Well, should EMS limit the use of rigid cervical collars?
As with the rest of anecdote-based medicine, or hunch-based medicine, we have been doing this for decades without any evidence of benefit. Do we know what we are doing?
But you have to prove that this is harmful, otherwise we cannot withhold the standard of ignorance.
Image credit. Regardless of brand. A perfect fit – every time. Right?
Where does the burden of proof rest? In medicine, it is supposed to be the responsibility of the person treating to convince the patient that the treatment is more likely to be beneficial than harmful. This is informed consent. Informed consent is often overlooked and replaced with a blanket consent for the doctor (or designee, such as nurse, EMT, medic, . . . ) to do whatever the doctor thinks is a good idea.
Is there any valid evidence that a backboard, or KED (Kendrick Extrication Device), or rigid cervical collar will improve any outcome?
Not for the backboard or KED, but we know that the rigid cervical collar is beneficial because it stabilizes the neck and we would not use it if it didn’t work.
That is the same excuse made for using a backboards, or a KED, without evidence. Is there any valid evidence?
Can I get back to you on that?
Even though there should be no need to go further in criticizing rigid cervical collars, in the medical fields, we like to believe that what we have been doing is good and not harmful, because we don’t want to think of ourselves as harming our patients. Ironically, this attitude stops us from eliminating harmful treatments. We harm our patients to protect ourselves from having to admit that we were harming our patients.
For those who insist on evidence of harm, Dr. Bryan Bledsoe and Dr. Dale Carrison have provided us with a thorough evidence-based explanation of the ways that rigid EMS collars can harm our patients.
Interestingly, one of the first protocols that significantly changed spinal immobilization practices came out of several EMS agencies in Northern California. In a rather sweeping protocol change, they elected to forgo rigid C-collars and use soft collars.
Do rigid cervical collars decrease manipulation of the neck/spine? Do rigid cervical collars protect patients from disability?
Read the article for a discussion of the evidence and of what we assume.
The argument in favor of backboards and collars is similar to the argument in favor of mandatory vaccination for school. It is a minor inconvenience for many, that protects against death/disability of some.
There is plenty of evidence for the vaccine argument. Vaccines are safe. Vaccines save lives. Vaccines are worth it. What about rigid EMS collars? Do they protect against death/disability?
Dr. Bledsoe and Dr. Carrison provide plenty of evidence to support their conclusions. What do the supporters of rigid cervical collars have?