Episode 196 - Prehospital Cervical Spine Immobilization In 2026: Evidence Vs. Dogma

We recently made some cervical spine immobilization protocol changes here at MCHD. Dr. Patrick and Dr. DePasquale discuss the history and literature that provide the foundation for rigid cervical collar use, along with the new MCHD protocol implementation. This has been a collaborative process with our local hospital partners, which has definitely involved give-and-take on both sides. REFERENCES 1. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996 Nov;27(9):647-9. 2. Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002 Jun;72(6):389-91. 3. Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001 Jun;56(6):511-3. 4. Lerner EB, Billittier AJ 4th, Moscati RM. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care. 1998 Apr-Jun;2(2):112-6. 5. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999 Oct-Dec;3(4):347-52 6. Mitra B, Bernard S, Yankoff C, Somesh A, Stewart C, Koolstra C, Talarico C, Nehme Z, Fitzgerald MC, Cameron PA. Change from semi-rigid to soft collars for prehospital management of trauma patients: An observational study. J Am Coll Emerg Physicians Open. 2024 Jul 17;5(4):e13239. 7. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014 Mar 15;31(6):531-40. 8. Millin MG, Innes JC, King GD, Abo BN, Kelly SM, Knoles CL, Vezzetti R, White CC 4th, Yee A, Gallagher JM. Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature. Prehosp Emerg Care. 2025 Aug 7:1-13. 9. Ramasamy A. Advanced trauma life support 2025: A brief review of updates. Injury. 2026 Apr;57(4):113079. doi: 10.1016/j.injury.2026.