GB2453996A

GB2453996A - Adjustable cervical collar with size indicating means

Info

Publication number: GB2453996A
Application number: GB0721002A
Authority: GB
Inventors: Glen Thomas Gears; Vincent Peter Lyles
Original assignee: LYSGEAR Ltd
Current assignee: LYSGEAR Ltd
Priority date: 2007-10-25
Filing date: 2007-10-25
Publication date: 2009-04-29
Also published as: GB0721002D0

Abstract

A two piece cervical collar comprising a front portion 1 to engage the chin and sternum, a rear portion to engage the occiput and trunk, means for releasably securing the front and rear portions 9, size indicating means 10 and wherein both sections are adjustable for size and the size indicating means 10 on the front are related to those on the rear. The left and right sides may be independently adjustable for size, the chin engaging portion may have pivotally mounted arms 7 and a cup 6 and allow slight torsion for bending of the patients neck. The posts 5 engaging the front and rear portions to the chin engaging and occiput engaging portions respectively may be hingedly connected, may use lockable rachets and pawls and may have indicia linked to the posts. There may also be apertures for the trachea 11 and cervical spine and lugs as tie off points for other devices such as masks or tubes.

Description

1 2453996 Cervical Collars This invention relates to cervical collars.

There are many accidents in which injury to the spine will be expected. In 2004 alone there were over 280,000 casualties in traffic accidents in Great Britain and 1.9 million injury accidents in the USA. A large proportion of those injured people would have had suspected injury to the spine. In such cases, attempts will be made to move the person's neck to anatomical neutral, a cervical collar applied and then the person would be immobilised on a spine board with additional head restraining blocks or on a vacuum mattress The person would then be transported by ambulance to hospital where they would be examined by medical staff. Preferably, the cervical collar is only removed when it has been established that there is no spinal injury needing continued immobilisation. Sometimes the collar will stay in place for many hours and sometimes for days if the patient is admitted to intensive care unconscious. In 44-.,, l+t r.'rir fkrc IC' cfrrg, rrcih,ijt, rf rrinr1rjnri nri nrpc *. . r---J --if the collar is not a good fit. Thus it is important that the collar not only provides immobilisation of the neck but is comfortable for extended wear.

Much work has been put into meeting these dual needs but there are still problems with cervical collars. At one time, a two-part collar was favoured as it provided more comfort because the rear portion could be positioned to fit.

Examples of such collars can be found in US 6,872,188, US 6,494,854, US 5,038,759 and US 5,180,361. A drawback with these collars is that they come in a number of sizes to fit the range of differently sized people. Typically there may be six or seven sizes and all sizes need to be stored on an ambulance; thus taking up valuable space. Once an ambulance has arrived at the site of an accident, the injured person may be some distance away from where the ambulance can safely park. A paramedic would have to take a selection of different collar sizes to the injured person, measure the person and hopefully find that they had brought the right size from the ambulance. Measurement typically relies on gauging how many fingerbreadths it is from the jaw to the upper trapezius muscle. However, there is no clear reference point on the trapezius muscle, which makes measurement uncertain. Moreover, if the patient has a clavicle fracture or trapezius spasm, the consequent scapula -elevation will make sizing very difficult. Once the collar has been selected and applied, it may need to be removed, as the measurement was inaccurate.

It should be noted that once the patient is immobilised, unused collars would have to be returned to the ambulance. It was common for such collars to be colour coded for size and/or marked with wording indicating size Thus a paramedic could then fit the appropriate back portion which corresponded to the front portion. US 6,872,188, mentioned above, has the provision of sizing indicia for a two-part collar. It should be noted here that whilst the construction of many of these two-part collars aimed to provide comfort and immobilisation, this only occurred if the right collar size was selected.

Moreover, none of these two-part collars had adjustability of the front or back portions to vary the height between the chin and sternum engaging parts and between the occiput and upper thorax engaging parts.

Sinale niece collars are also available. Initially, they came as a set of different sizes. Thus, a paramedic may carry, for example, three collars to a patient, rather than three front and three rear sections, and there is still a need to stock, store and carry a number of different sizes.

In response to the problem of having to have many different sizes of cervical collar, adjustable, single-piece cervical collars came to the fore. Examples of such collars are disclosed in, for example, US 6,663,581, US 5,797,863, US 5,795,315, and US 5,688,229. All these collars have a single neck-encircling band of material which has to be rigid enough to transfer the weight of the head to the torso. This rigidity inhibits the collar from forming a close fit, especially on the side of the neck where the free ends of the band are secured together. Moreover they all have problems with the length of the band and the relative positions of chin engaging and occiput engaging parts.

