4 October 2015

Hard Collars Out of C-Spine Trauma Guidelines

Bones Clinical

Semi-rigid (hard) collars are set to be removed from Australian guidelines for the routine management of suspected c-spine injury following trauma.

The International Liaison Committee on Resuscitation (ILCOR) released this recommendation as a draft back in February this year, and it is now leading to change in Australian trauma management guidelines. A number of countries have already adopted these changes. ILCOR asked the following question of the literature:

“Among adults and children with suspected traumatic cervical spinal injury (P), does spinal (I), compared with no spinal motion restriction (C), change neurological injury, complication mortality, pain, patient comfort, movement of the spine, hospital length of stay (O)?”

And the answer was that routine application of a semi-rigid collar is not recommended. This was not only because of no evidence of benefit but also because of considerable evidence of harm. Manual stabilisation, in situations such as extractions, may still afford potential benefit, based on current evidence. This is a radical departure from one of the bedrocks of A-B-C medicine embedded in all doctors.

The Queensland Ambulance Service have been in the lead regarding adoption of these new guidelines in Australia, having already moved from semi-rigid to soft collar (Philadelphia) recommendations for transport of patients across the State. The remaining Australian States and Territories are soon to follow.