The cervical spine must be immobilized in any patient with a suspected spinal injury until cervical spine injury can be excluded. Immobilization is performed at the same time that airway management is started. Cervical spine immobilization can be provided by the same individual that maintains the jaw thrust. Whenever possible, a hard cervical collar should be used. However, due to the limited number of sizes available, a properly fitting collar may not be possible. Omitting the application of a cervical collar is acceptable in children for whom no properly fitting rigid collar is available. The child should be placed on a spinal board or in a pediatric immobilizer designed for trauma immobilization. The head should be secured to the board by using towel rolls or commercially available head blocks and tape applied across the forehead and under the chin of the collar. If a collar is not used, tape should not be applied under the chin, because this may prevent the mouth from opening. The child's body is secured to the board by straps or wide cloth tape. Blanket rolls should be placed on either side of the child to prevent lateral movement of the child if logrolling becomes necessary to clear the airway. Clearance of the child's cervical spine by clinical or radiographic methods should wait until the primary survey is completed.
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