Collar Me Bad

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					                      Collar Me Bad
By John Erich,
Associate Editor

                      Study prompts worries that cervical devices may harm some patients

                      T  here’s little in EMS more automatic
                         than applying cervical collars to
                      patients with possible neck injuries.
                                                                  Research Lab, said in announcing
                                                                  the findings. “It is known that after a
                                                                  person has a bad injury, you can create
                                                                                                              and after application of a rigid collar
                                                                                                              and some typical patient maneuvers.
                                                                                                              Distraction was clearly visible—the
                      That doing this might in some cases         a secondary injury very easily. We have     collar consistently pushed the head up
                      harm them is a horrifying prospect.         discovered that the cervical collar, in     and away from the shoulders. In a living
                      But that’s an implication raised by
                      research published earlier this year by
                      the Journal of Trauma.                              “The cervical collar, in the case of a really bad
                        A team led by Baylor University ortho-
                      pedist Peleg Ben-Galim, MD, found that            injury, not only doesn’t protect the spine, but can
                      using extrication collars in the presence                 actually make things a lot worse.”
                      of severe dissociative neck injuries can
                      result in abnormal separation within
                      the upper cervical spine. On cadaver        the case of a really bad injury, not only   patient with unstable cervical anatomy,
                      models with recreated c-spine injuries,     doesn’t protect the spine, but can actu-    this could contribute to secondary
                      collars produced a separation of 7.3        ally make things a lot worse.”              injury—or worse.
                      +/- 4.0 mm between C1 and C2.                 The cadaver recreations were                What this means for EMS, though,
                        “Cervical extrication collars are put     based on real cases. Researchers            probably isn’t all that much yet. It’s
                      on about 15 million times a year…           cut the bodies’ neck ligaments and          certainly not enough to send systems
                      to protect the cervical spine in case       membranes but left supporting muscu-        out changing standards of care.
                      of a bad injury,” co-investigator John      lature, then captured images by x-ray,      C-collars remain appropriate and
                      Hipp, PhD, director of Baylor’s Spine       fluoroscopy and/or CT scan before           safe for most of the patients on whom
                                                                                                                 they’re used. But there are definitely
                                                                                                                 some things we should take from
                                                                                                                 these findings.
                                                                                                                    “It’s a call to bring everyone back
                                                                                                                 to the basics,” says Houston Fire
                                                                                                                 Department Medical Director David
                                                                                                                 Persse, MD, EMT-P, FACEP, who spoke
                                                                                                                 on the data at the Gathering of
                                                                                                                 Eagles conference. “When pe
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