FOAM Eye Catchers 11: C spine collars dumped

Much has happened of late as several organisations have one by one abandoned the hard C spine collar.

Last year scancrit reported that a major pre hospital service in Norway ceased the use of hard cervical collars.

Following this in October 2014, PHARM reported that the entire Queensland Ambulance Service (QAS) would in 2015 be ceasing the use of hard cervical collars.This was confirmed, when in December QAS released their rationale for the change, explaining why they would be replacing hard collars with soft collars. Their cervical collar procedures policy, released in February, is provided here. They are following the lead of their state-wide tertiary referral centre for spinal injuries, the Princess Alexandra Hospital, who abandoned hard collars in 2009 and have had no adverse outcomes as a result with an attendant significant reduction in complications.

This is a very significant change in practice in a large state of Australia.

Later in June, PHARM reported that the APLS guidelines for children have completely removed cervical collars from their recommendations.

Now of great significance, ILCOR, the international conglomerate of national resuscitation organisations, have released the 2015 guidelines which have already been incorporated in the European and American versions of these guidelines. They remark on the  lack of evidence of benefit and demonstrated evidence of harm and now specifically state “we recommend against routine application of cervical collars by first aid providers”.

The weight of the evidence suggests an absence of clear benefit of hard collars with substantial associated harm. I suspect it will be a matter of time before hard collars are consigned to the dustbin of medical history, at least for awake patients. Watch this space.

Want to know more?

Here is an evidence based review on the topic by the Queensland Ambulance Service.

Also the issues are well summarised in this article: Why EMS should limit the use of Rigid Cervical Collars

Finally this video well summaries the issues around spinal immobilisation in general including backboards and cervical collars.

As an aside, on the topic of C spines – EAST (Eastern Association for the Surgery of Trauma) have produced new guidelines recommending that high quality CT clearance of the C spine is sufficient in the obtunded patient i.e MRI is not required!