The question is not whether they should be applied as this question has
historically, lots of evidence. The question is would earlier application be
of benefit? ie; first response units on scene - in this case the fire
brigade.
An obvious statement by me (anecdotal)- the sooner the collar applied, the
less there is for potential for harm! But is there evidence for this??
At best (Seattle Fire Dept) gauruntee an on scene time of 4 minutes and
often it is less - in the four minutes prior to their arrival the patient
has the 'freedom to move their 'stiff/painfull' head and neck. If their GCS
is lowered then there is a greater chance of the patient moving an injured
body part, in this case the head and neck, without being conscious of doing
it. Our response time to 'Cat A' call is double this at best - therefore the
potential for movement over time is doubled - but does this necessarily mean
that further damage would occur with the time difference between Seattle and
the UK?
I would argue that the majority of the damage to the c-spine is witnessed on
the initial impact or within the first few seconds of an unstable fracture.
We apply c-collars to the majority of patients as soon as possible to ensure
the few patients with c-spine injuries will come to no further harm. By
involving other emergency services in areas such as this would promote the
no further harm policy we adopt for trauma patients.
Is there any evidence - probably not. It is difficult (possibly impossible
at this moment in time) to state that a person who has been moving thier
head around for the past 'x' minutes would benefit from the application of
collar 2, 3, 4 or 5 minutes earlier. We just don't have the facility to
measure this important question.
If you were to ask me if it is a good idea for the fire brigade to have the
facility to apply c-collars, the answer must be yes as it enhances patient
care when an ambulance/response unit has long running times.
Mike Bjarkoy
SRPara
Sussex. England
-----Original Message-----
From: The list will be of relevance to all trainees including
undergraduates and [mailto:[log in to unmask]]On Behalf Of
Geoff.Kittle
Sent: 17 December 2000 22:43
To: [log in to unmask]
Subject: Cervical Collars
Some help for a friend please. He has just been made a Station Officer in
the Fire Service and has been given responsibility for RTA and First Aid
training. He seeks references to justify the early application of cervical
collars. He has to convince the Fire Services Union that crews should carry
and be trained to use collars in case they are first on scene. My Pre
Hospital textbooks merely say that they should be applied!
Geoff Kittle
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