ANZCOR supports and follows the international, evidence based, ILCOR 2015 Consensus on Science and Treatment Recommendations (CoSTR) regarding immobilisation of victims with suspected spinal injury, which are to recommend against the use of semi-rigid (SR) cervical collars by first aid providers. The ILCOR recommendation, and as such, the ANZCOR recommendation takes into account both the lack of evidence of benefit, and the risk of harm. The ILCOR and ANZCOR guidelines are specifically applied to first aid providers, however the evidence against the use of SR collars applies equally to other pre-hospital users of SR collars. Therefore the 2016 ANZCOR guideline recommends that these other groups involved in pre-hospital care also review their management of suspected spinal injury, in regards to the use of SR collars.
Ideally, the recommendation for first aiders to manage victims with suspected spinal injury using manual techniques rather than with a SR collar would be part of a system wide approach, with every provider in the chain of care acting consistently, within an agreed management framework.
In recommending against the use of SR collars by first aiders, ANZCOR is not lowering the expectation of the victim needing the highest level of spinal care, nor implying that spinal care is unnecessary. Based on the evidence to date and international consensus, ANZCOR’s position on the best management for victims with suspected spinal injury is that victims should have:
- Immediate recognition of the potential for spinal injury
- Minimal movement and handling of victim
- Immediate assessment of the victim (DRSABC)
- Immediate spinal care with manual techniques
- Early transfer for definitive assessment and care
The evidence available to date, and international consensus opinion, suggests that these initiatives, not the physical application of a device such as a SR collar, are what lead to the best outcomes for the victims of spinal injury.
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