Risk Management Pitfalls:
“I didn’t think she needed a cervical collar because she was up and walking around at the scene of the accident.” It is safer to provide cervical spine immobilization until the history can be reviewed, the child can be examined thoroughly, and the appropriate radiographic evaluations can be performed.
“They didn’t have a pediatric backboard in the ambulance, and they forgot to put anything under him. Since he’s already secured on the adult board, we’ll just leave him on it.” Immobilization on an adult backboard with no adjustment to allow for the proportionately greater head and occiput size keeps the cervical spine of a child from being positioned in neutral alignment. The resulting position, with the neck flexed and the chin tucked, can lead to upper airway obstruction.
“She said her neck didn’t hurt, so I thought it was OK to take her out of the collar.” Remember that children will often tell you whatever you want to hear, partly to please you and partly because they don’t want to wear a cervical collar! This is especially true if the child is scared or overwhelmed by the situation. Also, the impact of other distracting injuries can be more challenging to sort out in young children. It is most prudent to leave the collar in place until other injuries have been cared for and the child can be reassured by a more familiar face.