The band is too long for small people so the midline of the occiput engaging part does not align with the midline of the occiput. For large people the band is too short so that the midline of the occiput engaging part again does not align with midline of the occiput. Another problem with the rear of these collars [except on as shown in Fig. 9 of US 5,795,31 5] is that there is no adjustment in height of the occiput engaging part and the part which engages the upper thorax A further problem with all these collars is that they come with instructions on how to size the collar before placing it on the patient. As with the two- piece collars described above, the paramedic typically tries to measure how many fingerbreadths it is from the patient's jaw to their upper trapezius muscle. Column 7 of US 5,795,315 clearly describes sizing and applying a collar. This section of text admits that the collar may need to be removed to re-size it to fit the patient, thus delaying transport of the patient to hospital.

The single piece adjustable collars mentioned above do not lend themselves to adjustment on the patient due to their rigidity. If a firm circumferential fit is attempted first it makes height adjustment very uncomfortable and may have adverse affects on the patient. Adjustment of the front of collar before wrapping the band around the patient's neck is unwieldy as the lenath of the neck-encircling band makes it difficult to control and achieve a correct sizing.

Attempts to overcome the problem of sizing the collar before placement on the patient probably led to US 6,423,020 and US 5,593,382 Both of these specifications disclose a single neck-encircling band having adjustability at the front and back. However, they are silent on how one assesses the height adjustment for the rear of the collar before its application to a patient.

Moreover, even though they disclose height adjustment at the rear, they do not overcome the problem of the relative positions of the chin engaging part and the occiput engaging part. So, even if one can establish a suitable height at the rear of the collar, there may not be a good fit unless the patient's neck circumference is near to the optimal size of the neck-encircling band. A smaller or larger neck circumference will lead to non-alignment of the midline of the back of the collar with the midline of the patient's occiput.

Column 5 of US 6,423,020 describes fitment of a collar with adjustment of the occipital support before application to a patient and how the chin engaging part is brought into contact with the patient. Fig. 6 illustrates sizing indicia but there is no text to describe how the indicia might be used. Clearly, the sizing indicia do not help in adjustments at the rear as these have already been made before the collar is applied.

All the above types of collar attempt to hold the neck in anatomical neutral as this is the position thought to minimise spinal cord injury. However, the instructions for use of such collars typically state that, if there is pain or resistance when attempting to move the neck to anatomical neutral, do not apply the collar. Instead, the instructions usually suggest using locally agreed protocols for immobilising the neck. Thus, in the situations where trauma to the neck is certain [as it is inhibiting movement], and immobilising the neck with a collar would be highly advantageous, prior art collars should not be used.

It will be apparent from the foregoing that there is a need for a cervical collar which can be adjusted to fit a variety of different sized patients and which provides a good comfortable fit at both the front and rear. It will also be apparent the there is a need for collars which can immobilise the neck in anatomical neutral or in another position if anatomical neutral cannot be achieved.

Thus, according to our invention, we provide a two-piece cervical collar comprising a front section having a chin engaging portion and a sternum engaging portion and a rear section having an occiput engaging portion and a trunk engaging portion, means for releasably securing the front and rear sections together, both sections comprising size indicating means, wherein both front and rear sections are adjustable for size and the size indicating means on the front section are related to the size indicating means on the rear section such that, in use, the setting of the front section indicates the desired related setting of the rear section.

The collar is advantageously formed of two separate pieces so as to allow separate adjustment of the front and rear sections. It will be clear that, in use, the front section is offered up to the patient and adjusted to engage the patient's chin and sternum. This gives a size reading which is then used to set the size of the rear section, i.e. the relative positions of the occiput-engaging portion and the trunk-engaging portion. The front and rear sections are preferably adjusted to the same size setting. Preferably the size indicating means on the front section matches the size indicating means on the rear section or there is a known or direct relationship between them. The rear section is then put in place and the two sections are releasably secured together. This arrangement provides a collar which can fit a variety of different sized people. Moreover, a collar according to this aspect of the invention provides good a!ignment of the rear section of the collar with the patient's head.

