During suspected spinal injury, how should you manage the airway during transport?

• A. Remove immobilization to check airway.
• B. Place patient in recovery position.
• C. Keep airway clear while maintaining immobilization.
• D. Hyperextend the neck to open airway.

Answer: (C)

In suspected spinal injury, the priority is to protect the spine while ensuring the airway stays open during transport. Any movement of the head or neck can worsen a spinal injury, so you keep the patient immobilized and use airway maneuvers that do not disrupt alignment. Clearing the airway with a jaw-thrust (not a head-tilt chin-lift) and suction as needed, plus the use of airway adjuncts if appropriate, lets you maintain patency without breaking immobilization. Hyperextending the neck is dangerous in this context because it can aggravate the injury, and placing the patient in a recovery position would require turning the spine, compromising stabilization. Removing immobilization to check the airway defeats spinal protection. So the best approach is to keep the airway clear while maintaining immobilization.