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Fri Dec 22 16:00:28 GMT 2006

Dear Dr.Joseph Catino and list-members

In treatment of severe wound patients whom it presents disturbance of
consciousness by head injuries, and cannot appeal for symptoms, as for
the medical workers, protection should treat a head cervix of the
patient even if the patient does not attach a cervical spine collar.

Philadelphia collar used in a medical scene well does not have a role to
protect cervical spine surely, and I think that there is a role to let
circumference recognize that rather "cervical spine / the cervical
spinal cord damage is possible to this patient". 

If there is no clear injury by image inspection(i.e. CT scan, MRI, and
so on...) and medical workers have common recognition such as the above,
we should remove a collar immediately. Is putting on a collar, and there
is a hindrance for respiratory tract management; and of a bedsore is the
cause.

There is a Japanese guideline to assume that you "should entrust it to
judgment of orthopedics specialist about the right or wrong of the
cervical spine collar removal". 

However, as for an orthopedist, it will be the fact that is "troubled
even if it is demanded such a difficult judgment".

SHINYAMA NAOKI M.D.
Kobe City General Hospital, Japan
Department of Surgery

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