During primary assessment, what is the first step in the ABCDE approach?

The first step in the ABCDE approach during primary assessment is to establish the airway. This is critical because an unobstructed airway is essential for effective breathing and oxygenation. If a patient's airway is compromised, oxygen cannot reach the lungs, leading to severe consequences. By ensuring that the airway is clear and functional, emergency responders can then proceed to assess other aspects of the patient's condition, such as breathing and circulation, without the immediate threat of hypoxia. This prioritization reflects the fundamental principle in trauma assessment that life-threatening conditions must be addressed first to stabilize the patient effectively.