No place for the rigid cervical collar in pre-hospital care

Abstract

The cervical collar was introduced to pre-hospital practice in 1967. It has been widely acknowledged that evidence supporting its use has been lacking, and that its use was therefore based upon hypothetical benefit. However, modern evidence challenges the very principle of immobilisations on which the collar's use was justified, and argues that the cervical collar is an ineffective immobilisation tool regardless. Cervical collars have always been thought to be a relatively harmless measure, and their precautionary use therefore encouraged in order to protect those few patients who have sustained an injury. Yet, there is an increasing volume of evidence to say that the application of cervical collars can be harmful to patients. An assessment of today's evidence justifies an immediate change of practice, and EMS providers across the world are adapting accordingly. The UK remains entrenched in rigid trauma protocol, which is not consistent with the principles of patient safety, evidence-based practice or the HCPC's Standards of Proficiency for Paramedics. Practice change is well overdue.