Supine Straps & C-Collar

[nwhitney]

I'm trying to come up with a good explanation for some Basic students as to why the shoulder straps should not be laying over the c-collar at all. Is it even an issue? I have an idea but would like others thoughts. It seems most of them are having a hard time keeping the straps off the collar.

 

[medicdan]

In general, if the board straps lay on the collar, they deform it, and can interfere with the immobilization it provides. Because it is commonly known that commerical C-Collars "detach" C1-C2, and cause more problems than they solve... it may all be moot

 

[MSDeltaFlt]

I'm trying to come up with a good explanation for some Basic students as to why the shoulder straps should not be laying over the c-collar at all. Is it even an issue? I have an idea but would like others thoughts. It seems most of them are having a hard time keeping the straps off the collar.

What do you mean? With the pt laying supine and the C-Collar applied?

 

[MSDeltaFlt]

In general, if the board straps lay on the collar, they deform it, and can interfere with the immobilization it provides. Because it is commonly known that commerical C-Collars "detach" C1-C2, and cause more problems than they solve... it may all be moot

Inanimate objects cannot detach anything from a pt. For anything to be detached from a pt would require active involvement from the one applying said inanimate object. In other words it would be the idiots applying the collar, not the collars themselves.

 

[nwhitney]

What do you mean? With the pt laying supine and the C-Collar applied?

PT laying supine on the lbb with a collar on. Straps coming over the shoulders and lay on top of the collar.

 

[nwhitney]

In general, if the board straps lay on the collar, they deform it, and can interfere with the immobilization it provides.

This is what I was originally thinking but didn't want to give the students any incorrect info.

 

[usafmedic45]

Inanimate objects cannot detach anything from a pt. For anything to be detached from a pt would require active involvement from the one applying said inanimate object. In other words it would be the idiots applying the collar, not the collars themselves.

I think he's referring more to the tendency of the "sized" collars to not fit very well on a large subset of the population. I seem to recall that a fluoroscopic study was done a few years back that showed that C-collars tended (even when 'properly sized') to force the neck into a traction state.

 

[mycrofft]

If it isn't tracting it isn't immobilizing.

Ask the inventor of the Halo rig. Or those infamous tongs, what were their names? Garner Wells.

Use a SAM splint to build a custom C collar. Following the instructions, try it a couple times in station, it can be surprisingly efficient, just make sure it is fastened properly with Coban or tape, and doesn't cock the head to one side...unless that is what you want. Radiolucent and reusable if they give it back, just flatten it with a rolling pin.

Reliance upon a C collar is like relying on a half-length condom, other measures must be taken. I still like the bivalved Philly collars, select the smallest size to work and pad. Better yet, leave the KED in place.

PS: C collars don't detach C1-C2, WE detach C1-C2. Well, us and severe deceleration forces. USAF, what kinds of cervical injuries do aircraft versus terrain produce?

 

[usafmedic45]

USAF, what kinds of cervical injuries do aircraft versus terrain produce?

Can you give me like a month and I'll forward you the full data for that? I'm actually working on the head and neck injury biomechanics article as we 'speak'. Suffice to say it's pretty similar- at least in the cursory review so far- to what you see in MVCs, except for a higher prevalence of compression injuries.

 

[mycrofft]

Hm reply didn't post. Redux: "Well..."

no......

 

[nwhitney]

In general, if the board straps lay on the collar, they deform it, and can interfere with the immobilization it provides.t

So for USAF & Mycroft is the above reason something you agree with? Other thoughts?

 

[mycrofft]

Use KED then LSB

1. Anything which defeats an immobilization measure for transport must be overcome quickly and without injury to the pt. I never had the problem you are describing but our collars and straps were different then. Frankly good head blocks and a nuccal stuffing should equal a C collar. A KED will do it too.
2. Are you referring top the way they strap the C collar into place in the head block subunit?

With the cross.traction offered by this head block setup, theoretically your net cervical traction due to straps would be near "zero", but the C collar could be flattened antero-posteriorly.

 

[medicdan]

Sorry, poor word choice-- I was looking for "separation" injuries

J Trauma. 2010 Aug;69(2):447-50.
Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury.
Ben-Galim P, Dreiangel N, Mattox KL, Reitman CA, Kalantar SB, Hipp JA.
Source
Spine Research Laboratory, Baylor College of Medicine, Houston, Texas 77030, USA.

 

[MSDeltaFlt]

PT laying supine on the lbb with a collar on. Straps coming over the shoulders and lay on top of the collar.

No. It won't do anything wrong. You can't choke the pt because the collar protects them. And no, they still won't be immobilized, only restricted. The only way any problem from subluxation on a supine, packaged pt after packaging would be enroute. Which means slow it down.

 

[nwhitney]

1. Anything which defeats an immobilization measure for transport must be overcome quickly and without injury to the pt. I never had the problem you are describing but our collars and straps were different then. Frankly good head blocks and a nuccal stuffing should equal a C collar. A KED will do it too.
2. Are you referring top the way they strap the C collar into place in the head block subunit?

I'm all for overcoming difficulties. However this is for students when learning how to board. They would fail if they skipped the collar.

I'll try and get some pics tomorrow night as I think a couple of more students need to test supine immobilization.

 

[mycrofft]

See pic added to my reply above.

IO've seen everything else gronched down into place by Captain Caveman at accident scenes, I bet I could squish a C collar with straps.


Have them board YOU and tell them what they are doing wrong. Just have backup....

 

[nwhitney]

I'm referring to the shoulder straps on a set of spider straps. Not any straps designed for the collar itself.

 

[mycrofft]

Apparently depends upon head block style

Straps appear here to impinge upon shoulder wings of the collar :

Here, they act to immobilize the head block, so presumably they would be less effective at being shoulder straps.:

Those straps are going to act that way unless you have a means of redirecting them superio-inferiorly so they describe a "H" and not a "V".

 

[Tigger]

Never had any issue with the shoulders of the spider straps touching the head blocks or collar. The shoulder straps are designed to go right over the shoulders, we should be trying to minimize the space between the top of the shoulder and the strap. If the handholds line up, there should be plenty of room for the blocks. Also those huge neoprene blocks might present a footprint issue, personally I think the smaller disposo-bag ones are easier to work with.

 

[mycrofft]

I'm looking at Life-Assist's catalog

Some brands, notable the Spider strap name brand used on a board with a narrowed head end, describe the "V". Ferno's Fastrap, the "BEST STRAP system", do not .
Tigger, hear you and agree. It can be done without one system fouling the other.

Here's the "BEST STRAP" system. Nice fig leafing of the manikin. Note the wide breast connection and shoulder anchors are on a board that doesn't taper to the top.

Now, the Spider system. Note single point for union of top and side shoulder straps and use of a tapering board.

I'd say, use a wide board for Spiders and other systems with a single union point for sure, and maybe save the taper boards for "wide-stance"strap systems.