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Patient Journey ACCIDENT PATIENT WALKS INTO ED C-SPINE CLEARED AND COLLAR REMOVED AMBULANCE EMERGENCY DEPARTMENT ON SITE SPINAL UNIT - TRACTION MANUAL IN-LINE CERVICAL COLLAR EXTRICATION PATIENT MOVED ONTO LOAD INTO TRANSPORT TO HANDOVER TO TRANSFER ONTO EXAMINATION BY NURSE HALO FIXATION SURGERY TRAUMA HEAD BLOCKS WAIT RADIOLOGY DIAGNOSIS SOFT TISSUE DAMAGE PATIENT MOVED ON GARDNER-WELLS FORCE APPLIED COLLAR MIGHT TRACTION HOME Event Event Event Event Event STABILISATION FETCHED & APPLIED (RTC) SPINAL BOARD/SCOOP AMBULANCE HOSPITAL ED ED STAFF TROLLEY / DOCTOR SPINAL UNIT TRACTION BED TONGS APPLIED BE REMOVED HALO BRACE WORN 8-12 WEEKS HALO BRACE TRANSFER PATIENT PLACED ON SURGERY COLLAR WORN FOR The patient strapped to a spinal The paramedics will always One paramedic will hold A KED Extrication device Long spine (rescue) boards FITTED REMOVED TO OR OPERATING TABLE PERFORMED SEVERAL WEEKS The patient, still board will be placed on a firm trolley. The patient will be placed The patient will be moved attempt to place the head in the patients head while the is often used to stabilise are valuable primarily for The patient will be placed The clinician will need access to the Depending on the condition 4 images are taken to clear the HALO FIXATION Normally Garners-Wells tongs Once the tongs are in strapped to a spinal A log roll and initial examination of in traction for short term onto a traction bed using Guidelines say that neutral alignment to alleviate other applies a collar. the patient during extrication from vehicles. flat on a spinal board posterior cervical spine to check for of the patient he/she may C-spine: will be used. Pins will be place a (50N?)force will board, will be placed on the back may be performed and the immobilisation while definitive a Jordan lifter whilst the Collars must be worn at The halo brace has been used as During this time the Collars normally worn The patient will be placed on an The main objectives of therapeutic management pressure on the spinal cord. transfer from a vehicle to Patients may also be and blocks or sandbags swelling or other abnormalities. be waiting a long time whilst - Peghole (through mouth for applied by a neurosurgeon to be applied through a Surgery performed. the ambulance bed. spinal board removed at the same surgery or other forms of registrar will support the all times to avoid further the initial treatment for odontoid patient will be in and during this step. operating table. The position will are to prevent neurological injuries and provide Adjustable collars normally a stretcher. transferred on a scoop held in place with tape wearing a collar. C1-C2) SURGERY the skull in either an OR or the pulley system. Examples of types of surgery: time. treatment are being planned. neck. neurological damage. fractures. out of hospital for depend on the injury and method symptomatic relief. If there is any pain, neurological carried in two sizes, adult stretcher or vacuum to stabilise the patients Current collars need to be removed - Lateral ICU. - mechanical fixation of the Description Description Description of surgery. The patient can be Description Description deterioration or resistance to and paediatric. Laerdal will mattress. head. temporarily to do this. regular check-ups and cervical spine through use of Alternatively the patient will be log- - Anterior placed in a prone, supine or lateral Collars such as the Aspen or the Philadelphia are movement the procedure will be carried in 6 sizes. A “halo” metal ring is secured x-rays, but will try to metal screws and fixtures rolled by 4 to 5 staff onto a slide and - Swimmers View Orthotist decides what position. 