airway is the safest and most appropriate. Many anesthesiologists state a preference for the fiberoptic bronchoscope to facilitate airway management, although there is considerable, favorable experience with the direct laryngoscope in cervical spinal injury patients. Direct laryngoscope with orotracheal intubation with in-line immobilization, with or without pharmacologic adjuncts and muscle relaxants represent the most effective method.