The spine, particularly the cervical spine, is a very important structure for continued and normal function in the human body. Seemingly small injuries to the c-spine can and do lead to paralysis, motor deficits, and death. Because of this, at one point in time, EMS workers placed just about every trauma patient in a C-collar, which the patient remained in until the hospital could rule out a c-spine injury.
As time went on, it was noticed that more patients were potentially being hurt than were being saved by the application of collars in the field, and the list of suspected injuries that should be collared shrank. Yet in America, collars are applied to a large number of awake and alert patients who have little indication of significant neck injuries. Norway, a leader in pre-hospital care, is arguing that this should stop unless it is temporarily needed for extrication.
So, which should American EMSs follow? What we do now as indicated in Prehospital Cervical Spinal Immobilization After Trauma, or should we start thinking a bit like the Norwegians and follow their findings as noted in Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review?
It has been shown that, oftentimes, a collar is placed on a patient who has no compromise to their spine, causing unnecessary discomfort. Even worse, we do know that some spinal injuries can be exacerbated by the application of a collar. Both the American paper and the Norwegian paper say that the routine trauma patient does not need to be placed in a collar, but then the American paper goes on to list which patients should be given such treatment while the counterpart states collars should only be used for extrication, and should only be temporarily placed on the patient. Both studies indicate that the patient will better benefit from a spine board, head blocks, and if available, a vacuum mattress. This, the papers claim, is particularly true for patients who are capable of protecting their own spine while awake and alert.
In the interest of bettering patient care, it is important that we look for better ways of performing our jobs and accept that, at times, what we have always done may not be the best thing we can keep doing for our patients. The average trauma patient does not have spinal injuries. Of those who do, the average patient will not benefit from a rigid collar, but rather, will be further injured by the device, if not simply being uncomfortable for little to no reason.
Until protocol officially changes, EMS providers should work with as much judgment room as they have available and treat the patient as the patient needs to be treated, not just as the book says. As we all know, “book EMS” and “real life EMS” are two different things, with the latter requiring experience and judgment. Our patients count on us to make the right call when it comes to protecting life and limb and the book does not always fall in line with that.
Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.