5 people will be needed commonly used. be abandoned and the neck If the patient has made their own way into to the skull with pins and to return to a ‘normal’ life. - pressure relief on the spinal moved across. collar to put on. for this manouver. splinted in the relevant position. A&E a collar may be applied as part of Metal whites out on X-ray two metal rods attached to a cord Some collars are better suited to skin care and triage? well-fitted plastic jacket. With personal hygiene than others. For example the Blocks will be removed temporarily It is easier for the radiologist this apparatus, it is possible to Aspen collar has removable pads which are Difficult to feed collar under Repeated transfers (log- during log-roll and examination. to read the images if there is a obtain complete fixation and washable and available as separate replacements. Airway may need to be cleared. neck especially if patient is lying Collars may come loose rolls) to and from the board clear indication that the patient is Collars will be to arrest almost all movement Issuing a spare set of pads could encourage down and hair/clothes get in when manoeuvring the may compromise spinal Vomiting - many patients will feel sick after a serious trauma. Collars put back on wrong by wearing a collar. patient. Stresses on neck due to movement. Pins can come loose and removed to avoid of the cervical spine. Keeping the neck stable improved skin care and allow the patient to the way. protection and induce a The paramedic will need to clear the mouth and airways with inexperienced clinician. head fall out of tongs! pressure sores and Muscles will be weak whilst positioning the use one set of pads while the others are being significant amount of spinal a suction unit and will need access to the mouth. Sizing - not clear how to Some patients complain Collar prevents patient opening other discomfort. and head feel heavy. patient. washed. movement. Patient not educated on how identify the right size. Doesn’t that the collar is the only mouth for peghole image. Tracheostomy - opening made in the front of the windpipe. cause of pain. to use the collar, fit the extreme sizes of patients. There might be a problem Getting patients to wear the collar for the prescribed finding enough people to A collar removes the natural curve amount of time can be challenging. The collar will Agitated patient - wants Pressure sores can develop Restricted storage in road/air perform a safe log-roll as of the cervical spine and could be normally be removed for showers, shaving etc. to take collar off: in a relatively short amount ambulances. you might only have two confused with soft tissue tension. - intoxicated/confused of time. Other reasons patients fail to wear collars as Robustness - consider paramedics. - uncomfortable prescribed: environment, device may get Jewellery, hair clips and other Problems Problems Problems Problems Problems When a scoop is used there - loss of control temperature stepped on. Velcro is known Current designs dig into the items left on by the ambulance is no place for the head - panic attack poor fit and rubbing against skin for getting stuck in hair or back of the head and/or personnel can be a problem blocks to attach. difficult to put on/take off rendered in mud. EASY TO APPLY the ears. requiring temporary removal of CORRECTLY collar. EASY TO APPLY CORRECTLY NEEDS TO BE COMFORTABLE MUST NOT CAUSE EASY TO IDENTIFY MUST ALLOW FOR EASY TO REMOVE PATIENT NEEDS NEEDS TO BE DISCOMFORT TO THE FAIL SAFE CORRECT SIZE VENOUS RETURN TO OPEN MOUTH COMFORTABLE ALLOWS FOR PATIENT INSTRUCTIONS OF USE ACCESS TO MOUTH MUST PASS FIREMAN NEEDS TO PROVIDE FEATURE THAT TEST ROBUST TO MUST NOT COVER NEEDS TO PROVIDE ADEQUATE SHOWS UP AS A STORE FRONT OF NECK ACCESS TO POSTERIOR ADEQUATE NEEDS TO BE IMMOBILISATION DURING MARKER ON X-RAYS ACCOMMODATES ALL PART OF NECK WITHOUT IMMOBILISATION DURING BREATHABLE TRANSFERS NEEDS TO BE SIZES AND SHAPES NEED FOR REMOVAL OF Requirements TRANSFERS Requirements Requirements Requirements Requirements BREATHABLE OF NECK COLLAR ABILITY TO EASILY EASY TO PUT ON AND REMOVE ITEMS SUCH EASY TO CLEANTAKE OFF BY PATIENT FASTENING MECHANISM AS JEWELLERY MUST WORK IN ALL CONDITIONS.
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