Skill Page - Cervical Collar

15 MAY 2015

Application of Cervical Collar

Mr Prashob U K, EMS

“Cervical spine injury requires continuous immobilization of the entire patient with a semi rigid cervical collar, head immobilization, spine board, tape, and straps before and during transfer to a definitive-care facility.”

Some Historical aspects

1. The inception of the Cervical Collar dates back to the Vietnam War in the early 1960’s.
2. It was considered that the current treatment of placing patients with cervical spine injury with only sandbags placed on each side of the head was inadequate,
3. The soft foam collar introduced in the late 60’s,
4. In the late 1970’s, semi rigid collars began to be developed using polyethylene plastic. Being extremely strong and durable
5. This product still remains the primary material used in collars today.

Cervical vertibrae.

Types of Injuries

FUNCTIONS OF THE CERVICAL COLLAR

1. To reduce compression of the cervical spine caused by the head.
2. To free the hand of care givers while the patient is being moved & splinted to a Full spine board
3. Temporary support to the head of a sitting or standing patient until the patient can be placed in a supine position.
4. Minimizing axial loading / unloading of the spine that takes place in an ambulance during transport (i.e. acceleration / deceleration).
5. To highlight to other Health Care Providers that the patient is a potential or actual Cervical spine injury victim

Indications of cervical collar
National Emergency X-Radiography Utilization Study (NEXUS) criteria.
The sensitivity of the NEXUS criteria to clinically significant cervical spine injury was reported as 99.6%

NEXUS criteria

1. Midline cervical tenderness.
2. AMS
3. Focal neurologic deficit.
4. Evidence of intoxication.
5. Painful distracting injury.

Indications of cervical collar
Midline cervical tenderness
Present if pain is elicited on palpation any cervical spinous process.
Focal neurologic deficit.
Any patient-reported or examiner-elicited neurologic deficit
Altered mental status
G C S ≤14
Disorientation to time, place, person or events
Inability to remember three objects at 5 minutes
Delayed or inappropriate response to external stimuli
Painful distracting injury.
Any condition thought by the clinician to be producing pain sufficient to distract the patient from a cervical spine injury. Examples may include:
    Any long bone fracture.
    A large laceration, degloving injury, or crush injury.
    Extensive burns.
    Any other injury producing acute functional impairment.

Evidence of intoxication

1. Recent history reported by the patient or an observer of intoxication or intoxicating ingestion
2. Evidence of intoxication on physical examination, such as odour of alcohol, slurred speech, ataxia, dysmetria
3. Behaviour consistent with intoxication
4. Tests of bodily secretions are positive for drugs (including but not limited to alcohol) affecting mental alertness.

Types of collar

PROCEDURE.
Explain procedure to the patient.

Applying a Cervical Collar to a Supine Patient

1. Choose correct size.  Measure with fingers from top of shoulder to bottom of chin.
2. First rescuer holds head in line.  Second rescuer slips back section of open collar under patient’s neck.
3. Correctly position collar to fit chin and neck.
4. Ensure collar fits correctly, following manufacturer’s instructions
5. Continue to manually support head and neck in line.

LIMITATIONS OF THE CERVICAL COLLAR

1. Only prevents 50% of cervical spine movement.
2. Is NOT designed to provide any traction to the head, but is only designed to support the weight of the head.
3. Provides no thoracic / lumbar spinal support.
4. Therefore following application of a Cervical Collar, Manual In-Line Stabilization of the head must be maintained until Full Spine Board Immobilization  is achieved.

DANGERS OF THE CERVICAL COLLAR

1. If the jaw support of the collar, clamps the teeth together, airway compromise may result if the patient vomits.
2. Cervical Collars that place pressure on the neck (either via collar design or too small a Cervical Collar being applied), may cause an increase in intracranial pressure.

X-ray C Spine With Collar