Deciding what to carry in your medical kit on an expedition is hard. You don’t want to leave anything out, but you can’t carry an entire hospital on your back. I mean, the wheels on the slit lamp really suck at crossing rough terrain. So you have to decide what goes and what doesn’t. Thus the reason for much of the improvisation inherent in wilderness medicine. An item that only does one job had better be the only item that can do that job, or it is extra weight.
C collars are one of those items. Now, ignoring the fact that many of them aren’t good at their job to begin with, they really aren’t good for much else. Sure, you could maybe improvise a pressure dressing out of it, but what else are you going to do? And while some of them do lay flat, they’re still pretty long and take up space that could be used for something else.
Enter the SAM splint®*. Waterproof, mouldable, and able to be cut to size, it can be used pretty much anywhere on the body. And everyone has seen the picture of one being used to immobilize the cervical spine. But does it work well in that role?
These authors put it to the test against a Philadelphia collar using 13 EM resident “volunteers”. I’m sure they were paid well for their time. Using a goniometer they measured maximal extension, rotation, and lateral flexion. They found that no statistically significant difference in any one measurement, but looking at the results the SAM does appear to allow slightly more rotation and extension, while doing a better job of limiting lateral flexion. This likely is due to the bulkiness of the SAM laterally.
While the method of measuring falls short of a radiographic gold standards, and the number of subjects is low (but powered to an 11° difference per the authors), it looks like the SAM splint, in fact, is just as good as a Philly collar at immobilizing the C spine. I am OK with it in an awake patient, but would add more reinforcement to an unconscious patient.
McGrath T, Murphy C. Comparison of a SAM splint-molded cervical collar with a Philadelphia cervical collar. Wilderness Environ Med. 2009 Summer;20(2):166-8 [PMID 19594206]
*I’m using SAM splint to cover all the mouldable splints out there, similar to how Xerox is used to cover all photocopiers. I do not receive any money from SAM Medical Products® for using their name here. You are welcome to use other splints, but this article only used the SAM.
EBM Gone Wild