In a pediatric head injury case with suspected spinal injury, which action is most appropriate at the scene?

• A. Stabilize the head, maintain spinal precautions, and prepare for rapid transport
• B. Remove the helmet immediately and begin rapid transport
• C. Start chest compressions if there is any sign of poor perfusion
• D. Delay transport until a physician arrives

Answer: (A)

When a child has a head injury with suspected spinal injury, the priority is to prevent movement of the head and neck and to get the patient to definitive care as quickly as possible. That means stabilizing the spine first, using manual stabilization or a cervical collar, and securing the patient to a backboard or other immobilization device while keeping the head aligned with the spine. Maintaining spinal precautions throughout any movement and during transport helps minimize the risk of a secondary spinal cord injury. Once immobilized, focus on rapid transport to an appropriate trauma facility and continuing careful assessment and monitoring en route.

Removing the helmet right away can disrupt alignment and movement control, which isn’t advised when spinal injury is suspected. Chest compressions are reserved for situations of cardiac arrest or severe poor perfusion, not a general head-injury scenario on scene. Delaying transport until a physician arrives isn’t appropriate for EMS care, since initiating and maintaining immobilization and rapid transport is within the scope of practice and improves outcomes.