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Mon Aug 24 09:05:05 BST 2009

To reprise what was raised the previous time this was debated on the
list. Application of a collar to GSW in the neck is a decision best made
by the individual attending at the scene, usually based upon a broad
training curriculum that incorporates both research and clinical
practice evidence and an evaluation of environment, situational
awareness, incident history and presence of actual neurological change
but also the mode of evacuation to the vehicle (manual portage over
uneven terrain to reach vehicle v parked outside victim's house). Of
importance not mentioned this time was the fact that application of
collar will also occlude the wound site which my be a more important
need than stabilisation but, at the same time may also serve to
secure/maintain pressure upon a wound dressing up to the point of
loading into a vehicle where a third pair of hands may not always be
available. 

Paul Harrison
Clinical Development Officer
Princess Royal Spinal Injuries Centre
Sheffield. UK

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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Christos Giannou
Sent: 23 August 2009 10:04
To: trauma-list at trauma.org
Subject: Cx collar and GSW

In addition to Micky's mention of the Barkana Y, Stein M, et al.
article,
there was also a previous one: Arishita GI, Vayer JS, Bellamy RF.
Cervical
spine immobilization of penetrating neck wounds in a hostile
environment. J
Trauma 1989; 29: 332 - 337. and a subsequent one:Rhee P, Kuncir
EJ, Johnson L, Brown C, et al. Cervical spine injury is highly
dependent on the mechanism of injury following blunt and penetrating
assault. J Trauma 2006;
61: 1166-1170.

ICRC practice and teaching for years has been to understand the
pathology
involved. The futility of a Cx collar for a GSW to the neck, or the
mandible
or brain for that matter, is only too obvious whatever the status of
consciousness of the patient. This position is confirmed in our new War
Surgery book published earlier this year.

-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
mob: (++30) 69 74 83 28 18
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Cx collar and GSW