C – Clinical practice
Soft collars for cervical spine immobilisation in trauma
H – How/where/why?
Recent studies have recommended the use of soft cervical spine collars over the previously used hard collar or Philadelphia collar. This is sometimes done in association with bilateral sand bagging and taping (during pre-hospital care or at clinicians discretion but not in paediatric trauma).
A – Affecting who?
Emergency department doctors, orthopaedics and trauma surgeons.
N – New or old?
Became mainstream practice at the Princess Alexandra hospital in 2009 and with the Queensland Ambulance Service in 2014.
G – Good or bad?
Soft collars do improve patient comfort for transport and while awaiting cervical spine clearance. The reported risks of hard cervical collars include:
1. Increased movement in the upper parts of the neck compared to no collar.
2. Increased ICP because of decreased venous return due venous compression of the neck.
3. Complicates airway management.
4. Increased risk of aspiration.
5. Increased extrication time and delay to definitive treatment.
6 Increase in mortality in patients with penetrating trauma in those immobilised.
E – Evidence
Kwan, I. et al. (2009) Spinal immobilisation for trauma patients, review, Published in the Cochrane Library, issue 1.