Rigid cervical collars, or C-collars, have been used to protect patients who have a potential spinal injury for nearly 60 years. Although our understanding of when and how to use them evolved over time, an important question remains: Are we using them to their greatest advantage?
Protecting the spine is a major focus in any trauma care. However, are there situations when alternative methods of spinal immobilization could provide equal or better patient outcomes?
Advantages & disadvantages
A common call to which EMS providers respond is for a patient who fell. Often, this is an older adult. When we arrive, we might ask the individual whether he/she remembers what happened. If the patient responds in the negative, numerous protocols typically guide us down the path of selective spinal immobilization, which can include a C-collar.
Although this is appropriate in many cases, it’s important to recognize that a C-collar isn’t always the best option. Assessing patients and what best fits their needs must be considered. For example, elderly patients who have significant kyphosis might not fit properly into a standard rigid collar. Forcing the neck into a neutral position might hyperextend the spine or compromise the airway.
This isn’t to suggest that C-collars lack value. They can reduce cervical spine motion and limit flexion and extension that could worsen an unstable spinal injury. Evidence also supports their short-term use during difficult extrications or when moving unstable patients, because the devices can help to maintain neutral head alignment during transport. Additionally, some patients report feeling more secure and comfortable with the mechanical support that a C-collar provides.
Despite these benefits, C-collars aren’t without potential disadvantages. One concern is the potential for increased intracranial pressure (ICP). A collar that’s applied too tightly can compress the jugular vein, impeding venous return from the brain and increasing ICP. This can be particularly harmful in patients who suffered a traumatic brain injury.
C-collars also can complicate airway management. Their rigid design might make bag-valve-mask ventilation, i-gel placement or endotracheal intubation more difficult, particularly in critically ill patients who require rapid airway intervention.
In addition, prolonged collar use—particularly in elderly patients—can contribute to pressure injuries and skin breakdown over the jawline and other bony prominences.
Alternatives
If a C-collar isn’t the most appropriate option, what alternatives are available for spinal immobilization?
The full-body vacuum mattress conforms to the patient’s natural body contours, to provide excellent spinal stability without forcing the neck into an unnatural position. They also distribute pressure more evenly than a C-collar can, to reduce the risk of pressure ulcers during prolonged transport.
For shorter transports, a combination of a scoop stretcher and foam head blocks can provide effective immobilization. A scoop stretcher allows providers to transfer patients with minimal spinal movement and helps to reduce the need to roll the patient from side to side. Once the patient is safely positioned on the cot, the scoop stretcher often can be removed, to improve comfort while maintaining appropriate spinal precautions. When paired with foam head blocks that are secured by tape or straps, this approach can provide cervical stabilization that’s comparable to that of a C-collar without placing pressure around the neck.
Minimize complications
Like many tools in EMS, the C-collar has an important role, but it isn’t a one-size-fits-all solution. Every patient presents with unique anatomy and clinical circumstances.
Careful assessment and clinical judgment should guide the decision to use a C-collar or other method of spinal immobilization. By selecting what’s most appropriate for each patient, EMS providers can protect the spine, minimize potential complications and, ultimately, improve patient care.
