UTSW/BioTel EMS TRAINING BULLETIN

November 2014

EMS TB 14-013 Cervical Collar (C-Collar) Selection

 

Refer to the UTSW/BioTel EMS Guidelines for Therapy, the Spinal Motion Restriction Policy, and TB 14-012 SPINAL MOTION RESTRICTION POLICY SUPPORT


Purpose:


To provide cervical collar (C-Collar) selection guidance to UTSW/BioTel EMS Providers for the implementation of the new Spinal Motion Restriction Policy in the 2014-2016 UTSW/BioTel EMS System Guidelines for Therapy.

Background:


The new UTSW/BioTel Spinal Motion Restriction Policy is now in effect.  UTSW/BioTel EMS agencies may stock both the X-Collar, and standard, rigid C-Collars.
The UTSW/Spinal Motion Restriction Policy  does not specify which type or brand of C-collar.
However, when different options are available, C-collar selection should be based on clinical criteria derived from the Spinal Motion Restriction Policy.

C-Collar Selection Criteria:

  1. X-Collar required, if available: For patients who meet ANY of the following criteria for spinal stabilization, the X-Collar and backboard shall be used:
    1. High energy mechanism of injury and any of the following:
    2. Drug or alcohol intoxication
    3. Altered mental status
    4. Inability to communicate
    5. Distracting injury
    6. Neurologic complaint or finding (e.g., numbness or motor weakness)
    7. Cervical spine that requires splinting in place (cannot be moved into a midline position)
    8. Anatomic deformity of the spine
  2. Standard C-Collar permissible: For patients who meet the requirements for spinal stabilization, but who DO NOT meet any of the criteria above, either a rigid C-Collar or an X-Collar shall be used.  A standard rigid C-Collar may be preferable for:
    1. Patients who are found to be ambulatory at the scene upon EMS arrival.
    2. Patients who must be immobilized for an extended period of time.
    3. Patients for whom a backboard is not otherwise indicated.

Additional Teaching Points:

  1. The goal of care for the patient with a possible spine injury is spinal stabilization to protect from further injury. A C-Collar is a tool to assist in achieving that goal. Proper size selection and proper application for each patient and circumstances are critical, regardless of the brand or style used.
  2. Spinal motion restriction (“spinal precautions”) shall be established and maintained, not only by application of a cervical collar, but also by properly securing the patient to the EMS stretcher or backboard, if one is used.
  3. Attention to spinal precautions is paramount for patients at risk for spinal injury. This includes use of a cervical collar, adequately securing the patient to a stretcher and/or backboard, minimizing movement/transfers, and maintenance of in-line stabilization during any necessary movement/transfers.
  4. Complete and accurate documentation in the ePCR regarding patient evaluation, C-Collar selection, and spinal motion restriction implementation is always required.

Summary:

 

For questions about the new Spinal Motion Restriction Policy or the use of cervical collars, contact BioTel or your EMS Field Supervisor.