In the cases of major trauma, responders should ensure the stability of the cervical spine with immobilization. Use the jaw thrust maneuver rather than head tilt and chin lift to open the airway. Personal protective equipment such as a pocket mask or bag-mask should be used, especially if there are bodily fluids present. Responders should control major bleeding with direct pressure and dressings. CPR and defibrillation should be started immediately if the patient is unresponsive without a pulse.