ERC CERVICAL COLLAR SCEPTICS

iPhoneIcon_BigThe ERC, the European Resuscitation Council, have issued new guidelines for first aid, section 9 of their guidelines. And it includes an interesting and rather controversial take on cervical collars and spinal immobilisation that’s similar to what we have been propagating for some years now. They say: “The routine application of a cervical collar by a first aid provider is not recommended”, and comment on limitations of the current view of cervical collars as a good routine device in trauma. Read the out-take.

Here’s the full section on spinal immobilisation. The rest of the guideline is – as always – also worth a read.

Cervical spinal motion restriction
Definitions
• Spinal immobilisation is defined as the process of immobilising
the spine using a combination of devices (e.g. backboard and cervical
collar) intended to restrict spinal motion.
• Cervical spinal motion restriction is defined as the reduction or
limitation of cervical spine movement using mechanical cervical
devices including cervical collars and sandbags with tape.
• Spinal stabilisation is defined as physical maintenance of the
spine in a neutral position prior to applying spinal motion restriction
devices.

In suspected cervical spine injury it has been routine to apply
cervical collars to the neck, in order to avoid further injury from
spinal movement. However, this intervention has been based on
consensus and opinion rather than on scientific evidence.
Furthermore, clinically significant adverse effects, such as raised
intracranial pressure, have been shown to occur following the
application of a cervical collar.

2015 First Aid Guideline
The routine application of a cervical collar by a first aid provider
is not recommended.

In suspected cervical spine injury, manually support the head in
a position limiting angular movement until experienced healthcare
providers are available (Good Practice Point).

Moving away from the collar?
So the cervical collar might still be placed, but they’re saying it’s not worth it for inexperienced first aid providers. They might get the benefit/harm ratio wrong, and they might not apply it correctly. But they are also mentioning serious harms from cervical collars, and pointing to the lack of evidence for them in general. It’s worth quoting this little part again:

“In suspected cervical spine injury it has been routine to apply
cervical collars to the neck, in order to avoid further injury from
spinal movement. However, this intervention has been based on
consensus and opinion rather than on scientific evidence.”

The conclusion seems to be that we need to take care of the spine, but there are several ways to reduce spine movement and keep the head/neck in a neutral position. Other techniques might be just as good. We’ll be back with more when the Norwegian national guidelines that specifically speaks on spinal stabilisation are released.

European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid, Resuscitation 2015.

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2 Responses to ERC CERVICAL COLLAR SCEPTICS

  1. Pingback: ERC CERVICAL COLLAR SCEPTICS | Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds

  2. HEMS_Doc says:

    Sound debate, But: a lot of focus on throwing the neckcollar out. I would like to see a little more focus on how then to handle a suspected neckinjury.
    A lot of focus on unnecessary neck collars, pls remember that we do see the opposite as well ie neck fractures without Any stabilization..

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