C Collar- trauma pearl #3

Trauma pearls #3

When does the collar get applied?
You've done the courses, or heard the rhetoric, Airway with simultaneous C-spine stabilisation, breathing, circulation, disability.
The doctrine , dogma, cornerstone of trauma patient assessment.  But what of the collar? When does  it actually get applied?  For years there has been a teaching of its importance, but exactly in the primary and secondary assessment sequence is it most appropriate to apply?
The historical notion of Airway and simultaneous C-spine precautions stemmed from the old inappropriate resuscitation practice of checking airway by rolling the patient to the side and tilting (hyper extending ) the patient's head.  In a trauma patient this manoeuvre would potentially harm a high spinal injured patients spinal cord.  Thus the techniques of chin lift and jaw thrust were developed to open airways without tilting the head. The full stabilisation and immobilisation of the spine, including the application of spinal C-collar , back board and head blocks came later, but somehow got confused in the sequencing.

Don't put the collar on in A!
Back to the intent of Airway assessment, we see it is about "do no harm". Hold that neck still while you are assessing and managing that airway. It was never about applying a collar. Manual inline stabilisation means using a colleague to hold the head still.
Now think about this; you don't want me wasting time sizing, and applying a c-collar, when I have not even assessed if you are breathing, or have a heart beat do you? No. These are far to important to delay. So put off collar fitting till later.

When?
Well the C collar is just another gadget so after "E" exposing the patient, go for it. Or even apply as the last thing before the log roll, but don't delay your Primary assessment.  Nothing is gained by application of a collar.