Limitations and safety concerns related to the currently used cervical orthoses in preclinical emergency settings

Abstract

Abstract Research question: Are the currently used cervical orthoses suitable for immobilizing the cervical spine for patients with preexisting ankylosing spondylitis, an anatomically short neck, or obesity? Materials and Methods: Tools, immobilization methods, completion time, sagittal displacement, and feedback on result were compared for one control and two severe case scenarios simulated on appropriately built manikins. Scenario 1 simulated a young patient who sustained a bicycle fall with no fracture. Scenario 2 simulated a short-necked middle-aged patient who met a vehicle accident and showed C7/T1 bilateral facet dislocation fracture. Scenario 3 simulated an elderly patient with preexisting ankylosing spondylitis who fell down stairs and sustained a C6/C7 non-displaced fracture. Results: For scenarios 1 and 2, the immobilization rate with the collar was 100% vs. 86%, average completion time was 90 s vs. 175 s, rate of attempts involving tool changes was 16% vs. 49%, rate of attempts with the collar forced in position was 0% vs. 32%, and proportion of cases with satisfactory results was 100% vs. 5%. For scenarios 1 and 3, the immobilization rate with the collar was 100% vs. 16%. For scenario 3, the rates of critical and highly critical sagittal deviation were 54% and 13.5%, respectively, while the efficiency of immobilization was 0%. Discussion and conclusion: Currently used rigid collars can increase the time on-scene and tamper with spinal alignment. They cannot be easily and safely applied to elderly, overweight patients and those with an anatomically short neck and can diminish the outcomes for these patients.