Quantifying Cervical Range of Motion Following Video-Based Cervical Collar Placement Training: A Pilot Study

Cervical collars have been a component of the prehospital standard of care for suspected spinal cord injuries for over 30 years. However, inconsistent placement techniques and limited training may reduce their effectiveness. There is limited research evaluating how well bedside application by nursing staff limits cervical spine motion. The purpose of this pilot study was to establish a baseline efficacy of emergency nursing cervical collar placement in limiting cervical range of motion and to determine whether manufacturer-provided training improves motion restriction.

This was a prospective repeated measures pilot study conducted in a Southwest Level I trauma center. Emergency nurses placed rigid cervical collars on healthy volunteers in a controlled simulation environment, both before and after viewing a short manufacturer's training video. Cervical range of motion, specifically flexion-extension and left-right side-bending, was quantified via video analysis. Quantifications were performed in 3 phases: baseline (without a cervical collar), pre-education cervical collar placement, and post-education cervical collar placement. Pre- and post-education surveys assessed provider confidence.

Ten emergency nurses with varying levels of experience placed cervical collars on 3 healthy volunteers. Mean (SD) baseline range of motion without a cervical collar was 45.0° (18.6°) for flexion, 31.4° (12.5°) for extension, 39.7° (9.7°) for right side-bending, and 40.6° (9.5°) for left side-bending. Post-education collar placement significantly reduced motion in extension (P = .007), right side-bending (P = .006), and left side-bending (P = .024). Total flexion-extension (P = .003) and side-bending (P < .001) also improved post-education. Prior to training, 9 out of 10 providers reported themselves as "somewhat confident." Post-education, 9 out of 10 providers reported themselves as either "quite confident" or "extremely confident," demonstrating a shift towards improved confidence.

Simulation-based training was associated with improved cervical collar placement technique among emergency nursing staff in this pilot sample. Reduced cervical range of motion and bolstered provider confidence were observed, suggesting the utility of structured re-education for enhancing clinical spinal immobilization skills.