Final answer:
The first action in this situation is to secure the child's airway and control the cervical spine.
Step-by-step explanation:
When a small child falls through ice and is pulled out of the water apneic and pulseless, the first action should be to secure the child's airway and control the cervical spine. This is important to ensure that there is a clear airway for breathing and to prevent any further injury to the child's neck or spine. Once the airway is secured, CPR should be started immediately to initiate circulation and provide oxygen to the child's brain and vital organs.