# c-collar for 7 month old?



## jkrewko (Aug 6, 2011)

what size would you use. all the pedi collars i have seen still look to large for a child that small. advice, equipment i can check out online? suggestions etc..


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## MMiz (Aug 6, 2011)

The pediatric cervical collars I've seen have one for 0-6 months.  If they're too big then I'd use towels and tape to immobilize the pediatric patient.


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## abckidsmom (Aug 6, 2011)

Towels and tape.  I have only immobilized a baby that small two or three times, ever, and at least one of those times was in the car seat they were in.

You need earplugs if you make the decision to immobilize a young infant.


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## bigbaldguy (Aug 7, 2011)

Saw a baby coming in to an ER once pulled out of a bad accident with very possible cervical injury. Kid was still in car seat and they just filled voids around kid with whatever they had on hand then duck taped the kid down like a cacoon. Inelegant but very effective. They even put a strip across the kids forehead to prevent him from moving head. The kid might have lost some skin when they cut him out but he was definitely immobilized.


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## depri (Aug 7, 2011)

bigbaldguy said:


> Saw a baby coming in to an ER once pulled out of a bad accident with very possible cervical injury. Kid was still in car seat and they just filled voids around kid with whatever they had on hand then duck taped the kid down like a cacoon. Inelegant but very effective. They even put a strip across the kids forehead to prevent him from moving head. The kid might have lost some skin when they cut him out but he was definitely immobilized.



Sounds like another bullet point to add to the list of things duct tape is good for/can fix: stabilization of possible cervical injuries.  Do what you gotta do.


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## abckidsmom (Aug 7, 2011)

depri said:


> Sounds like another bullet point to add to the list of things duct tape is good for/can fix: stabilization of possible cervical injuries.  Do what you gotta do.



It's fairly standard, guys, the strip of wide tape across the forehead.  And it's medical tape, not duct tape.


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## ArcticKat (Aug 7, 2011)

abckidsmom said:


> You need earplugs if you make the decision to immobilize a young infant.



That works for all patients I immobilize.    The car seat is a spectacular immobilization device and although once it's in an accident it should be replaced, it's typically still sufficient for transporting an infant in and, in many cases, is X-ray translucent.


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## bigbaldguy (Aug 7, 2011)

abckidsmom said:


> It's fairly standard, guys, the strip of wide tape across the forehead.  And it's medical tape, not duct tape.



This was actually plain old duct tape, this was Houston FD. They use a lot of it in these parts for spine board strap downs Ect. I suspect they used it in this instance because the child was really trying to wiggle. In a long transport time situation the kid invariably gets their head out. I've had problems getting medical tape to work in a similar situation. If I were almost positive that a child in a car seat had a neck injury I think I would skip the medical tape and Also go for the duct tape. I've never had to secure a really a tiny baby though.

Oh wait do you mean it's not "duct tape because it's being used as medical tape" kind of thing lol sorry I'm an idiot.


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## Nerd13 (Aug 7, 2011)

I like to call duct tape 'Universal Rescue Tape'. Makes me feel better about it haha.


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## depri (Aug 7, 2011)

Haha "Universal Rescue Tape." I like the sound of that; gotta make it more professional.


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## JJR512 (Aug 9, 2011)

Wow!

In my service, if I needed a C-collar for an infant, I would just grab the infant-sized C-collar (the one marked "Infant" on it). It never would have occurred to me to use towels or duct tape. Thanks for all the great tips! ^_^

(Our infant C-collars are made by Ambu, if anyone's interested.)


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## frdude1000 (Aug 9, 2011)

We were taught in class to fold a blanket into a long rectangle and wrap it around an infants neck.  You can use a KED with blankets and padding to immobilize the infant once collared.


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## Nerd13 (Aug 10, 2011)

As far as actual collars go we have pediatric adjustable collars that have three sizes, the smallest being infant. It's really, really tiny. I can see it actually fitting but I can also imagine it would be pretty scary for a little one. Thankfully, I haven't had to use it yet. We also have some old stiffneck peds sizes in the stock but the adjustable ones are a lot easier to size and use.

