10/22/2025
Do C-collars help or hurt?
Check this out!
🚨 What if everything you thought you knew about spinal immobilization… was wrong? 🚨
You’ve got a trauma patient. Maybe they fell. Maybe it’s a rollover. You strap on a c-collar, secure the backboard, and feel like you’ve done everything right.
But what if that collar is hurting them more than helping?
What if the backboard is doing more harm than good?
An important review from NAEMSP just dropped, and it challenges decades of prehospital dogma.
📚 The Study:
Over 3,900 papers screened
115 studies included in analysis
Topics: spinal immobilization, motion restriction (SMR), delayed neurological injury, and associated harms
🧠 What They Found:
• Zero studies showed a clear clinical benefit to spinal immobilization or SMR
• 55 studies showed patient harm
• Immobilization may actually increase spinal movement during transport, especially at the c-spine to thorax junction
• Stronger evidence links hypoperfusion, not movement, to worsening neuro outcomes
⚠️ One study claimed a benefit, but had major flaws:
• Included patients with moderate disability as a "favorable outcome"
• Did not control for blood pressure
• Excluded patients with traumatic brain injury
✅ Takeaway:
• There’s no high-quality evidence that immobilization prevents spinal cord injury
• There’s plenty of evidence that it causes harm
• Focus should shift to resuscitation and perfusion, not strapping patients to boards
🛑 Bottom line: It’s time to rethink the collar and backboard. Use them only during extrication, not transport. And don’t let old habits cause new harm.
📖 This review from NAEMSP is a must-read for EMS medical directors, educators, and field providers alike.https://www.handtevy.com/wp-content/uploads/2025/08/Prehospital-Trauma-Compendium-Prehospital-Management-of-Spinal-Cord-Injuries-A-NAEMSP-Comprehensive-Review-and-Analysis-of-the-Literature.pdf
