After significant facial trauma, what should EMTs be most vigilant for?

• A. Spinal column injury
• B. Basilar skull fracture
• C. Airway obstruction
• D. Displaced mandible

Answer: (A)

The priority in significant facial trauma is to protect the cervical spine. A high-energy facial injury often accompanies a neck or head injury that may not be obvious at first. If the neck is moved, a potential cervical spine injury can be worsened, risking spinal cord damage. Because of that, EMTs should keep the head and neck immobilized in a neutral position from the moment of assessment and continue immobilization during transport. Apply a rigid cervical collar and use in-line stabilization to prevent movement, even while evaluating and securing the airway. Airway management is crucial, but it must be done with spinal precautions in place—use techniques that maintain alignment of the spine. Other issues like basilar skull fracture or displaced mandible can complicate the situation, but the immediate and most critical concern is protecting the spine to avoid additional injury.