At the scene of a train accident, which victim should the nurse attend to first?

In emergency triage, the primary focus is on determining which patients require immediate intervention to sustain life. In this scenario, the individual experiencing airway obstruction is the highest priority because an airway obstruction can lead to hypoxia and death within minutes if not promptly addressed.

Airway management is a critical component of advanced life support, and ensuring that a patient can breathe effectively is paramount. This condition directly threatens the patient's ability to oxygenate their blood, which is essential for survival. Therefore, the nurse must first assess and clear the airway of the victim with obstruction, as this could have immediate life-or-death implications.

In contrast, while the other victims may be in distress, such as experiencing severe pain or anxiety, these conditions, while still serious and deserving of attention, do not pose an immediate threat to life in the same way that airway compromise does. The victim with altered level of consciousness also requires attention but could be less critical than one with a clear obstruction, as their airway may still be patent, allowing for some degree of oxygenation, especially if they are breathing on their own. Promptly dealing with the airway obstruction is thus the most critical action the nurse should take.