Preferably, left and right sides of the front and rear sections of the collar are independently adjustable and have respective sizing indicia. With this embodiment of the invention, the front section of the collar can be offered up to a patient in, for example, some dearee of side flexion or traoezius soasm.

adjusted, and the left and right readings used to set the size of the rear section. The relative height and angle between the occiput engaging portion and the trunk engaging portion at the rear is preferably adjusted to match the relative height and angle between the chin engaging portion and the sternum engaging portion at the front The angular setting of the front section therefore preferably indicates the desired related angular setting of the rear section.

Preferably, the chin-engaging portion has a cup to receive the chin and jaw supporting arms either side of the cup. The arms are preferably pivotally mounted on the rest of the front section of the collar and the material from which the collar is made preferably allows for slight torsion along the arms and thereby accommodation of side bending of a patient's neck. Preferably, a pair of posts are hingedly attached, one to each side of the chin-engaging portion, laterally to the cup and each is received by the front section.

Preferably the posts and their hinging are moulded as part of the chin-engaging portion. Preferably each such hinging comprises two hinges generally perpendicular to each other and may include flexible elements allowing movement of the posts relative to the rest of the chin-engaging portion. Lockable ratchet and pawis, or other equivalent system, may cooperate between the posts and the front section to maintain the relative position of the chin engaging portion and the sternum-engaging portion.

Preferably, the indicia are linked to the posts and show the adjustment. For example, numerals could be used on the left side and letters on the right or a colour scheme could be adopted. Whatever indicia are used on the front of the collar, they advise on the setting of the rear. One arrangement of size indicating means may include apertured channels which show the position of markings on the posts. It should be noted that lockable ratchet and pawls may be provided at the pivots between the jaw supporting arms and the rest of the front section instead of, or in addition to, lockable ratchet and pawls between the posts and the front section. It should also be noted that the pivots may be virtual and moveable by engagement of lugs in grooves.

Th e2tre ic ridrsj-1 nnvc1 nr inventive in its own riaht and thus from a second aspect of the invention, we provide a cervical collar wherein a front section comprises a sternum engaging portion and, hinged thereto by jaw supporting arms, a chin engaging portion, and a pair of posts extending from the jaw supporting arms to the front section where they are lockably received.

From a further aspect the invention provides a cervical collar comprising a front section comprising a sternum engaging portion and a chin engaging portion hingedly connected thereto by jaw supporting means, said jaw supporting means being lockably positioned in use relative to the front section. Preferably a pair of posts extend from the jaw supporting means to be lockably received by the front section.

Preferably, the front section will have an unobstructed aperture of sufficient size to allow a clear view and access to the trachea. Deviation of the trachea is an indicator of chest trauma and thus a good view is vital from an emergency viewpoint. Moreover, for the patient's survival, access to the trachea may be paramount. Preferably, the collar further comprises a rear section preferably having an unobstructed aperture which allows palpation of the cervical spine. This is of clear advantage from an emergency medical practitioner's viewpoint as it allows examination of the cervical spine without removal of the collar [without such an aperture, the patient would need to be log rolled by four staff and supported by the staff while the doctor examined the cervical spine].

Preferably, an occipital engaging portion is hinged to the rear section.

Abutments are preferably provided to limit movement of the occipital engaging portion at the hinges. Occipital engaging portions according to this preferred embodiment of the invention are oriented to provide a large contact area with the occiput. Moreover, they tend to support the occiput rather than push it anteriorly, which occurs with most conventional collars.

This feature is considered novel and inventive in its own right and thus from a third aspect of the invention, we provide a cervical collar wherein a rear coot:or oompre 2 thor2x 1Inr1 nnrtirrn nri n nr.r'.initl enciaaina portion, the distance between the portions being adjustable and means being provided for securing the portions in their adjusted position, wherein a large aperture is present, upper and lower margins of the aperture being defined respectively by the occipital engaging and the thorax engaging portions.

Preferably the aperture is relatively large, e.g. as compared to the rear section. This can advantageously provide for examination of the cervical spine through the aperture without removal of the collar. Further preferably the aperture is variable in size, e.g. as a result of the adjustable distance between the thorax and occipital engaging portions.

Many forms of height adjustment means for the rear section of the collar will be apparent to the skilled person such as ratchet and pawl, or a series of slots with cooperating pegs or detents. It is preferable that the height adjustment means can be re-set in case a setting is selected in error.

