Are cervical collars effective and safe in prehospital spinal cord injury management?
Abstract
Background:
In the UK, around 500–600 people a year sustain traumatic injuries to the spinal cord, half of which involve the cervical spine. UK ambulance guidelines stipulate that if immobilisation is indicated, the entire spine should be immobilised using an orthopaedic scoop stretcher, head restraints and a rigid cervical collar. However, the use of cervical collars is being debated in the paramedic profession. Although they were originally considered harmless and used as a precautionary measure, an increasing amount of evidence suggests otherwise and it is argued that they can do more harm than good. Therefore, it is debatable whether using them is consistent with the principles of patient safety and evidence-based practice.
Aim:
A literature review was carried out to comprehensively examine research surrounding the adverse effects of cervical collars and the range of movement they allow to gain a comprehensive understanding of their efficacy.
Methods:
The EBSCOhost Health Science Research database was searched. Seven articles were found and chosen for inclusion in the literature review.
Results:
Two themes were identified regarding cervical collars: adverse effects and range of movement.
Conclusion:
Evidence suggests that cervical collars can cause more harm than good, and UK ambulance guidelines for spinal immobilisation should be reconsidered.
In the UK, major trauma affects 20 000 people each year, with approximately 500–600 people sustaining injuries to the spinal cord (National Institute for Health and Care Excellence (NICE) (2016). This costs the NHS £0.3–0.4 billion annually (National Audit Office, 2010).
A spinal cord injury (SCI) is damage to the spinal cord; half of the fractures that cause SCI involve the cervical spine (Spinal Injuries Association, 2009) (Figure 1). SCIs generally affect young adults and commonly result from road traffic collisions, falls, sports and domestic violence (Casey, 2017). Mortality is highest during the first year after the injury and is correlated with injury site and severity (World Health Organization, 2013). Secondary conditions, such as respiratory dysfunction and pulmonary infections, as well as suicide, can result from SCI in the long term (Hagen et al, 2010).
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed