Cervical Collar

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The cervical collar , also called cervical collet with the Quebec, is a Attelle making it possible to immobilize the cervical Vertèbre S, i.e. the neck: it restricts the movements of the head compared to the shoulders. It is recommended to pose it for any fall height and traffic accident, as when one notes an attack with the head (wound with the chin, the face or on the scalp, bump, depression, turbid of the conscience): the shock on the head could cause a lesion of the cervical ones.

The abuse language wants that the term “Minerve” is used to indicate applications of the neck posed in medical environment, while the term “collar cervical” indicates provisional devices used into pre-hospital. There does not exist however any official definition (French Academy, PHTLS,…) differentiating these terms.

Various models

There exist two models of cervical collars: models out of foam and models rigid.

The foam models consist of thick dense a foam band covered with a washable plastic film which one rolls up around the neck. They present two bumps to the top and a bump downwards between the two:

the bumps to the top are intended to maintain the sides of the chin, to avoid the rotation of the head;
the bump to the bottom is pressed on the chest and avoids the inflection of the neck forwards.

These models are less effective than the rigid models, and were thus almost abandoned.

The rigid models consist of two flexible plastic parts, upholstered by foam. The first part makes the turn of the neck (left gray on the photograph), once rolled up, it has a great rigidity in the axis of the neck; it presents a bump to the bottom which is pressed on the chest. The second part (left yellow on the photograph), riveted on the first, takes the shape of the chin and immobilizes it.

There exist several sizes of cervical collars, according to the morphology of the victim (turn and height of neck); there are in general six sizes of collar: infant, child, and four sizes adult (without neck, short, average or long neck). The collars can be tightened more or less, making it possible to adapt in a more precise way to the turn of the neck; certain rigid models are adjustable in height, which makes it possible to have one adult collar.

Installation of a cervical collar

In the case of a suspicion of traumatism of the Rachis, the installation of the cervical collar is systematic. The collar must be posed as soon as possible, after realization of the gestures of maintenance of the vital Fonctions: stop of the Hemorrhage S and Release of the air routes.

The collar must be installation before any mobilization of the victim (raising); in the case of an unconscious person and who ventilates, and in the absence of a team being able intuber, one will pose the collar after the withdrawal of the helmet (if necessary) and before turning the person in PLS, except if one notes an obstruction of the air routes (for example vomiting) in which case one will turn the emergency person on the side.

For the installation of the collar, the head must be put in the alignment of the chest, in neutral position. During all the operation, a rescuer maintains the head in position; if the victim is lengthened, it is with knees in the axis of the victim, the front armlevers resting on its thighs, and if the victim sat (in general in a car), it is put behind it, its front armlevers rest on the file of the armchair; it holds the head in latéro-side catch.

Limits of the cervical collar

The cervical collar, even in its rigid version, does not immobilize completely: it allows 25 more 30 % of the movements of inflection and extension, like 50 % of the movements of side inflection. Once posed, it is necessary thus to continue to maintain the head, in particular if the victim is agitated, and this to complement of the immobilization: Mattress immobilisator with depression, Splint of extraction (standard KED ®) or chock and girthing on a hard Plane . If the victim is calm, that it was well explained to him that it was necessary that it remains motionless, one can release the head so necessary (for example if one needs the first-aid worker for another thing).

Let us note in addition that the position of the head imposed by the cervical collar makes difficult the Intubation trachéale: the ideal position for intubation is to approach an alignment Bouche - Pharynx - Larynx, which in an adult represents a back rocker of the head of approximately 35 ° (angle of Belhouse); it is thus frequent to see a medical team demolishing the cervical collar the time of intubation, then to give it.

Impromptu cervical collar

While waiting for the arrival of the helps, the immobilization of a conscious person is done in maintaining normally the head. However, it can be necessary to release the head, for example to deal with other victims, or if one is alone to go to prevent the helps. In this case, one can put objects (for example clothing) around the head of the victim; these objects constitute a reference mark for the victim, to which one will say Na not to move the head.

One can also have recourse to an impromptu cervical collar. The simplest solution consists to take a folded newspaper and to roll up it around the neck of the victim. The width of folding will be adjusted so that the newspaper rests on the shoulders and under the ears; the newspaper can be maintained in place by a bond (for example a tie) or adhesive tape, but does not have to obstruct breathing.

If one leaves in excursion with a compact foam mattress (standard “square-mat'”), one can draw before leaving contours cervical foam collars; it is then enough to cut out the mattress and to set up it, tightening will be done with a bond without obstructing breathing.

In the case of a person sitting in a vehicle, one can plan to maintain the head against the head-rest using a bond (for example a belt), provided that the person holds naturally sitted (car on the wheel with horizontal or inclined backwards).

These systems allow waiting of the helps, but do not constitute to in no case an effective immobilization.

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