A young male involved in an industrial accident has eyes closed, not moving, with several large contusions on his arms, a forehead laceration with minimal bleeding, and a closed deformity to his right leg. What should you do first?

• A. Open airway and assess breathing status
• B. Immobilize and transport
• C. Check his blood glucose
• D. Apply a tourniquet to the leg

Answer: (A)

In a trauma patient who is unresponsive, the top priority is securing the airway and ensuring adequate breathing. Open the airway and assess breathing status right away, using a jaw-thrust to protect the spine if you suspect a head or neck injury. Look for chest movement, listen for breath sounds, and feel for air. If the patient isn’t breathing or isn’t breathing adequately, start rescue breaths (and CPR if needed) and provide oxygen as available. Only after the airway and breathing are stabilized do you move on to immobilization and rapid transport, spinal protection, and management of other injuries.

The other actions aren’t the immediate priority in this scenario: immobilizing and transporting comes after airway and breathing are addressed; checking blood glucose isn’t the first step in a trauma primary survey unless there’s a specific suspicion of hypoglycemia; and a tourniquet is only for life-threatening external bleeding, which isn’t indicated as the first step here.