A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:

• A. Stabilize her head and perform a primary assessment
• B. Apply limb splints immediately
• C. Check blood pressure first
• D. Move her to a vehicle for faster transport

Answer: (A)

In blunt trauma with signs of potential spinal injury, the priority is to protect the spine while rapidly assessing life threats. With this patient, stabilizing the head and neck to maintain neutral alignment prevents further injury as you evaluate airway, breathing, and circulation. Once the spine is immobilized, you perform a rapid primary survey to determine and treat immediate threats to life, starting with airway management and ensuring adequate ventilation, while keeping the spine stabilized. After the critical order of operations—stabilize, then assess—you can address other injuries and transport plans.

Choosing to apply limb splints immediately could move the patient and risk worsening a spinal injury, and checking blood pressure first would not override the need to secure the airway and protect the spine during the initial assessment. Moving the patient to a vehicle for faster transport is unsafe without proper spinal immobilization.