Spinal Boards and Cervical Collars

Spine boards, either short or long, are made from plastic or wood to provide a rigid surface on which to bind the patient to ensure that no movement occurs in the cervical, thoracic, or lumbar spine during transportation. Straps with buckles or Velcro fasteners are used to secure the patient to the board. Some boards have attached firm head blocks for either side of the head and straps to go across these blocks to keep the head steady between them. Rolled up blankets ("blanket rolls") secured to the board with tape are also effective head blocks. A popular and effective variation of the short board is the Kendrick extrication device (KED) (Ferno, Wilmington, OH), which consists of slats of rigid material bound together by heavy cloth. The KED immobilizes the cervical spine, wraps partly around the patient, and is then strapped the rest of the way around the thorax and around the thighs for secure immobilization. The patient can be lifted using the KED straps, allowing for easier and safer extrication from a vehicle.

Rigid cervical collars are more accurately called cervical extrication devices. Multiple types are commercially available for use in the field: Philadelphia collar (Philadelphia Cervical Collar Co., Westville, NJ), the StifNeck (Laerdal Medical Corp., Wappingers Falls, NY), and the Neck-Loc (Un-I-Med, Louisville, KY). These collars come either as two asymmetric pieces, which are used and marked for back and front, or as a single piece that is folded into the correct shape. By themselves, collars are not adequate for complete cervical immobilization; additional lateral support is required to avoid lateral movement. For complete immobilization, the patient needs to be strapped on the backboard and secured with head blocks and head straps. Once the patient is well secured to the board, the collar does not add a significant amount of stabilization and can actually be removed without compromise of the spine. However, the collar is often left in place for added protection. Patients with mandible or soft tissue neck injuries should probably not have a collar applied because of the potential for airway compromise that could be masked by the collar. More recent designs have openings in the front to allow observation of the trachea and jugular veins, but this may not be adequate for observing other neck areas. Soft cervical collars are not adequate or appropriate for out-of-hospital care.

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