A 42-year-old man was ejected from his car and is found prone, not moving and not breathing. The first action is:

• A. Manually stabilize his head.
• B. Administer high-flow oxygen.
• C. Assess his breathing effort.
• D. Use the jaw-thrust maneuver.

Answer: (A)

In this trauma scenario, protecting the spine is the immediate priority. A high-speed crash with ejection puts the cervical spine at risk for a serious spinal cord injury, and any movement of the head or neck could worsen that injury. Therefore the first action is to manually stabilize the head and neck in a neutral alignment to maintain spinal immobilization while you assess airway and breathing and prepare for airway management.

Once inline stabilization is established, you would proceed to open the airway (typically with a jaw-thrust that minimizes neck movement) and begin ventilation if the patient is not breathing, using high-flow oxygen as you establish a patent airway. The emphasis here is that spinal protection comes before airway maneuvers; the other steps are important but follow stabilization.