C-Collars on their way out?

[Dustdevil]

I don't like to use anything other than the big Ferno blocks. They do a better job than anything else I have ever used, plus there is the added benefit of having the blocks to use as chocks to wedge in between the patient's hips and the cot rails. After all, if you immobilise the head, but leave the rest of the body flopping around, you are defeating the purpose of immobilisation. I know of no other CID that provides for this possibility, and pillows and blankets simply won't do the job.

[DwayneEMTP]

Is there any respectable body of evidence showing that any of the spinal precaution hoops that we jump through do any significant good?

I'm of the seemingly unpopular belief that, intuitively, non of this, in the vast majority of my patients is worth spit. If pain is bad, in most cases, and relieving physical pain by splinting or other non pharmacological means is good, (leading to the belief of a positive anatomical/physiological shift to the positive has occurred) then I have to say I can think of very few times that I've mediated spinal pain via LB/collar. And in most cases just the opposite was true. Is this only my experience?

As mentioned before, for many studies that support a body of thought, another can be expected that will show something different, and often opposite. But in the world of spinal precautions it seems that the data against just keeps piling up.

Unfortunately not only the manufacturers of these types of products will kick and scream at a move against, but there is a large population of providers that have few skills beyond spinal precautions that will also feel devalued if these skills are removed and will cry as well. How does this population continue to feel heroic if we no longer need to make applying a collar and some straps appear to be 'life saving?'

Pretty interesting discussion.

Dwayne

[Eydawn]

My thinking is this... every time I've seen or done spinal immob, I felt that it was nigh-impossible to apply the collar without moving the patient's head. Which to me defeats the purpose of applying spinal immob.

I think that you can achieve just as good immobilization without inducing the feelings of claustrophobia and physical discomfort that using a c-collar and hard LSB brings about... I'm interested to see what more research brings about. I agree that the most of what I've seen has leaned towards getting rid of it...

Wendy

CO EMT-B

[JPINFV]

Is there any respectable body of evidence showing that any of the spinal precaution hoops that we jump through do any significant good?

It would be interesting to see what the difference is for a trial looking only at patients that meet specific criteria such as NEXUS and Canadian C-Spine rule. As long as the criteria for spinal immobilization is "trauma" you won't see a change, regardless of if you're looking at p value or relative risk. The number of trauma patients who are c-spined only on the basis of being a trauma patient (and thus, more likely than not lack a c-spine injury, little less an unstable one) will overshadow the population of patients that may actually benefit. It's like asking if D50 or Narcan are effective by only looking at coma cocktail patients.

Until that time, my money is going to be bet solely on "no benefit" (and black, always black!).

Edited January 28, 2010 by JPINFV

[Chief1C]

Has any one seen a c-collar system using vacuum splint technology. If you think about it wouldn't elongate the neck, allow movement, it would conform to the patient and could be built to bridge out to the shoulders and give a better base to the c-collar. Fore that matter it could be formed in such a manner as to support the head as well so the weight would not be suspended by a neck that is immobilized. One of you guys develop that and become a millionaire.

That was invented more than 30 years ago. Things get phased out of use entirely for reasons known to that era. Find someone that gave it up and ask why.

[Richard B the EMT]

Another counter study will appear soon (funded by an association representing the manufacturers of c-collars) with hired guns to refute the whole notion of the first study.

As Mark Twain said, so many years ago:

There's lies, damned lies, and statistics!

[armymedic571]

Actually, I read this article, and find the conclusions of the auther ridiculous.

They looked at people that died from trauma. But.....How did they die. Were they brought into the Hospital alive and with Spinal precautions? I think this study is flawed at best. Baylor University gets a big .