Do We Still Need The C-Collar


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Sean G., M.D. -

I am forever comforted by the fact that things I pretty much did by winging it on my own with that oft neglected skill(common sense) is getting evidenced based...I always thought it was stupid and useless to fight a collar onto a combative patient and most of my career I would tell the nurses to leave em be....scan them, but leave the collar off.

Brad S. -

Agree Sean, my practice also, the 'dirty little secret", turned out not to be dirty at all.
In review of the lit, still not great consensus or ED protocols(some pre-hospital stuff), which we need to change culture
So Chris, if you have an awake blunt trauma patient with high degree of suspicion for fracture or even documented fracture do you place in a well-fitting, less rigid Aspen or Philly collar, or do something different?

Neil L. -

Just after some clarity. Is this literature just for rigid collars or does this include the practise of using an Aspen or phili collar while you wait for the scan. Also the example of the 80 yrs old with a C1 fracture - so what are you putting them in if the n.surgeon says its for medical management only?? Thanks.

Paul B., M.D. -

Most of the papers mentioned here had a focus on spinal immobilization with a longboard, not simply a cervical collar. It concerns me to hear the longboard literature being used as a reason to remove collars. Combative patients aside, I agree ... no reason to fight the patient. However, sedation is an oft-forgotten critical management piece of the altered trauma patient. Avoid pithing the patient.

I'm an EMS physician in NYC and a strong proponent of reducing longboard use. I am NOT a "no-collar" EM/EMS doc, however, for both the ED and the EMS system. I've seen enough "wow, I'm glad we scanned them" trauma patients in my career to know that we don't know all, and I feel our system has far too many providers getting a suboptimal exam to safely reduce collar use in the right population.

My concern here is the complete lack of recognition of the person who should be spearheading the Longboard Revolution in your respective location, and subsequently the coming Cervical Collar Revolution: the EMS physician. Yes, we exist. We have an increasing number of fellowship trained docs in the medical community. We have a board now through ABEM. One of us probably works in your hospital ... even if they haven't gone through the board yet.

Again, the EM:RAP moderators forget to mention the importance of an EMS Physician in a prehospital care topic. This is a topic that should have been handled by Dr. Mell, as Dr. Swaminathan mentions just about every sub-specialist to involve except the colleague you have in your faculty that likely knows this material best.

Rob O -

Hi Paul, Thanks for bringing up these issues. As to the credentials, Dr Colwell is indeed board certified EMS physician and ran the Denver EMS program for 15 years. Since there has been so much discussion on this particular segment, we are putting together a special edition to flush out the questions and controversies.

Abdullah Al-Somali -

i was about to intubate a pt who fell in the bathroom & sustained a subdural hematoma today and my attending was so far up his ass concentrating on the c collar making a huge fuss that his not on a collar! i can't wait for that special edition episode :) thanks for all what you guys redoing on EM:RAP.

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