What is the field care approach to a penetrating head injury?

• A. Provide airway and breathing support, protect the spine, and evacuate rapidly; avoid aggressive manipulation.
• B. Immediately remove the penetrating object on-site.
• C. Apply heat to the wound.
• D. Delay evacuation to observe.

Answer: (A)

In penetrating head injuries, the priority is to preserve life by securing the airway and supporting breathing, protecting the spine, and getting the patient to definitive care rapidly while avoiding any manipulation that could worsen bleeding or brain injury. Don’t remove the penetrating object on scene—removing it can trigger massive bleeding and further brain injury. Instead, stabilize the head and the object with bulky dressings and immobilize the neck if a spinal injury is suspected. Provide airway support (for example, suction and rescue breaths as needed) and high‑flow oxygen, and prepare for rapid evacuation to a facility equipped for neurosurgical care. Heating the wound and delaying evacuation to observe do not help and can worsen outcomes.