ADVANCED RESCUE REFRESHER TRAINING STANDARD V02.1 ANNEXES
2020-10-01_TSR_ARTR_V02.1
unconscious injured person without the use of MILS or a transfer board with head blocks. In this case the use of a cervical collar is an effective means of controlling head movement and maintaining the airway of an unconscious injured person. There are risks involved in the use of a cervical collar, and therefore they must be used sparingly, for the minimum duration necessary and only as a last resort where no other possibility for head support and or maintaining an airway exist. Technicians trained in advanced rescue techniques must be aware of the risks and be able to demonstrate risk mitigation techniques where an unconscious injured person is wearing a cervical collar. Furthermore, they must be able to accurately size and correctly fit a cervical collar to an unconscious injured person. To summarise, the use of a cervical collar during rescue is intended only as a means to support the head and maintain the airway of an unconscious injured person during rescue activities where no other possibilities to do so exist. For these reasons the use in this context is not considered routine and the teaching of these is not considered to be contradictory to the first aid guidelines recommendations. 4. RISKS OF ROUTINE APPLICATION OF CERVICAL COLLAR All of the first aid guidelines point to the risks, amongst others, of raising the intercranial pressure and complications with airway management of a person who is wearing a collar.
Intercranial pressure increase
By applying a cervical collar, or any other device, to a person’s neck there is a risk that the jugular veins can be compressed thereby reducing the amount of blood flowing from the head. The restricted venous drainage from the head increases the blood pressure in and around the brain (the intercranial pressure (ICP)). The pressure and discomfort of wearing a collar could also lead to an increase of agitation and movement in a person thereby increasing the blood pressure and exacerbating the rise in ICP.
Airway management complications
Applying a cervical collar can also restrict the opening of a person’s mouth. By restricting the mouth opening there is a risk that, in the event of vomiting, the oral cavity will not be able to be cleared sufficiently leading to a risk of the airway being obstructed. Additionally, a cervical collar could, through the compression of the airway, also restrict the airway. In both cases the risks can be exacerbated by an incorrectly sized or incorrectly fitted cervical collar which can in some cases completely obstruct the airway. 5. MITIGATION OF THE RISKS When assessing methods to support the head during a rescue the principles of the hierarchy of control should be applied to the use of a cervical collar in that the use of a cervical collar must be avoided whenever possible.
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