Take this for what it's worth since I can't RSI, but my main issues are what you outlined. I think the laryngoscope as a murder weapon series (or at least the concepts) should be something drilled into our heads (both in training and medic school), because I've seen post intubation arrests multiple times in the ED due to those things not being addressed. At least on the RSI's and crics I've seen, I can't think of very many where a easy paced resus then induction would have been inappropriate.What exactly are people's concerns with "over RSI-ing" patients who have ambiguously intact airway reflexes? Is it hypotension? Oversedation?
Regardless of what meds, if any, you are pushing in an alive patient, you should be extremely cognizant of the patients blood pressure and resuscitate them (fluids, push dose pressors) up above 90-100 systolic at the absolute minimum before even thinking about intubation, because just the act of passing the tube and ventilating is going to drop their pressure from the vagal response and potentially a preload drop from the ventilation itself. I don't think trying to avoid sedation or paralysis for fear of this is going to fix the issue, plus its pretty inhumane to not at least sedate alive patients who are getting plastic shoved down their throat. You can always give them more epi to bring them back up after the RSI meds go in.