Citation

Veljanoski D, Grier G, Wilson MH. Prehosp. Disaster Med. 2017; 32(6): 701-702.

Affiliation

Neurosurgery and Prehospital Care,The Institute of Prehospital Care,London's Air Ambulance,London,United Kingdom.

Copyright

(Copyright © 2017, Cambridge University Press)

DOI

10.1017/S1049023X17006975

PMID

29108527

Abstract

For forty years, the cervical collar has been a centerpiece in the prehospital treatment of suspected spinal injury, and in the past two years, a number of guidelines have emerged which recommend a more selective approach to spinal immobilization for this group of trauma patients. There is increasing awareness that “triple immobilization,” using a cervical collar, soft blocks, and tape to immobilize the cervical spine, is not a benign procedure and that the evidence base for this practice is equivocal. The most recent Norwegian guidelines for the treatment of suspected spinal injury encourage clinicians to carefully consider whether the patient can self-immobilize, thus avoiding un-needed application of a cervical collar, which may be uncomfortable or incorrectly fitted. Over-immobilization of trauma patients by Emergency Medical Services (EMS) has been described previously, with one small retrospective review finding that 15.8% of patients who were immobilized by EMS had met the criteria for clearance of their spine.

Progress in reaching a unifying, consensus guideline appropriate for the diverse group of clinicians involved in the prehospital care of trauma patients is imminent. However, regional uptake of these new guidelines may be slow as “triple immobilization” may still be considered as a safety anchor by clinicians and it may be perceived as being synonymous with definitive prehospital management of suspected spinal injury. For this reason, the cervical collar is a piece of equipment that can still be found in ambulance vehicles worldwide. In view of emerging guidelines recommending selective spinal immobilization (SSI), for example, using manual in-line stabilization (MILS), it is foreseeable that “triple immobilization” may be subject to organizational governance which may necessitate an evaluation of its monetary burden.

We submitted freedom of information requests to every National Health Service (NHS; London, United Kingdom) Ambulance Trust in the United Kingdom regarding expenditure on cervical collars in the last ten years. We received complete responses from every NHS Ambulance Trust in England, Scotland, and Wales (n = 13) for 2015-2016. Total expenditure over this one-year period was £441,103 (US $585,165), and this ranged from £804 (US $1066; Isle of Wight NHS Ambulance Trust) to £71,990 (US $95,591; North West NHS Ambulance Trust)....

Copyright © World Association for Disaster and Emergency Medicine 2017

Veljanoski D , Grier G , Wilson MH. Counting the cost of cervical collars.

Language: en

Keywords

EMS Emergency Medical Services; MILS manual in-line stabilization; NHS National Health Service; SCI spinal cord injury; SSI selective spinal immobilization; cervical collar; prehospital; spinal injury