Read the complete article; Spinal Cord Injury (SCI) in the Medical Library > Pathophysiology.
It is important to assess and consider the entire spinal column, not only the cervical spine. If there is any thoracic or lumbar pain, consider against asking the patient to move themselves and instead lifting the patient for extrication, particularly in circumstances where additional support or resources are available
High risk factors include:
In the absence of neurological signs, a co-operative pain free patient will generally not require a semi-rigid cervical collar. Patients that are able to self extricate without aggravation of their injury may be encouraged to take a few steps to the stretcher. Ensure a lanyard has been placed around the neck and they have received education about self splinting, to keep their head and neck as still as possible prior to movement. If the patient has or begins to experience neck pain, weakness in limbs or neurological signs during self-extrication attempts they should stop and the situation should be reassessed.
If a patient is unable to extricate themselves without assistance a spinal injury should be assumed. It is important that the patient moves themselves and is not assisted by the practitioner. If a patient getting up from the floor is going to aggravate their injury alternative methods such as a scoop stretcher should be used.
In the co-operative patient the following steps (spinal precautions) should be used:
"Evidence indicates no benefit to routine application of a Semi-Rigid collar in the absence of neurological symptoms. Because we cannot clear your neck we ask that you stay in a comfortable neutral position and avoid moving your head and neck as much as possible."
An unco-operative patient who refuses to follow commands and advice, however, maintains capacity to do so will generally not tolerate a semi-rigid collar. Forcefully attempting to apply a semi-rigid collar may result in increased movement or agitation thus preventing the goal of the collar. Good clinical judgement is required with a careful analysis of risk vs. benefit. Organic causes of agitation and significant mechanisms of injury must be ruled out wherever practicable prior to adopting this approach.
General principles for consideration:
Follow guidance of medical staff.
In the absence of neurological signs, a co-operative pain free patient will generally not require a semi-rigid cervical collar. If a patient is able to self-extricate they should be encouraged to do so. The patient should also be instructed to keep their head and neck as still as possible. If the patient has or begins to experience neck pain, weakness in limbs or neurological signs during self-extrication attempts they should stop and the situation should be reassessed.
If a patient is unable to extricate themselves without assistance a spinal injury should be assumed unless able to be ruled out via the clinical decision rule. It is important that the patient moves themselves and is not manipulated by the practitioner.
In the co-operative patient the following steps (i.e. spinal precautions) should be considered:
"Evidence indicates no benefit to routine application of a Semi-Rigid collar in the absence of neurological symptoms. Because we cannot clear your neck we ask that you stay in a comfortable neutral position and avoid moving your head and neck as much as possible."
An unco-operative patient who refuses to follow commands and advice, however, maintains capacity to do so will generally not tolerate a semi-rigid collar. Forcefully attempting to apply a semi-rigid collar may result in increased movement or agitation thus preventing the goal of the collar. Good clinical judgement is required with a careful analysis of risk vs. benefit. Organic causes of agitation and significant mechanisms of injury must be ruled out wherever practicable prior to adopting this approach.
General principles for consideration:
Follow guidance of medical staff.
General Principles:
In situations where a semi-rigid Cervical Collar has been placed prior to ambulance arrival the following principles should be considered and followed:
Employ spinal precautions if any of the following assessment findings are present, associated with trauma as defined above:
A semi-rigid cervical collar should be placed if:
NOTE: Neurological symptoms suggestive of injury include (but are not limited to):
If a semi-rigid collar is placed, it is preferable to lift and extricate the patient via the use a of scoop stretcher. The patient should be rolled as little as possible. They should NOT be walked.
A semi-rigid cervical collar should be placed if:
NOTE: Neurological symptoms suggestive of injury include (but are not limited to):
If a semi-rigid collar is placed, it is preferable to lift and extricate the patient via the use a of scoop stretcher. The patient should be rolled as little as possible. They should NOT be walked.
The Royal Australian and New Zealand College of Radiologists. (2015). Paediatric Cervical Spine Trauma . Retrieved November 16, 2016, from RANZCR: http://www.ranzcr.edu.au/documents-download/3838-print-version-paediatric-cervical-spine
Connor, D., Porter, K., Bloch, M., & Greaves, I. (2013, December). Pre-hospital Spinal Immobilisation: An Initial Consensus Statement. Emergency Medicine, 30(12), 1067-1069.
Deasy, C., & Cameron, P. (2011). Routine application of cervical collars – What is the evidence? Injury, 841-842. doi:10.1016/j.injury.2011.06.191
Engsberg, J., J., S., Shurtleff, T., Eggars, J., Shafer, J., & Naunheim, R. (2013). Cervical Spine Motion During Extrication. The Journal of Emergency Medicine, 44, 122-127. doi:10.1016/j.jemermed.2012.02.082
Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. New England Journal of Medicine. 2000; 343(2): 94-9
Hood, N., & Considine, J. (2015). Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. Australasian Emergency Nursing Journal, 18, 118-137. doi:10.1016/j.aenj.2015.03.003
Kornhall DK, Jorgensen JJ, Brommeland T, et al. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scandinavian Journal of Trauma and Resuscitation Emergency Medicine. 2017;25:2.
Lee, M., McPhee, R., & Stringer, M. (2008). An evidence-based approach to human dermatomes. Clinical Anatomy, 21(5), 363-373. doi: 10.1002/ca.20636
Nikolić, S. & Živković, V. Cervical spine injuries in suicidal hanging without a long-drop—patterns and possible underlying mechanisms of injury: an autopsy study. Forensic Science, Medicine and Pathology (2014) 10: 193. doi:10.1007/s12024-014-9550-y
Oteir, A., Smith, K., Stoelwinder, J., Middleton, J., & Jennings, P. (2015). Should suspected cervical spinal cord injury be immobilised? :A systematic review. Injury, 46, 528-535. doi:10.1016/j.injury.2014.12.032
Paykin, G., O'Reilly, G., Ackland, H., & Mitra, B. (2017). The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients. Injury, 48, 1020-1024. doi:10.1016/j.injury.2017.02.013
Stanton, D., Hardcastle, T., Muhlbauer, D., & van Zyl, D. (2017). Cervical collars and immobilisation: A South African best practice recommendation. African Journal of Emergency Medicine, 4-8. doi:10.1016/j.afjem.2017.01.007
Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA. 2001; 286(15): 1841-8.
St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved