Significant facial trauma should raise the EMT's index of suspicion for which injury?

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

Answer: (C)

Significant facial trauma often comes from high-energy impacts that can transmit force to the neck, so you must treat the cervical spine as potentially injured. The cervical spine injury is the injury you should be most vigilant for because it can be occult—patients may not have obvious neck pain or neurologic deficits right away, yet the spine could be damaged. This is why immobilizing the head and neck and assessing for any signs of neurologic compromise are essential during evaluation and transport, to prevent further injury to the spinal cord. While airway issues, facial fractures, or basilar skull fractures can occur with facial trauma, the immediate, hidden danger that drives the EMS approach is a possible spinal column injury.