The trauma of the cervical area is in Italy the most frequent cause of death under 45 years old, with an incidence of around 120 cases per 100,000 inhabitants. 30% of these injuries is to reconnect to car accidents. It is also interesting to note that 27% of patients that reported a spine’s trauma does not feel any pain, so it’s necessary to pay attention even in absence of obvious symptoms, to not cause serious secondary damages. Spinal column’s traumas are a huge burden for the economy of each country, as they mainly affect people during their most productive years. In addition, many of traumatized patients present disabling conditions, that have a significant impact both on the human and on the economic level.
For these reasons, it is essential to cure the organization of pre-hospital treatment, which, if done in a professional and efficient way, can provide a significant reduction in deaths and disabilities. Many researches show that the number of deaths due to avoidable cervical traumas is considerably higher in case of absence of structures and dedicated personnel.
The assistance to a traumatized patient is characterised by four key points
- Triage on the territory, which is the first general overview of the injuries and the therapeutic priorities of the patient;
- Proper use of the equipment supplied and the application of the necessary support techniques;
- Implementation of basic resuscitation;
- Patient’s transportation in a hospital that can offer a proper and timely treatment.
In addition, in case of cervical and spinal immobilization a reference point is the principle of conditioning. As principle of conditioning is meant the annulment of the points of major elasticity, to ensure mechanical stability to the patient and limit the transfer of kinetic energy to the body. Patient’s immobilization has the purpose to uniform the reactions of his body against motion and stresses, in order to prevent secondary damage.
A key device in the application of the conditioning’s principle is the cervical collar. On the market there are many models, classified primarily in monovalve (one piece) and bivalve (two pieces); the second is certainly more suitable for the immobilization of cervical spine, especially during the emergency phase, given the fact that the two-piece construction ensures a more conforming application to patient’s anatomy and an immobilization more symmetrical and more stable. Cervical collar’s aim is to restrict flexor, extensor and turning neck’s movements and should be removed only after checking the absence of a cervical spine’s injury.
For what it concerns the application of cervical collar, that has to be compulsory carried out by two rescuers, we recommend you follow the following guidelines
- the first rescuer places thumb and forefinger of one hand into the sockets under the cheekbones of patient’s face and with the other hand place the same fingers in the sockets under the head’s basal process. While aligning the cervical area, he make a slight diagonal traction;
- the second rescuer stays behind the patient and puts thumbs on first rescuer’s hand’s fingers that support the head. At this point puts little fingers and ring fingers on first rescuer’s hand’s fingers located in the sockets under the cheekbones;
- he continues supporting patient’s nape on his chest to further stabilize the grab;
- he remains in this position, while the first rescuer proceeds to measure the right size of cervical collar;
- after clearing the neck, he first begins by applying the front valve, followed by the rear one, that has to be fixed by fastening straps.