How should you handle a casualty who is restrained in a vehicle crash?

• A. Do not remove seat belt; only remove if necessary for airway or to access the chest; immobilize and prepare for evacuation
• B. Immediately cut the seat belt
• C. Remove the seat belt and move the casualty
• D. Leave casualty in place and wait for rescue

Answer: (A)

In a vehicle crash with a restrained casualty, the priority is to keep the person as still and securely positioned as possible to protect the spine and reduce the risk of worsening internal injuries. The seat belt acts to immobilize the body and prevent ejection or further movement, so it should generally remain in place.

The best approach is to avoid removing the belt unless there is a clear, immediate need to access the airway or to reach the chest for life‑saving treatment. If you do need to loosen or cut the belt to gain airway access or to perform chest compressions, do so only to the extent required and while maintaining as much immobilization of the spine as possible. After addressing airway or chest needs, immobilize the casualty for evacuation and keep them in a stable position to minimize movement.

Leaving the casualty in place and waiting for rescue is not sufficient on its own, nor is removing the belt entirely and moving the casualty, or cutting the belt without a justifiable medical reason. Those actions can increase the risk of spinal injury and other complications.