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

02 May 2017
Volume 7 · Issue 1


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.

This review article describes how the rigid cervical collar was introduced to practice, and explains the rationale for its inception. The same rationale is then critically analysed against a range of modern evidence challenging the validity and safety of the rigid collar. Practice changes across the world are highlighted, and relevant UK based guidance reviewed.

In 1967, Dr JD Farrington, an orthopaedic surgeon at Lakeland Memorial Hospital in Wisconsin, published a paper entitled ‘Death in a Ditch’ (Farrington, 1967). He explained that the purpose of his paper was to standardise pre-hospital training, equipment and practice which he appeared to attribute to an increased mortality\morbidity rate within his community. In particular, Farrington explains that physicians must apply a cervical collar in order to prevent the ‘sloppy and inefficient removal of a victim from their vehicle’. Whilst immobilisation principles and makeshift collars were used in the Vietnam war during the early 1960s (William Marsh Rice University, 2012), Farrington appears to be the first to recommend its practice in civilian medicine (Bledsoe, 2013).

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