Among the following patient scenarios, who represents the most urgent need for immediate transport?

• A. 29-year-old female with bilateral wrist fractures and neck pain
• B. 27-year-old male with abdominal pain and a fractured collarbone
• C. 35-year-old female with a pelvic fracture and SBP 70 mmHg
• D. 35-year-old male with a stable radius and ulna fracture

Answer: (C)

When assessing who needs immediate transport, the most urgent scenario is the one showing life-threatening shock from bleeding, not just painful injuries. A pelvic fracture with a systolic blood pressure of 70 mmHg indicates massive hemorrhage and failing circulation. Pelvic injuries can bleed extensively into the pelvic cavity and retroperitoneum, so the patient is unstable and at imminent risk of death without rapid intervention and definitive care. This requires immediate transport, rapid assessment, and prompt measures to stabilize circulation (such as pelvic stabilization and rapid IV access) while prioritizing rapid arrival to a trauma center.

The other scenarios involve injuries that, while serious, do not present with current instability or ongoing hemorrhage. Bilateral wrist fractures with neck pain may be painful and require immobilization, but they do not typically cause rapid hemodynamic collapse. Abdominal pain with a clavicle fracture could be concerning, but if there’s no ongoing bleeding and vitals are stable, transport can proceed with standard assessment. A stable radius and ulna fracture is clearly less urgent, with no signs of shock or airway/breathing compromise.