So What: Are C-Collars on the Path of the Dinosaurs - Part 2 of 2

Routine application of cervical collars in trauma care lacks strong evidence, as the incidence of delayed-onset spinal cord injury is extremely low compared to the millions of collars applied annually. These devices often force the neck into unnatural positions and may increase intracranial pressure, posing potential risks to patients without clear clinical benefit. Instead of reflexive immobilization, clinicians should utilize a directed physical exam and clinical judgment to identify the small subset of patients—such as those who are obtunded, hypermetabolic, or unable to protect their own airway—who truly require spinal motion restriction. Moving away from universal collar use toward a more selective, evidence-based approach mirrors the management of advanced airways, prioritizing patient safety while minimizing unnecessary interventions. This shift requires overcoming institutional biases and medical-legal pressures that currently drive reflexive, low-yield clinical practices.