A 33-year-old factory worker pinned between two pieces of machinery; after a rapid head-to-toe assessment, you should:

• A. Carefully log roll him to check his back.
• B. Prepare for immediate transport.
• C. Perform a detailed secondary exam.
• D. Palpate his pelvis to assess for crepitus.

Answer: (B)

In crush injuries with a high-energy mechanism, the priority after a quick head-to-toe assessment is rapid transport. The patient may have hidden life-threatening injuries or developing complications (airway/breathing issues, major bleeding, spinal injury, or crush syndrome) that can deteriorate quickly, so delaying to perform a detailed secondary exam on the scene can worsen outcomes. You stabilize and monitor as needed, control obvious life threats, immobilize if indicated, and then get the patient to definitive care without unnecessary delays. Ongoing assessment and care continue en route, but the focus on immediate transport ensures the patient reaches higher-level care where definitive interventions can be performed.