I also forgot to mention that I've seen some companies use Coban to immobilize the head to the board. It had to be pretty tight but it actually looked pretty comfy and did a pretty good job of immobilizing.


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## Handsome Robb (Aug 10, 2011)

For what its worth, we use duct tape and disposable head blocks to immobilize the head of patients on the ski hill, but thats an extreme environment. 

Back on topic, I have always been told in the case of an MVA with a child restrained in a car seat to leave them in the seat and pad the voids.

Not in a seat and no collar to fit, lots and lots of towel rolls.


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## MedicBender (Aug 10, 2011)

We have always used CPR boards or a child immobilization board for infants. 

Maryland protocol states infants are not to be immobilized in car seats. I understand their logic, however it seems like there is more risk in moving the infant from one seat to another. 

Here's an example of the board we use http://www.med-worldwide.com/pediatric-immobilization-board-plastic-clips-al-l484c-p72615


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## Handsome Robb (Aug 10, 2011)

With all due respect to the MDs that wrote Maryland's protocols, have they ever tried to move an infant from a car seat to a infant LSB while maintaining C-spine? lol


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## AUSEMT (Aug 11, 2011)

*wiggling makes it worse???*

I recently had a 3 yr old with suspected C-spine injuries after he fell backwards off a bench and lost consciousness mid-examination, had the Chief medical officer with me (he has a PhD- irrelevant but cool). the MOI wasn't that severe and he had no immediate/ obvious indications of a spinal, so we decided to forgo C-collar and just use sand bags and manual in-line because the collar causes children so much discomfort that they wiggle and generally exacerbate injuries....
just an idea for mild MOI's and no obvious indications?


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## mikie (Aug 19, 2011)

NVRob said:


> With all due respect to the MDs that wrote Maryland's protocols, have they ever tried to move an infant from a car seat to a infant LSB while maintaining C-spine? lol



Yes, in the pediatric ED when they are removing the patient from the damaged car seat to a board till c-spine is cleared.


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## usafmedic45 (Aug 19, 2011)

> Maryland protocol states infants are not to be immobilized in car seats. I understand their logic, however it seems like there is more risk in moving the infant from one seat to another.



Just another example of why Maryland is pretty much only useful as an example of how not to run an EMS system. 



> Yes, in the pediatric ED when they are removing the patient from the damaged car seat to a board till c-spine is cleared.



Everywhere else just x-rays or CTs them in the seat unless resuscitation is necessary.  But then again, Shock Trauma isn't really a trauma center so I imagine they do it their own little way just like everything else.


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## mikie (Aug 19, 2011)

usafmedic45 said:


> Everywhere else just x-rays or CTs them in the seat unless resuscitation  is necessary.  But then again, Shock Trauma isn't really a trauma  center so I imagine they do it their own little way just like everything  else.



You're right about that, Shock Trauma is a PARC- Primary Adult Resource  Center.  I believe their minimum age (technically they can accept any  patient; it's the consulting physicians discretion when you consult  anyway) is 15...correct me if i'm wrong fellow MDers...

Now at Hopkins, a Level 1 Peds, you're right, they'll likely just snap  shots bedside, but as someone mentioned, we're not supposed to  transport them in their seat if it was involved in a MVA (possible  unforeseen carseat damage, i suppose is one rationale)


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## MedicBender (Aug 20, 2011)

usafmedic45 said:


> Just another example of why Maryland is pretty much only useful as an example of how not to run an EMS system



Amen. 


During my rotations at STC you would rarely see anyone under 18 there. With Hopkins fairly close by, STC will tell them to head over to that way.


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## CANMAN (Aug 20, 2011)

MedicBender said:


> Amen.
> 
> 
> During my rotations at STC you would rarely see anyone under 18 there. With Hopkins fairly close by, STC will tell them to head over to that way.



My question is what is the matter with the above practice? Also Shock Trauma will gladly see anyone who is 15 years old and up. I am assuming your clinical at STC was a whole 8 hour share day/night in which you got to see less then <50% of the patient population that Shock Trauma sees. The two hospitals are 3.0 miles apart.....Maryland certainly may not be the most progressive EMS state in the nation but between UMMS and Hopkins medical care doesn't get much better. STC has little to nothing with how progressive or not progressive MD protocols are written.


