Conception et évaluation d’un collet cervical préhospitalier

Abstract

Some cervical spine lesions are unstable and movement of the cervical spine can cause secondary injuries (Timothy, Towns and Girn, 2004). To limit movement, the neck is stabilized using a prehospital cervical collar when a cervical spine injury is suspected. The existing prehospital cervical collars generate high pressure points at the bony prominences (Plaisier et al., 1994). When these pressure points are maintained over a long period and they are higher than the critical capillary pressure, they may cause pressure ulcer (Kosiak, 1961). These skin lesions are very painful for the patient and are very costly for hospitals (Plaisier et al., 1994). The main objective of this project is to design a new concept of prehospital cervical collar reducing cervical collar complications while satisfying the requirements of practitioners and patients. To reach this goal, the design parameters and performance evaluation criteria for prehospital cervical collars were identified from a literature review and interviews in a prehospital service unit. A design process, including brainstorming and evaluation grid, helped design a new prehospital cervical collar. The performance of the new collar was compared to the performance of two commonly used cervical collars (Stifneck Laerdal and X-Collar). They were installed on three normal volunteer subjects in seated position by a trained paramedic and the time of application was recorded. The maximum range of motion (flexion-extension, lateral bending and axial rotation) of the head was measured using a 3D optical system. The pressure between the cervical collar and the skin with bony protuberances (chin, occiput, zygomatic and sternum) was measured. The acquisition sequence was repeated three times for each subject and cervical collars. At the end of the three tests, volunteers and paramedic have completed a questionnaire on the level of comfort and ease of application of the cervical collar, respectively. The results show that the prototype provides similar immobilization, decreased pressure in the occiput, lower time of application, increased ease of application and a better overall comfort compared to both pre-hospital cervical collars. Taking into account of the ponderation of each performance criterion, the prototype’s cumulative performance scored 83 % compared to 56 % and 66 % for the two current cervical collars. In conclusion, the prototype decreased pressure on the chin, while satisfying the requirements of practitioners. Thus, in the longer term, the victims with risk of injury to the cervical spine will benefit from a collar limiting the risk of pressure ulcer on the chin. In addition, this project allowed the advancement of knowledge in the field of acute care, especially in the design strategies of pre-hospital cervical collars.

Date	26 Oct 2015
Original language	French
Awarding Institution	École de technologie supérieure
Supervisor	Yvan Petit (Supervisor) & Jean Marc Mac-Thiong (Co-supervisor)