In a sudden deceleration crash with an unrestrained patient, what should be performed first during the initial assessment?

• A. Check pulse
• B. Open airway
• C. Spinal precautions
• D. Place cervical collar

Answer: (C)

In a sudden high-energy crash with an unrestrained patient, protecting the cervical spine is the top priority because the mechanism of injury can cause spinal injuries even when there are no obvious signs. Immobility of the neck prevents movement that could worsen a spinal cord injury during the initial assessment and any subsequent handling. The first step is to maintain spinal precautions—keep the head and neck aligned with the spine, immobilize the spine, and apply a cervical collar as needed—so you don’t transfer injury while you check the patient. After spine precautions are established, you proceed with airway, breathing, and circulation assessments, ensuring any airway management is performed with the neck stabilized. This approach minimizes the risk of secondary spinal injury right from the start.