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## mikie (Aug 20, 2011)

*I beg to differ...*



CANMAN13 said:


> STC has little to nothing with how progressive or not progressive MD protocols are written.



Dr. Alcorta - state medical director & practicing physician at STC...Are you sure there is no connection?


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## JJR512 (Aug 20, 2011)

mikie said:


> Dr. Alcorta - state medical director & practicing physician at STC...Are you sure there is no connection?


 
Dr. Alcorta is the state medical director, but he does not write new protocols and put them in place. Not on his own.

I'm sure Dr. Alcorta has privileges at UMMC and STC, but to the best of my knowledge, he's never actually "worked" at STC (as a practicing physician). The main hospital he's associated with is Suburban Hospital in Bethesda (which _is_ a trauma center).


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## CANMAN (Aug 20, 2011)

Yes, I know where he works, but what relation does him working at Shock Trauma have to do with how progressive the protocols in the state are or aren't. That doesn't make any senes. Trauma care is trauma care. Medical interventions are usually where you find progression in a state EMS system and where MD is lacking. What if he worked at Hopkins? MIEMSS is not an office of UMMS or the other way around. The state protocols are devised by a board of health care practioners from many different systems and facilites. 

To help stay on topic, in my experience the only C-Collars that even remotely fit peds patients (correctly) are Miami J Collars.


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## CANMAN (Aug 20, 2011)

JJR512 said:


> Dr. Alcorta is the state medical director, but he does not write new protocols and put them in place. Not on his own.
> 
> I'm sure Dr. Alcorta has privileges at UMMC and STC, but to the best of my knowledge, he's never actually "worked" at STC (as a practicing physician). The main hospital he's associated with is Suburban Hospital in Bethesda (which _is_ a trauma center).



Thank you from someone who actually knows what they are talking about and works in the system as do I......Rarely do you ever find backup on this site haha.


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## mikie (Aug 20, 2011)

*So it has been a while*



JJR512 said:


> Dr. Alcorta is the state medical director, but he does not write new protocols and put them in place. Not on his own.
> 
> I'm sure Dr. Alcorta has privileges at UMMC and STC, but to the best of my knowledge, he's never actually "worked" at STC (as a practicing physician). The main hospital he's associated with is Suburban Hospital in Bethesda (which _is_ a trauma center).



It was about ten years ago, check out his little bio at the bottom of the page.

edit: you know what, i maybe confusing myself w/ scalea


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## CANMAN (Aug 20, 2011)

mikie said:


> It was about ten years ago, check out his little bio at the bottom of the page.
> 
> edit: you know what, i maybe confusing myself w/ scalea



Read it: It says Suburban which is in Montgomery County, not Baltimore. I find it funny that he called is Suburban Hospital Shock Trauma Center because they are far from a top notch trauma care center..... I think you are confusing him with Thomas Scalea who is the Physician in Chief @ Shock Trauma....


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## JJR512 (Aug 20, 2011)

mikie said:


> It was about ten years ago, check out his little bio at the bottom of the page.
> 
> edit: you know what, i maybe confusing myself w/ scalea


 
Dr. Thomas Scalea is the head guy (not sure of his exact title off the top of my head) at STC.

What might be the confusing factor is the way Dr. Alcorta says he works at the Suburban Hospital Shock Trauma Center. I've seen it written that way both in the article you just linked to as well as a few other places. So if that's what it's truly called, it's _a_ STC, but not _the_ STC, lol.



CANMAN13 said:


> Thank you from someone who actually knows what they are talking about and works in the system as do I......Rarely do you ever find backup on this site haha.


 
You're welcome, and I do try to help out where/when I can. However, I do feel I should point out, just for the record, that *mikie* is actually in the Baltimore area as well.  Mikie, are you still in this area?


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## mikie (Aug 20, 2011)

i divert to PM as this thread is about ped's collars.


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## Tigger (Aug 20, 2011)

I fail to see the rationale behind banning the use of carseats for c-spine precautions. Again this come down to sound judgement, if the seat is clearly mangled maybe don't use it? The unforeseen damage argument is silly, if the exterior shows no sign of intrusion, there's not going to be any protrusions in the seat's interior. As stated above, removing the child without excessive movement is going to be difficult.

