In a critically injured patient, which actions are appropriate to perform at the scene?

• A. Primary survey, correction of immediate life threats, and spinal precautions.
• B. Secondary assessment before transport.
• C. Detailed head-to-toe examination at the scene.
• D. Delayed immobilization until hospital.

Answer: (A)

In a critically injured patient, the priority is to rapidly identify and treat life threats while keeping the spine protected to prevent secondary injury. This is best achieved by performing the primary survey and addressing immediate life threats, along with spinal precautions, at the scene.

The primary survey focuses on airway with cervical spine stabilization, breathing, and circulation first. Ensure the airway is open and protected, provide ventilation support as needed, control any life-threatening bleeding, and manage circulation to prevent or treat shock. Protect the patient’s neck from further injury by maintaining inline stabilization and immobilizing the spine during movement and transport. After these urgent steps, you can assess neurologic status and exposure, but only after life threats are being managed.

Secondary assessment and a detailed head-to-toe exam take valuable time and are not appropriate while a patient is crashing or deteriorating; those evaluations are better saved for after stabilization or during transport. Immobilization should not be delayed, because moving a potentially injured spine without protection can worsen injury. By focusing on the primary survey, immediate threats, and spinal precautions, you maximize chances of preserving life and neurological function while getting the patient to definitive care promptly.