Soft neck collar to replace hard – times are a changin!

image from http://www.actimed.com.au/images/products/collar.jpg (no conflicts of interest exist)

We have posted about this growing controversy of prehospital cervical spine neck collars previously since last year, when UK prehospital faculty published a consensus statement , highlighting lack of evidence for hard neck collars and raising concerns of harm being done. Since then Norwegian and Dutch ambulance protocols have shown signs of change to modify or even eliminate the use of hard neck collars in prehospital setting.

Via my PHARM network I had heard in my own state of Queensland, Australia, that one Brisbane hospital/ED had changed to using soft neck collars and remarkably that the QUeensland Ambulance Service was planning to remove all hard neck collars and replace with soft neck collars.

When the QAS SOP and EBM review are published online by QAS/Queensland Health I will post it up but its clear the decision has been made and rollout implementation will be soon underway. For now most QAS units still  use hard neck collar as per current SOP but the soft neck collar SOP will be phased in, in near future.

To be honest, whilst seemingly radical decision, I support it fully!

Times are a changin!

Whats your opinion?

 

14 Comments
  1. This is very interesting. As a stateside ground-transport/response medic, I have never seen a soft collar in the field nor in the ED as a means of cervical immobilization.

    The radical change at the moment stems from the National Association of EMS Physicians position statement that recommends limited use of a long board; however, looking back at the accompanying resource document (PubMed: http://goo.gl/7ZKwSl), there isn’t so much as a hint that the practice surrounding collars should change as well.

    Could you point us toward some of the research driving this decision? I’d love to check it out!

  2. Back to what we used to do in the QATB days (pre QAS). Actually examine the patient and if they had evidence of a potential spinal injury put on a soft collar, place them on a stretcher (not strapped to a spine board, scoop, combicarrier or any other torture device) and drive them to hospital. We’ve had 20+ years of madness of ‘immobilising’ patients all based on about 0 evidence, finally we’ve regained our senses.

  3. He guys interesting times. Is the SOP available yet? A couple of questions:
    What immobilisation would be used pre-hospitally in a patient with likely spine injury, i.e. those with obvious neurological deficits with a worrying mechanism?
    What immobilisation is then used in the ED post imaging with confirmation of injury/instability?

    I think it is a step forward but just wonder how they deal with the confirmed or likely cases of spinal injury?

    Cheers
    James

    • my advice would be use of an accepted collar like Philadelphia or Aspen that is used to treat some cervical spine fractures, both prehospital and in ED

      I would also advise use of a vacuum spinal mattress as well to maintain whole body immobilisation for prehospital transport

      the soft collar SOP is for those patients with a possible suspected C spine injury.
      for those with proven or obvious C spine injury with neurologic deficits, the use a combination of techniques to ensure best spinal care.

      • Hi Minh thanks for the reply! I am a little confused though. In Queensland pre-hospitally will all patients with concerns around a cervical spinal injury including those who are obtunded or have neurological deficits be placed in a soft collar? Or will the soft collars be used for those with a low risk of injury? Are the ambulance service carrying a Philly/Aspen/standard hard collar as an alternative?

        The vac mat I have found to be a great immobilisation device particularly for secondary retrievals but it can have some issues pre-hospitably:
        They are quite bulky limiting access to the patient.
        They have a habit of becoming punctured at the worst moment!
        They are also a great insulator which is ideal on a snowy mountain in Scotland (watch out for the crampons) but not so good on a 40 degree day in Sydney!! Have you found you have managed to cook many patients up north?

        I am aware that the evidence of benefit for hard collars is non-existent and there is plenty of evidence of harm. I guess I’m just interested to see how far the Queenslanders are moving away from there use.

      • It’s pretty much soft collars across the board but personally I would still use a hard collar if proven neurological deficit and it should be a hospital standard one like an Aspen or Philadelphia . That’s my personal opinion based on hospital standard of care
        Obtunded patients will get soft collar
        Awake patients will either get no collar or soft collar
        What’s your email?

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