Here towels and tape are used if the child is not in a car seat and c-spine precautions is necessary. If possible and the child does not need c-spine precautions, we will transport the child in the car seat, which is both safer and more comfortable for the child. 


Sent from my out of area communications device.


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## attnondeck (Sep 21, 2011)

right from the NY state WREMAC protocals from 2011. 

Do not transport a pediatric patient who meets Major Trauma criteria in the car seat involved in the crash.


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## Handsome Robb (Sep 21, 2011)

Well what is WREMAC's major trauma criteria?

Most all of our trauma criteria are based on mechanism alone, not pt presentation.


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## attnondeck (Sep 22, 2011)

Age < 15 should be transported to the pediatric trauma center.

Glasgow Coma Scale < 14
• Respiratory rate < 10 or > 29 breaths per minute (< 20 breaths per minute if < 1 year old)
• Systolic blood pressure < 90 mmHg (adult) or < (age(yr) x 2) + 70 (pediatric to age 10)

these are the ones that apply....   but pretty much any kid is going to be transported to woman and childrens hospital in buffalo(15-25 min from our district)  WHICH IS out ped trauma center...


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## IRIDEZX6R (Sep 22, 2011)

When I was in emt school, my instructor was big on teaching alternative ways to do things. My favorite c-collar replacment is the vacuum splint and tape. works really well. I've had to use it in the field when I couldn't get the pt midline, agonal and extreme pain on movment so I used the vac splint to keep the neck stable in that posistion.


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## jbrynels (Oct 5, 2011)

I have had to immobilize a patient like this one time. The patient was in the carseat, so I cut out the car seat and left the child in, but prior to this I just rolled a towel and curved it around the head in between the head and the seat, it made a great immobilization device and I used tape to hold it in. It was extremely easy to do. The hardest part is that children do not like to sit still, especially infants, especially when they are uncomfortable. But yeah I found it super easy.


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## hoss42141 (Oct 5, 2011)

abckidsmom said:


> It's fairly standard, guys, the strip of wide tape across the forehead.  And it's medical tape, not duct tape.



Not all the time. I have seen "duct tape" used to help immobilize a pt. Yes, medical tape would have worked too, but you grab what is the closest to you. No need to run to the truck to get medical tape if duct tape is closer.


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## mycrofft (Oct 5, 2011)

*Hey, argue about people elsewhere...like PM's?*

And about the New York thing?:
"Do not transport a pediatric patient who meets Major Trauma criteria in the car seat involved in the crash".

That's because after the accident the car seat is no longer considered safe and needs to be replaced. I think that applies more to LE chucking the kid into the squad car after an accident, but some desk brain applied it to EMS without specifying the circumstances.

Any studies about it? Like the ones about removing football or motorcycle helmets?


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## BlakeFabian (Oct 16, 2011)

C-Spine doesn't necessarily mean using a C-Collar. The goal is to immobilize the head, neck, & back. You're allowed to use whatever you have to in order to accomplish that.

If your Ped collar is too big, go grab a towel & some tape and/or coband.


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## Calichic (Oct 16, 2011)

Nerd13 said:


> I like to call duct tape 'Universal Rescue Tape'. Makes me feel better about it haha.



I like that one, In San Diego, Ca..we don't get anything fancy only the nicer areas get the good equipment .. for c-spine we get white duct tape.. 

kid immobilization 
when we responded to a multi pt MVA there were a couple kids involved 
1 toddler was immobilized to the carseat towel wrapped around neck and pillows and whatever available to fill in voids and the infant was on a backboard with a t-shirt wrapped around neck for a collar
Kids were not my pts , but thats how I saw the other unit handle it  
I have not had a peds yet


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## attnondeck (Oct 23, 2011)

we use duck tape all the time.

i had a 5yo f fall down 12 stairs the other day.  she slid down on her back.  i was driving and another(newer) emt b was in the back.(we were meeting a driver on scene)    i called to the emt in the  back and said grab 4 towels and bring them in with us.  she was confused until i used them to immobalize.


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