From the Guidelines
The routine application of cervical collars by first aid providers is not recommended due to the potential harms, such as increased intracranial pressure, and the lack of evidence showing clinical benefit for injured patients. When a cervical spine injury is suspected, it is crucial to prioritize the patient's safety and stability.
Key Considerations
- The patient should remain still, with a second person maintaining manual in-line stabilization of the head and neck, if possible, to prevent further injury.
- The decision to apply a cervical collar should be made with caution, considering the potential risks and benefits, as noted in the 2015 international consensus on first aid science with treatment recommendations 1.
- If a cervical collar is applied, it is essential to select an appropriately sized rigid cervical collar and apply it correctly to avoid causing further harm.
Application Procedure
- The collar should be applied by positioning the back portion first, then bringing the front section under the chin and securing the Velcro straps on both sides.
- The collar should fit snugly but not restrict breathing or cause pressure points, with the chin resting comfortably in the chin piece, and the collar extending from the jaw to the shoulders.
Important Reminders
- A cervical collar is a temporary measure and not a definitive treatment for cervical spine injuries.
- Even with a collar in place, the patient should be treated as having an unstable spine until cleared by a physician, as the collar does not guarantee the prevention of further injury.
- The task force discussion highlighted the importance of recognizing the potential value of manual stabilization in certain circumstances, but also noted the lack of evidence supporting the routine application of cervical collars by first aid providers 1.
From the Research
Cervical Orthosis Application
The proper application of a cervical orthosis (neck brace) for a cervical spine injury involves immobilization of the cervical spine to prevent further injury. According to 2, initial management of the cervical spine fracture begins at the scene of injury with prehospital care, which involves immobilisation of the cervical spine with "triple immobilisation" followed by initial airway management in the ED while maintaining in-line neck stabilisation.
Immobilization Methods
There are different methods of immobilization, including the use of rigid and soft collars. A study by 3 recommends the use of a combination of a rigid cervical collar and supportive blocks on a backboard with straps to limit motion of the cervical spine. However, another study by 4 suggests that the use of soft collars may be less painful for patients and result in less agitation, although a larger study is needed to determine the safety of this approach.
Comparison of Rigid and Soft Collars
A systematic review and meta-analysis by 5 compared the use of soft and rigid collars in the prehospital management of cervical trauma. The study found that rigid collars provided significantly higher stability compared to no collar and to soft collars in flexion/extension and rotation movements. However, the study also found that there was no significant difference in secondary spinal cord injuries for soft collar and for rigid collar.
Prehospital Immobilization
A systematic review by 6 examined the efficacy of cervical spinal immobilisation in patients with suspected cervical spinal cord injury. The study found that there is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes, and that there is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilisation.
Key Points
- Immobilization of the cervical spine is crucial to prevent further injury in patients with cervical spine injuries
- Different methods of immobilization, including rigid and soft collars, are available
- Rigid collars provide higher stability, but soft collars may be less painful and result in less agitation
- There is a lack of high-level evidence on the effect of prehospital cervical spine immobilisation on patient outcomes
- Large prospective studies are needed to determine the clinical benefit of prehospital spinal immobilisation, as noted in studies 2, 4, 3, 5, 6