Doing away with cervical collars

[CentralCalEMT]

Where I work, the CCEMSA region in Central California, who actually has had a relatively progressive selective spinal immobilization protocol for years even though they area in CA has further changed their trauma protocol. As of January 1, all rigid C collars are being taken off the ambulances and are no longer to be used. I know the trend is thankfully moving away from placing everyone in spinal precautions, but has anyone's agencies out there done away with rigid collars entirely?

Spinal precautions are only to be taken in patients with actual deficits, are unconscious, or have major multi system trauma and even then, we will be using soft collars rather than the hard plastic ones and KEDs are preferred over backboards. Even patients with generalized back and neck pain will not be boarded and collared any more but rather gently moved to the gurney, placed supine and their head and neck supported while we are doing this! I for one am excited that California EMS seems to be moving in the right direction.

If anyone out there works for a system that did away with rigid collars, I was just wondering how you liked it? Also, especially in systems with volunteer first responders with minimal training, how well it has worked out with the first responders who have had C-Spine drilled into their minds for years. Did you find that it was hard to break some of them of their habits or was it well received across the board.

 

[Tigger]

We are struggling to break the fire guys and some of more entrenched ambulance providers from the mindset that mechanism must equal c-spine. With that said we have not gone away from collars entirely. "Low risk" patients are placed in a c-collar and instructed to self extricate to the cot. Patient's with deficits or those that cannot be properly assessed are placed on vacuum mattresses.

I am surprised to see that the KED is favored as one oft-cited study shows that the application of the KED to cause more cervical spine manipulation than any other spinal motion restriction technique used by EMS.

 

[CodeBru1984]

Where I work, the CCEMSA region in Central California, who actually has had a relatively progressive selective spinal immobilization protocol for years even though they area in CA has further changed their trauma protocol. As of January 1, all rigid C collars are being taken off the ambulances and are no longer to be used. I know the trend is thankfully moving away from placing everyone in spinal precautions, but has anyone's agencies out there done away with rigid collars entirely?

Spinal precautions are only to be taken in patients with actual deficits, are unconscious, or have major multi system trauma and even then, we will be using soft collars rather than the hard plastic ones and KEDs are preferred over backboards. Even patients with generalized back and neck pain will not be boarded and collared any more but rather gently moved to the gurney, placed supine and their head and neck supported while we are doing this! I for one am excited that California EMS seems to be moving in the right direction.

If anyone out there works for a system that did away with rigid collars, I was just wondering how you liked it? Also, especially in systems with volunteer first responders with minimal training, how well it has worked out with the first responders who have had C-Spine drilled into their minds for years. Did you find that it was hard to break some of them of their habits or was it well received across the board.

We're still actively utilizing Spinal Immobilization in Kern County.

 

[terrible one]

Good to see this. I can't tell you how many fire guys have insisted that a pt must be placed in full cervical immobilization simply because of MOI. One of my biggest pet peeves.

 

[RocketMedic]

I am pleased by this.

 

[avdrummerboy]

Here in ICEMA we've done away with C-SPINE'ing for the most part. I haven't boarded anyone in like 8 months now, we still use collars but only as deemed necessary. I've had to stop a few fire guys and even some of our own from doing a full immobilization, but other than that no real problems or issues, it's worked out just as nice as the years of study told us it would!

 

[Jim37F]

Here in ICEMA we've done away with C-SPINE'ing for the most part. I haven't boarded anyone in like 8 months now, we still use collars but only as deemed necessary. I've had to stop a few fire guys and even some of our own from doing a full immobilization, but other than that no real problems or issues, it's worked out just as nice as the years of study told us it would!

I was just thinking that I hadn't boarded anyone in like 3-4 months here (couple c - collars but no boards and one boarded for extrication, unconscious unresponsive medical patient who needed to be carried upstairs to street level, yay for hillside homes) but then I had two patients in 3 days get put in full SMR, but we had to justify both of them, one a 99 yo F front passenger in a car that rear ended a parked car at 40 mph and the other another lady (I forget the age but 50ish) ran straight into a median at 30mph, complaining of severe back pain, with a Hx of back problems and surgeries

 

[medicsb]

I hope changes like this are being studied, it'd be nice to know whether or not this sort of change has any positive, negative, or no change on patient outcomes. I definitely agree that spinal immobilization is often not required, but I worry that the pendulum could swing too far in the other direction where patients that actually need immobilization don't receive it and we don't know because no one is actually "watching".

 

[SandpitMedic]

Literally watched a couple of fire medics chase a stable lady around a scene with a c-collar the other day simply because she was involved in a t-bone accident that met intrusion mechanism criteria.

No pain, no deficits, no acute complaints... No critical thinking skills either.

Then they backboarded her... Until her back hurt.... I tried to be an advocate- fire didn't like that.

 

[avdrummerboy]

I hope changes like this are being studied, it'd be nice to know whether or not this sort of change has any positive, negative, or no change on patient outcomes. I definitely agree that spinal immobilization is often not required, but I worry that the pendulum could swing too far in the other direction where patients that actually need immobilization don't receive it and we don't know because no one is actually "watching".

Don't know how much reading you have done on back boarding/ c collaring, but it was doing WAY more harm than good. For that 1 in a million call that someone misses (and my personal opinion is that it's not hard to know if someone should legitimately be c spined) the numbers will still be much smaller than the million to one chance that spinal precautions actually cause harm that wasn't there originally!