How to fit a collar

All healthcare professionals should know how to fit a collar. Injuries to the neck can happen anywhere, anytime. This video shows how to fit a collar to a patient who needs their cervical spine (neck) immobilised.

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This video was kindly sponsored by Ossur who supply a specific type of Miami-J collar to Barts Health NHS Trust where we are based. For more information on the collar check out this link!

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✍ Medical illustrator:

[Brainbook]

Has anyone here ever need to wear a collar? What was it like?

[joelpatricksantiago]

Great video, doc.

What would be the best way to go about this in remote areas (as in hiking for example)?

[pa]

I got question!
How do they remove full face helment in hospital if u were in accident that potentially damaged your neck?

[braedenk]

Could you do a video on single piece cervical collars? I am an American paramedic, and the collars we use pre hospital are either ambu or laerdal brand. I'm also interested to know if you all use the NSAIDS mnemonic in Britain for selective spinal motion restriction.

[lotharsoran]

I have a question, well, about a situation anyway. It is about what I, as a member of the public can safely do to help at an accident scene. I have attempted to help at a few accidents, until the paramedics arrive. For example: I saw an elderly gent (84 he told me), trip badly over a high curb and fall unconscious. He hit his head on the way down, on a wall, but rolled onto his back before he passed out. I had heard some loud snaps and cracks when he fell, and he hollered loudly before he hit his head, then that was cut off. No one knew what to do, and neither did I, but I kind of just followed logic. I blocked off the area with my electric wheelchair, as people were still trying to get past and stepping on him. Literally, they were stepping on and over him because they were rushing to get a bus. Can you believe that? It was so callous. I mean, it was chaos, and I started to get a bit irritated because everyone was flocking around, wanting to see, trying to take video instead of doing anything useful.

I told them off for being inconsiderate of his rights whilst he was in a vulnerable state, and shamed them into stopping. I told them to delete that stuff or else I'd get the police on them. I made them leave, to cross the street. Some entitled idiot actually started berating me for "getting in the way", and I calmly told him that the man might be dying, and that he should have more respect and humanity for an obviously badly injured elderly person, who certainly did not mean to cause any problems, and that he was being very selfish. That shut him up.

I got down to the injured man's level, checked his pulse and breathing. Both weren't good. The pulse was strange, all fluttery sometimes, and when he breathed it sounded harsh, like a guttural wheezing, and it wasn't as regular as I would have liked. His chest was hitching as it went up and down, and it sounded slightly bubbly.

So, I loosened some clothing which seemed to help his breathing. I wiped blood out of his mouth, and off of his nose. I took my coat and other people's coats and put them on him because his skin was scarily cold. I wasn't sure if I should move his head, so I just put my hands under the back of his skull, then onto the neck at the sides, and supported it so that his head stayed still, and straight with my wrists and forearms. I had tilted it very slightly backwards, I had been told that is good, and that seemed to help. But, there was this really nasty grating feeling under my fingers in his neck when he tried to move. There was lots of blood from a cut on the front of his head but it wasn't squirting out, and I could not see bone. I had touched that area gently and it seemed solid, so I just had someone place a gauze pad from my little medkit on there with some pressure to help out. It quickly got soaked though. I got someone to call 999 whilst I was sorting this all out, and had them put the phone next to me on speaker. They ran me through some checks and I answered them.

He woke up before the paramedics arrived, and was upset. But I was worried because his speech was all slurred and he was having trouble staying awake. His eyes were strange as well. I asked someone to shine a light on the pupils and one of them did not move, it just stayed really big. So I just spoke to him, told him my name, and kept him answering questions. Every time I found something new, I told the 999 operator. I did what I could to check his pulse at intervals whilst keeping him still, and following the directions from the 999 operator. But I could only take his pulse with my fingers at the side of his neck. I didn't dare let go of his head to move.

I had been taught some CPR and first aid, but this was way beyond what I had learned. I thought he was going to die right there in front of me. I was actually quite scared, but I could see that he was terrified, so I just pretended that I knew exactly what I was doing, told him I would look after him, that I had had training for this, and that he needed to stay still. I felt bad for lying to him, but he wanted to try to get up and walk away, even though he was shaking all over, so I thought he would listen to me more if I told him I had medical training. He calmed down but said that his hip was really hurting him, and his side. I looked and his right leg was at a weird angle at the hip, not at all natural, sticking out to the side. I don't think it should have moved that far. Halfway down his thigh the leg did a strange kink, so I thought it must be broken. I asked someone to check for me if there was any bone sticking out by cutting the pants there. But I told them not to touch it, just in case. There was no sticking out bone but there was a big bruise already. I didn't know what to do about that, so I just left it alone. I was worried that if I moved his leg I would make it worse.

I said that he was doing great, that everything would be fine, and that the ambulance was on the way. I had been told a good trick to keep people awake was to pinch their ear, and when it looked like he was fading out, I did that. It seemed to work, though I did apologise when he came around each time again.

When the paramedics came, I told them what I had seen and found in as short answers as possible totheir questions. I was going to move out of their way, but they told me to stay and keep holding his head for the time being. When they were done asking their questions to him, he started talking to me again about his grandchildren, and the medics just kind of nodded at me, so I just kept talking to him whilst they got the board, and collar and did everything they needed to do.

The most heartbreaking part was that the injured guy was such a sweetheart. He kept apologising for "causing a fuss". I told him not to worry, that what was important was that he would be OK. Anyway, I know that is long, but, weirdly I can remember all of it. Every detail.

Is there anything I should have done to help him? Anything different, or something I should not have done? If it happens again, I'd rather know. I realise that you probably won't get to read this, but this video reminded me really strongly of that incident. Looking down at that poor guy whilst he was lying there, and not really having a clue about the best thing to do, to help him. The oddest thing was that even though I was scared, I felt completely cold and calm at the same time. Sorry if that does not make sense. There have been other times that a similar feeling has happened... when I helped a cyclist who had been hit by a car. Someone who overdosed on drugs. When my dad had a heart attack and I had to CPR him. When a student of mine had a grand mal epileptic seizure. That same weird feeling every time.

The paramedics said a lot of medical jargon to each other I did not understand. They did lots of tests, very fast, I was amazed by their speed and surety. When it was time for the collar, the medic put his hands over mine, and I slowly slid my hands out from under his, at his direction. Because my wheelchair was a bit away, I just pulled myself to lean against the wall. I had blood all over me. I was shocked by how much there was, it seemed to be everywhere. They popped him onto a bed and took off with the sirens and lights going. Another medic had checked me out for shock, she said, and given me a metallic blanket.

Turned out he had broken or dislocated his right hip, broken his right leg at the top, given himself a brain injury, a hairline fracture on the right front side if his skull, busted some ribs on the right side, which nicked a lung and hurt his neck. I was amazed that he did all that just from falling down, but he told me afterwards that he has "brittle bones", when I saw him in the pub next time. There's a medical word for it that I do not know. He was alright in the end, but it was a long road to recovery for him.