Those fantastic Vikings over at one of my favourite FOAMed sites, ScanCrit have been rampaging through the dogma of cervical collars for some time, and now it seems the campaign is coming to a head:
This is a pretty big move; c-collars have been part of the fundamentals of EMS since the birth of the specialty despite an almost complete lack of evidence of any benefit.
Many studies have been carried out on cadavers and healthy volunteers and have shown that spinal immobilization may actually increase distraction between vertebrae, increase ICP, impair airway management, impair ventilation, act as a fulcrum which increases spine movement on transfer, cause pressure sores and even if well fitted still allow for 30 degrees of movement in any plane!
As for studies showing the benefit, they are…
The lack of evidence for benefit along with the increasing evidence of harm has been the impetus for this move and Bergen EMS are to be applauded for taking the initiative. I predict there will be howls of protest coming from the international EMS community, so I will be watching with interest to see how they get on. Nonetheless I think it is the sensible thing to do. With nothing but hypothetical benefits and an increasing weight of evidence of harm, the right thing to do is to completely re-evaluate practice.
So when can we expect to see a change to our practice? I predict: never. Sadly the dogma of c-collars for all is very, very well embedded in our culture, handed down from generation to generation as holy sacrament, never to be questioned. I will therefore continue my practice of using c-collars carefully where required and the spine-board never (except as an extrication device)
For more information on the general badness of cervical collars, check out ScanCrits other post here and head over to Sydney HEMS site for a three part series here, here and here as well as posts on the futility of collars in penetrating and ballistic neck injuries.