(picture attribution HERE)
Hi! Here is the recent Norwegian article in Journal of Neurotrauma
PREHOSPITAL USE OF CERVICAL COLLARS IN TRAUMA PATIENTS : A CRITICAL REVIEW
Basically after a comprehensive literature review in their paper, these Norwegian authors suggest the cessation to all routine prehospital application of cervical collars for trauma patients unless there is a temporary need during extrication. They further suggest the best way to immobilise the neck if needed is using spinal board, head straps and head blocks and ideally spinal vacuum mattress.
This contrasts to an American paper in Neurosurgery here
PREHOSPITAL CERVICAL SPINE IMMOBILIZATION AFTER TRAUMA
This 2013 review paper recommends using cervical collar , spinal board, head blocks and straps as the best method still of neck immobilisation.
Both papers have the advice and cite the literature that in general we dont need to immobilise cervical spines of many trauma patients routinely. In particular awake patients can generally protect their own cervical spines better than any splint!
In my own prehospital care provision I have tended over time too adopt the position of the Norwegians! But then again I have luxury of placing patient into a comfy vacuum mattress!
When you think of it, it does seem ludicrous we place awake, cooperative patients in these cervical collars as a routine! Both papers strongly suggest using clinical decision rules to clear cervical spines in low risk trauma patients.
It can be a big deal this issue of what to do with trauma patients in remote locations who need to get “their C spine cleared” before removing neck collar. Traditionally this meant Xrays. Still does in many cases but is probably quite a waste of resources and patient morbidity for very little gain.
For example recently I flew a patient out of a remote hospital for this exact reason : need to clear the C Spine with xrays that could not be done at local hospital after a car rollover.
Patient was in cervical collar, supine for over 4hrs, even with a bladder catheter in to remove need to situp! They had a clavicle fracture but no other obvious injuries..and neck pain..well everyone gets neck pain after being in cervical collar for >2hrs! It was difficult to tell after so many hours! They certainly had an occipital headache from lying supine for so long!
No neurological signs at all.
I was tempted to remove the collar and advise she get driven to nearest hospital with form to have her “clearance” xrays! They were alert, awake, cooperative and could do better job at protecting own neck than any piece of plastic/foam!
It seemed excessive to transport but I did as the wheels were in motion and patient certainly expected such after so many hours in that painful cervical collar!
Which brings me onto another point! We should be using the more comfortable cervical collars like the ASpen or Philadelphia if we are going to still use cervical collars at all!
So go the Norwegians I say!