What are the types of hard cervical collars?

Types of Hard Cervical Collars

Hard cervical collars include several specific types: rigid collars such as the Stifneck, Philadelphia collar, Newport collar, and Miami J collar, which are the most commonly used devices for cervical spine immobilization in trauma settings. 1, 2

Specific Hard Collar Types and Their Characteristics

Stifneck Collar

• Exerts pressure exceeding capillary closing pressure at most contact points, creating significant risk for pressure ulcers 2
• Rated poorest for patient comfort (0.85 on a 0-5 scale) 2
• Associated with highest risk of soft-tissue complications due to excessive pressure 2

Philadelphia Collar

• Exposes wearers to significantly higher pressures when supine compared to upright position (p < 0.001) 2
• Moderate comfort rating (3.00 on a 0-5 scale) 2
• Commonly used but has notable pressure-related complications 2

Newport Collar

• Exerts pressure well below capillary closing pressure, making it one of the safest options for skin integrity 2
• Highest comfort rating (3.80 on a 0-5 scale) 2
• Recommended as a "patient-friendly" collar with favorable skin pressure patterns 2

Miami J Collar

• Exerts pressure well below capillary closing pressure 2
• Good comfort rating (3.45 on a 0-5 scale) 2
• Demonstrated significantly greater reduction in flexion compared to some other collars 1
• Recommended for superior patient comfort and reduced soft-tissue complications 2

Aspen Collar

• Showed greater percent reduction in extension and lateral bending compared to Miami J 1
• Effective in restricting range of motion in the cervical spine 1

Important Clinical Context About Hard Collar Use

Despite the availability of these various hard collar types, current evidence suggests against routine use of any cervical collars by first aid providers due to documented harms that outweigh potential benefits. 3, 4

Key Harms of Hard Collar Use

• Increase intracranial pressure, particularly dangerous in patients with co-existing head trauma 3, 4
• Cause pressure sores requiring skin grafting and potentially leading to sepsis 4
• Complicate airway management with life-threatening potential 4
• Lead to ventilator-associated pneumonia and delirium with prolonged use 4
• Paradoxically may not effectively restrict movement of unstable cervical injuries, especially at craniocervical and cervicothoracic junctions 4

Evidence-Based Recommendations

• The American Heart Association recommends against routine application of cervical collars by first aid providers (weak recommendation, very-low-quality evidence) 3
• If a collar must be used, Newport or Miami J collars are preferred due to favorable skin pressure patterns and superior patient comfort 2
• For patients requiring airway management, at least the anterior portion of the collar should be removed to facilitate intubation 4

Critical Pitfalls to Avoid

• Prolonged collar use beyond 48-72 hours causes morbidity that may exceed the risks of missed cervical spine injury 5
• Pressure ulcer development occurs in up to 38% of patients with prolonged collar placement (>21 days average) 6
• Each pressure ulcer costs approximately $30,000 to treat with prolonged healing time 5