Debate: It Is Time To Throw Away The Hard Cervical Collar

Darren Braude and Karim Brohi debate over the utility of hard cervical collars. Darren argues that it is time to do away with hard cervical collars. He raises some assumptions. The first being that movement of the spine is bad. As he explains, movement is not the problem. Rather, energy deposition in the spine causes injury, not simply movement. With that being said, the problem is that the hard collar does not prevent movement! Surely, the benefits of the hard collar outweigh the risks. Darren argues otherwise. He discusses the effects of the hard collar on ICP and venous drainage of the brain. The issue here is that the patients with the highest risk of cervical injuries also carry the highest risk of concomitant brain injuries – and we as clinicians should not tolerate any increased risk to the brain. Finally, Darren argues that the hard cervical collar impairs airway management which is the priority for any emergency situation. Cervical collars are unlikely to help and can cause harm! Karim argues in favour of hard cervical collars. He contends that the lack of quality evidence in this field is problematic. Furthermore, Karim believes it is easier to suggest harm than to prove harm. Likewise, it is also easier to suggest harm than to prove benefit. With that being said, Karim concedes that some of the harm Darren raises are possible and can occur. However, he states that no one recently has practiced medicine in a world without cervical collars. The improvements in spinal care therefore cannot be separated from the use of hard cervical collars. He asks the question; do you want to mess with these improved outcomes? Karim also points out, that patient complaints about spinal care are rarely about the cervical collar specifically. He goes on to discuss how to navigate patient concerns. Tune in to this enthralling debate between Darren and Karim. For more like this, head to our podcast page. #CodaPodcast