Which action is MOST important when immobilizing a patient with a suspected spinal injury?

• A. Vest-style immobilization device should routinely be used.
• B. Check range of motion by asking the patient to move the head.
• C. Select and apply the appropriate size of extrication collar.
• D. Secure the patient's head prior to immobilizing the torso.

Answer: (C)

Fitting and applying a properly sized cervical collar is the most important step in immobilizing a patient with a suspected spinal injury. The cervical spine is the most vulnerable during movement, and a collar that fits correctly limits flexion, extension, rotation, and lateral bending at C-spine, helping prevent secondary injury during handling and transport. If the collar is too small, it won’t stabilize the neck effectively and can press on airway structures; if too large, it may not control movement and can shift out of place. Therefore selecting the right size and securely placing it to fit snugly around the neck just under the jaw and behind the ears is foundational to cervical spine protection.

Vest-style immobilization and torso securing are important components of overall immobilization, but they won’t adequately protect the neck if the collar doesn’t fit properly. Asking the patient to move their head to “check ROM” is unsafe in suspected spinal injury because any neck movement could worsen injury.