after smacc con

COLLARSCOLLARS

KARIM BROHI, KARIM BROHI, FRCS FRCAFRCS FRCA

Professor of Trauma Sciences, Queen Mary University of LondonProfessor of Trauma Sciences, Queen Mary University of LondonConsultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts HealthConsultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts HealthClinical Lead, London’s Air AmbulanceClinical Lead, London’s Air AmbulanceDirector, London Major Trauma SystemDirector, London Major Trauma System

Queen Mary University of Londonwww.c4ts.qmul.ac.uk

Royal London Major Trauma CentreBarts Health NHS Trust

LET’S AGREE…

LET’S AGREE…

Not everyone needs immobilisation

LET’S AGREE…

Self extrication is a thing

LET’S AGREE…

Self-splinting is a thing

LET’S ALSO AGREE…

Spine and spinal cord injuries are not a joke

LET’S ALSO AGREE…LET’S ALSO AGREE…

LET’S ALSO AGREE…

Spine and spinal cord injuries are not a joke

LET’S ALSO AGREE…

If this happens in your systemyou have a much bigger problem

LET’S NOT PRETEND…

That there is any quality evidence

LET’S NOT PRETEND…

That there is any quality evidence

It is easier to suggest harm than to prove harm

It is MUCH EASIER to suggest harm than to prove benefit

It is easier to suggest harm than to prove harm

It is MUCH EASIER to suggest harm than to prove benefit

Airway devices can…

Increase aspirationRaise ICPCause pressure ulcersBe uncomfortable

Airway devices can…

Increase aspirationRaise ICPCause pressure ulcersBe uncomfortable

Cervical collars can…

Increase aspirationRaise ICPCause pressure ulcersBe uncomfortable

LET’S ALSO NOT PRETEND…

We know what a world without collars looks like

28%

18%25%

12%

LIFETIME COST OF TETRAPLEGIA:$4,000,000

CERVICAL COLLAR$10

LIFETIME COST OF TETRAPLEGIA:$4,000,000

CERVICAL COLLAR$10

LET’S ALSO NOT PRETEND…

We have ever asked patients

COLLARS ARE A SIDESHOW

PROLONGED IMMOBILISATION IS THE

ABSOLUTE ISSUE

IF YOU THINK COLLARS ARE THE PROBLEM

YOUR SYSTEM IS BROKEN

IMMOBILISE HIGH-RISK ONLY

UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION

(UNLESS TRANSFERRING)

CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS A HARD COLLAR

99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS

IF CAN’T CLEAR IN THIS TIMEFRAME:REPLACE WITH MIAMI-J / PHILADELPHIA

IMMOBILISE HIGH-RISK ONLY

UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION

(UNLESS TRANSFERRING)

CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS A HARD COLLAR

99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS

IF CAN’T CLEAR IN THIS TIMEFRAME:REPLACE WITH MIAMI-J / PHILADELPHIA

IMMOBILISE HIGH-RISK ONLY

UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION

(UNLESS TRANSFERRING)

CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS A HARD COLLAR

99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS

IF CAN’T CLEAR IN THIS TIMEFRAME:REPLACE WITH MIAMI-J / PHILADELPHIA

IMMOBILISE HIGH-RISK ONLY

UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION

(UNLESS TRANSFERRING)

CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS A HARD COLLAR

99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS

IF CAN’T CLEAR IN THIS TIMEFRAME:REPLACE WITH MIAMI-J / PHILADELPHIA

IMMOBILISE HIGH-RISK ONLY

UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION

(UNLESS TRANSFERRING)

CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS A HARD COLLAR

99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS

IF CAN’T CLEAR IN THIS TIMEFRAME:REPLACE WITH MIAMI-J / PHILADELPHIA

SAFESIMPLE

EFFICIENTCONSISTENT

IF YOU STILL THINK COLLARS ARE A PROBLEM

DO THE RCT

28%

18%25%

12%

WHAT DO WE REALLY NEED TO CHANGE?