Cervical collar is the main device used for atraumatic immobilization of the cervical area: light and practical, it allows a quick access at neck’s front part, allowing at the same time jaw’s opening and limiting active and passive movements, without interfering with breathing and patient’s blood flow. The application can also be performed on a tracheostomy and in general does not hinder any type of emergency resuscitation actions.
The main function of this device is to protect cervical spine from any secondary damage caused by patient’s transportation, which could also result in serious injuries. Cervical collar ensures partial immobilization of cervical spine, given the fact that a 100% immobilization is considered to be unfeasible. To not compromise product’s efficacy it’s fundamental to correctly apply it and choose the right size. A too large collar causes head’s iperextension, pushing back the mandible and blocking the respiratory system; on the other side a too small cervical collar causes breathing problems or compression of neck’s soft tissues.
The right measure
To choose the right collar size it’s used to follow the fingers practice. Measure with fingers the distance between the chin’s base and the trapezium’s upper margin. Compare the obtained measure with the cervical collar side in order to choose the size that correspond to that measure.
The neutral position
The neutral position is the right position in which patient must stay. This position is manually obtained and is followed by the application of the cervical collar. The rescuer take patient’s head and brings it in neutral position, that must be maintained during all the travel to the hospital. Cervical alignment can take place when the patient is supine, seated, semi-seated or standing. In neutral positioning the parameters used as reference are patient’s gaze direction, that must be perpendicular to vertebral column (patient must look in front), and alignment between acromion and auditory meatus.
Immobilisation ensured by the cervical collar rises with the presidium’s increasing height and rigidity: more a cervical collar is high and rigid, and more it limits neck’s movements. Rigid models, for example, presents both these characteristics. It’s necessary to be trained to rapidly and rightly apply a cervical collar; so it’s fundamental for a rescuer to make periodic tests to maintain high level of dexterity. Furthermore it’s important that the collar is always applied by two rescuers at the same time. Using bivalve (two pieces) cervical collars is firstly applied the chin support and then the back one. Before applying the collar it’s important to control the cervical area and the head in order to identify injuries or contusions and take away possible glass fragments, jewels and other objects.
Application of cervical collar
While the first rescuer is in charged to manually align the spinal column, the second one applies the chin support passing the Velcro strap behind the head and fixing it on the other side of the collar. After he applies the back support, paying attention to the arrows that signal the right side, and fixes it with the lateral strap closures.
An efficient cervical collar avoids that head’s weight negatively impact on spinal column.
Cervical collars allow temporary immobilisation, that alone is not sufficient to guarantee a total immobilisation. It’s for that reason that it’s necessary to combine it with other immobilisation techniques and devices, like manual immobilisation, spine board, vacuum mattress and KED extrication device.
Adult’s main causes of spine trauma are related to car accidents, dives in low water, falls from high and similar things; while for what it concerns children, are more frequent bike falls, impacts versus motorbike and other vehicles and so on. These traumas could be followed by vertebral fractures, dislocations, muscles and ligaments’ sprains. In these cases there are no doubts about the necessity to immobilise cervical rachis, given the fact that these injuries related to the spinal cord could cause post-traumatic paralysis.
Social, psychological, therapeutic and rehabilitative impacts on these traumas particularly hit younger patients. Recent studies demonstrate how, on the overall traumatised patients, 4.3% present cervical rachis injuries and 4.4% thoracic and lumbar rachis injuries. Among died patients within one hour from the arrival at the hospital, almost 50% present cervical rachis injuries.
Studies demonstrate that cervical rachis injuries could be present even in absence of big pain; it happens in 27% on the overall cases. Cervical immobilisation is compulsory for paediatric patients; that because their head is proportionally bigger than the rest of the body, so it’s more vulnerable in acceleration and deceleration traumas. A spine column trauma has to be considered in all multiple traumas, especially in case of head traumas. Spinal cord injuries’ probability is higher, given the relation between head and body. Cervical sprains and dislocations are more frequent for children under 8 years old, while the older ones are more vulnerable to injuries.