Prehospital Emergency Care Podcast Ep. 157: Special Episode - Prehospital Management of Spinal Cord Injuries
Nov 27, 2025
Join Dr. John Gallagher, an EMS physician from Hawaii and co-author of a key literature review, alongside Dr. Ken Milne, a skeptic in emergency medicine and podcaster, as they explore the controversial topic of spinal cord injury management. They discuss the surprising lack of evidence supporting routine spinal immobilization and the potential harms of cervical collars. The conversation emphasizes judicious use of collars, focusing more on patient-centered outcomes and highlighting the importance of clinical judgment in prehospital care.
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No Evidence Collars Prevent Neurologic Harm
- The review asked whether cervical collars and spinal immobilization provide patient-centered benefit after trauma.
- Authors found no published evidence that routine immobilization prevents delayed neurologic injury.
Literature Was Entirely One-Sided
- The authors were surprised to find all included studies pointed the same way against benefit.
- Table four visually showed an empty column for papers demonstrating benefit.
Collars Don't Consistently Reduce Movement
- Studies assessing collars' biomechanical effect showed mixed results on spinal movement.
- Some papers reported collars increased movement, others showed no effect or reduced motion.