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:
- 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:
- High energy mechanism of injury and any of the following:
- Drug or alcohol intoxication
- Altered mental status
- Inability to communicate
- Distracting injury
- Neurologic complaint or finding (e.g., numbness or motor weakness)
- Cervical spine that requires splinting in place (cannot be moved into a midline position)
- Anatomic deformity of the spine
- 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:
- Patients who are found to be ambulatory at the scene upon EMS arrival.
- Patients who must be immobilized for an extended period of time.
- Patients for whom a backboard is not otherwise indicated.
Additional Teaching Points:
- 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.
- 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.
- 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.
- Complete and accurate documentation in the ePCR regarding patient evaluation, C-Collar selection, and spinal motion restriction implementation is always required.
Summary:
- For a select group of patients at low-risk of spinal injury, based on mechanism of injury and clinical presentation, the use of a standard, rigid c-collar, instead of an X-Collar, may be permissible or preferred.
- Regardless of the brand or style of C-Collar used, EMS Providers must exercise sound clinical judgment and attention to detail during implementation of the UTSW/BioTel EMS System Spinal Motion Restriction Policy.
For questions about the new Spinal Motion Restriction Policy or the use of cervical collars, contact BioTel or your EMS Field Supervisor.