Podcast#19: “Cervical Collars”

© tigerschmttendorf (flickr)Did you read the article about the fire crew that cut the roof off a police car after a patient took refuge following a two car bumper bashing? Complained about whiplash and ended up being collared and boarded. It was in all the tabloid newspapers? If you didn’t read it, I’m pretty sure you will find several stories similar in nature across the internet and I’m pretty sure you would have rolled your eyes skywards, wondering why would someone want to place a cervical collar around certain patients. In this podcast I get the opportunity to discuss with Emergency Medicine Consultant Jonathan Benger that exact question “Why do we put cervical collars on conscious trauma patients?”

Listen to Podcast#19: “Cervical Collars”

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The Show Notes:
The show notes are made available to signed up members of the members messroom area. Links to Journal articles and slides are provided in support of the podcast

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1/ Journal Reference:“Why Do We Put Cervical Collars On Conscious Trauma Patients?” J Benger & J Blackham Scand J Trauma Resusc Emerg Med. 2009; 17: 44. Open Access here

Abstract::
In this commentary we argue that fully alert, stable and co-operative trauma patients do not require the application of a semi-rigid cervical collar, even if they are suspected of underlying cervical spine fracture, unless their conscious level deteriorates or they find the short-term support of a cervical collar helpful. Despite the historical and cultural barriers that exist, the potential benefits are such that this hypothesis merits rigorous testing in well-designed research trials.

2/ Journal Reference:“Out-of-hospital spinal immobilization: its effect on neurologic injury.” Hauswauld et al Academic Emerg Med. 1998 Mar;5(3):214-9 Pubmed

Abstract::
OBJECTIVE:
To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries

3/ Journal Reference:“The Canadian C-spine rule for radiography in alert and stable trauma patients.” Stiell et al JAMA. 2001 Oct 17;286(15):1841-8 Pubmed

Abstract::
OBJECTIVE:
To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients.

4/ Study Reference:“Implementation of the Canadian C-spine rule: prospective12 centre cluster randomised trial” Stiell et al BMJ. 2009; 339:b4146 Open Access BMJ

My Guests Bio:


Jonathan BengerBio: Professor Jonathan Benger
Jonathan is the Director of the Academic Department of Emergency Care at the University of the West of England, Bristol and a Consultant in Emergency Medicine. He also works regularly in pre-hospital care, having helped to establish the pre-hospital critical care team at Great Western Ambulance Service. His research interests include:• The evaluation of new diagnostic technologies
• Resuscitation, critical illness and emergency airway management
• Drug and alcohol use and their impact on urgent care delivery
• Pre-hospital care and ambulance designProfessor Benger chairs the Clinical Effectiveness Committee of the College of Emergency Medicine, and is closely involved with guideline and policy development in the UK, including the current quality and innovation agenda.

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4 Responses to “Podcast#19: “Cervical Collars””

  1. kangaroobeach says:

    Wanna make a million bucks? I was taught that the Laederal multifit collars are designed for EMS providers in the USA, to reach through drivers window and apply collar around the driver in left hand seat

    …which means the market is open for us to design a version for applying thro’ the right window…for UK, Aus, NZ, Japan….

    Who’s in with me?

  2. Matthew Harris says:

    Hi Tim.
    Errr . . . great idea, but I think your buisness plan might be a bit flawed when it comes to accomodating the passenger on the otherside of the vehicle . . . thanks anyway.

    (I’m now having to check which side our collars fasten from . . is there a standard?)

  3. kangaroobeach says:

    Rats!

    But single drivers > cars with passengers in general

    As far as I am aware, the reason the collars fasten in the way they do is to facilitate passage through the left window, around neck of (Nth American) driver and then secure…

    Still not too late to get on board with this once-in-a-lifetime opportunity to make a million. Or perhaps not. Interesting though.

    Great podcast by the way!

    Do you guys still use head blocks in the UK?

    We’ve abandoned unless intubated and paralysed – too much risk of torsion head immobilised but neck-body moving

  4. mattdoc1979 says:

    Ah the great JB and his focus on clinical acumen. Possibly one of the most sensible men in medicine. Listen, for he speaks the truth. Hopefully we will see the way we think about cervical immobilisation change over the next 10 years.