What should be immobilized first in a patient with suspected spinal injury during rescue?

• A. The spine, with airway considerations following.
• B. The vehicle and windows.
• C. The equipment used for rescue.
• D. The patient’s clothing.

Answer: (A)

In a rescue scenario with a suspected spinal injury, the top priority is to immobilize the spine to prevent any movement that could worsen damage to the spinal cord. Movement can shift vertebrae and compress or transect neural tissue, making outcomes far worse. Stabilizing the spine means keeping the head, neck, and torso in a neutral, aligned position—say, using a cervical collar and securing the patient to a backboard or other rigid immobilization device—before you do anything else. Once the spine is immobilized, address the airway, but always maintain inline stabilization so you don’t compromise the spinal alignment while you manage breathing or insert airway adjuncts. The other actions—like immobilizing the vehicle, windows, or clothing—don’t protect the spine itself and can wait until the patient’s spine is secured, since they don’t prevent movement of the spine during extraction or care.