Baylor study doubts neck brace standard

Applying a brace to the neck of a trauma patient, standard procedure for many decades, can worsen the injury and lead to severe paralysis or death, according to a new study by Houston researchers.

Many of us have suspected for years that we were doing little to no good by the routine placement of cervical collars. In fact some states, Maine in particular revised their standards years ago. Still, the evidence (and it’s preliminary) that we might actually be increasing mortality and morbidity is alarming.

To study the phenomenon, Baylor researchers made an incision in cadaver neck ligaments based on patient X-rays, then simulated clinical scenarios by applying cervical collars and putting the bodies in ambulances and driving a distance.

In all the cadavers, imaging technologies found that the collar increased the rupture. In effect, the collars pushed the head away from the shoulders, Ben-Galim said.

Keeping in mind that cadavers don’t react exactly as living people, the results are interesting.

There is no obvious alternative to cervical collars, though hospitals often place sandbags under the back of the patient’s head. Less commonly, some EMS teams at the scene wedge the head of the patient between foam bolsters on the backboard.

Less commonly? I don’t know what the standard is in Texas (I can find out), but around these parts seeing a MVA patient without a collar is less common. To say the least. The part about placing a sandbag under the patient’s head is odd too, because doing that would require exactly the kind of manipulation that causes further injury.

One national expert called the study interesting but said he wasn’t sure it would change the standard of care.

Probably not because “standard of care” is set by juries, not research or doctors. It’s a legal, not medical, term. Which most people in EMS don’t realize.

I don’t think this will change protocols or practice immediately, but it opens the door to further study and research which might lead to changes in protocol. I’d say that is likely because once the lawyers get interested in injuries caused by a particular treatment, you can bet that at some point a jury will indeed change standard of care. If you doubt me, turn on daytime TV.

As was pointed out a couple of weeks ago, “We Like To Use Interventions That Preserve Life”. As opposed to the ones, that while well established and have had an industry built around them, increase death and the severity of illness.