Podcast #27 - Out with the Hard Collar and in with the Soft Collar with Minh Le Cong
Soft collars are being supported more with a growing body of literature. There is growing support for the change from semi-rigid (hard) collars to soft collars by a number of organizations, especially prehospital, in nations such as Australia. After our initial primer podcast on this subject, we review some of the finer points to this debate on this podcast. Details on the pros and cons are mentioned more extensively in the podcast itself so take a listen.
The mannequin picture above posted by Minh Le Cong shows one example of a soft collar. Unfortunately, as the image below shows, semi-rigid (hard) collars are often put on wrong and have many potential harms to patients. However, some consider this a very lively debate and one worth having. Pros and cons are discussed in the podcast thoroughly as mentioned above, but let us talk about some of the supporting evidence for why it may be worth ditching the traditional collars and go with a softer option.
Some of the papers that led to probably the biggest push to ditch the traditional semi-rigid (hard) collars was from Australia as discussed in the podcast. The ANZCOR guideline 9.1.6 is frequently cited and is usually the foundation for many of the arguments. There is also an update from May 2016 from ANZCOR also available on the site.
As a result of ANZCOR multiple organizations have changed their guidelines and/or protocols to reflect this update. The Queensland Ambulance Service performed asystematic review which led to a Clinical Practice Guideline and a Clinical Practice Procedures update. In turn, others such as the National Rugby League (formerly the Australian Rugby League) andRoyal Life Saving Society Australia have also made changes.
Additionally, there have been additional reviews as to the topic. Our guest for this topic, Minh Le Cong, a flying doctor in Australia, has also been closely following the topic regarding c-collars. It is worth noting that he is in Queensland where many of the changes are occurring. Emergency Care Institute (of New South Wales) also has a post. Some of the myths of cervical collars has been addressed in blog posts such as the one from ScanCrit. Fortunately, medicine in the United States is starting to catch on as evidenced by articles such as in JEMS.
Part of the reason this topic is being discussed again right now is thanks to an update in the Norwegian guidelines on spinal immobilization which also discusses the potential harms of a cervical collar and why routine use of a rigid collar is not recommended with emphasis on a selective approach. ScanCrit also has a brief article regarding its publication. The Norwegian guidelines, just like those of Queensland, are all available with free access.
Most likely with new updates the section will probably continue to be updated here unless there are other major updates worthy of their own post for further discussion. What are your thoughts on cervical spine management in trauma? Is the semi-rigid (hard) collar out and the soft collar is now in? Let us know by giving us your feedback on Twitter or Facebook. Remember to look us up on Libsyn and on iTunes. Minh is also available on Twitter. If you have any questions comment below, email at firstname.lastname@example.org, or send a message from the page. We hope to talk to everyone again soon. Until then, continue to provide total care everywhere.
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