In a mass casualty incident with multiple head-injured victims, what is the highest priority?

• A. The airway with cervical spine control
• B. Immediate head CT
• C. Rapid intravenous fluid bolus
• D. Cessation of all bleeding first

Answer: (A)

Securing the airway with cervical spine protection is the highest priority. In head injuries, protecting the airway and ensuring adequate oxygenation is crucial because hypoxia rapidly worsens brain injury and can lead to secondary brain damage. Airway management must be done with in-line cervical spine stabilization to prevent worsening any potential spinal injury during intubation or airway maneuvers.

Imaging like a head CT is important but cannot be the first step in a mass casualty scenario if the patient’s airway and breathing aren’t secured. Quick IV fluid boosts may be needed for circulation, but they do not prevent hypoxic injury if the airway is compromised. Controlling external bleeding is essential, yet without a patent airway and effective ventilation, the patient’s condition can deteriorate too quickly.

In practice, stabilize the spine, secure or protect the airway (consider rapid sequence intubation if indicated), and ensure adequate oxygenation before moving on to other interventions.