In keeping with conventional collars, the means for releasably securing the front and rear sections together are preferably strips of hook and loop fastenings such as Velcro�. However, as discussed in US 5,795,315, the hook elements may be moulded as part of the collar rather than being glued on. Also, in keeping with conventional collars the materials for manufacture of collars according to the invention are radio-translucent allowing the collar to remain in situ during imaging Preferably, a collar according to the invention comprises a pair of lugs which act as tie-off points for an endotracheal tube, laryngeal mask, oxygen mask or such like.

Some preferred embodiments of the present invention will now be described, by way of example only, and with reference to the accompanying figures, in which: Fig. 1 is a front view of a front section of a collar according to an embodiment of the invcnfjrn Fig. 2 is a schematic exploded view from the rear of the front section shown in Fig.1; Fig. 3 is view of the font section of the collar of Fig. I curved in a manner similar to its arrangement for placing on a person; Fig. 4 is a view of a rear section of a collar according to an embodiment of the invention; Fig. 5 is a view of the occipital engaging portion of the rear section as shown in Fig. 4; Fig. 6 is a view of the trunk-engaging portion of the rear section as shown in Fig. 4; Figs. 7 is a view of hinging used in the front section of the collar shown in Figs. 1 to 3; Fig. 8A and 8B are schematic views of the hinging used in the front section of the collar as shown in Figs. 1 to 3 and 7; Fig. 9 is a cross-sectional view of the hinging used in the rear section of the collar as shown in Fig 4; Fig. 10 shows an adjustable section of a cervical collar suitable for use in embodiments of the present invention; Fig. 11 shows the collar of Fig. 10 in a fastened condition; and Fig 12 is a cross section of the one way adjustment means of Figs. 10 to 11 Front section 1 of a collar according to a preferred embodiment of the invention is shown in Figs. 1 to 3 and comprises a chin engaging portion 2 and a sternum-engaging portion 3 which are held together by hinges 4 and posts 5. The chin engaging portion 2 comprises a chin cup 6 and a pair of jaw supporting arms 7 which have bonded thereto a layer of cushioning foam 8.

The sternum engaging portion 3 has a pair of moulded hook areas 9 which will bind with loops on fabric in the manner of Velcro �. The sternum engaging portion 3 also includes a pair of apertured indicia panels 10 which are moulded flat with the rest of the sternum engaging portion 3 and then folded forwards and back onto the rest of the sternum engaging portion 3 to form channels which surround the posts 5. The indicia panels 10 are welded in this position. The space where the indicia panels 10 were moulded now forms an aperture 11 for tracheal access. A layer of cushioning foam 12 is bonded to the sternum-engaging portion 3.

Rear section 13 of a collar according to a preferred embodiment of the invention, and its major parts, are shown in Figs. 4 to 6. Rear section 13 comprises an occipital engaging portion 14 and a trunk- engaging portion 15.

The occipital engaging portion 14 comprises an occiput panel 16, having a cushion 17, lockable clips 18, and fastening straps 19, which cooperate with the hook areas 9 on the front section 1 to hold the collar together. The straps 19 are secured to the rear section 13 by rivets 20, which pass through holes 21 in the occiput-engaging portion 14. The occipital panel 16 is attached to the rest of the occiput engaging portion 14 by hinges 22 with adjacent abutments 22a, as shown in greater detail in Fig. 9 where the material is thinner to form a hinge and the abutments limit movement at the hinge.

The trunk engaging portion 15 comprises a pair of slots 23 and a pair of indicia panels 24 which, like the indicia panels 10 of the front section 1, are moulded substantially flat with the rest of the trunk engaging portion 1 5 and are folded out and secured to form channels [not shown] which receive webs of the occipital engaging portion 14. Lugs 26 pass through slots 27 and notches 28 and are fused to the rest of the trunk-engaging portion 15. To further secure the occipital and the trunk engaging portions together, large head rivets 29 pass through slots 23 and holes 30.

In forming the rear section 13 of the collar an aperture is created by folding the indicia panels 24 away from their moulded positions. It will be noted from Fig. 6 that teeth 31 are present on the rear of,ndicia panels 24 and these cooperate with the lockable clips 18.

Fig. 7 shows how a post 5 is attached to a jaw supporting arm 7 by a first hinge 32 formed by grooves 32a and 32b, which allow folding of the plastic, and a second hinge 33 substantially perpendicular to the first hinge 32. Teeth 34 are shown which engage with a ratchet [not shown] inside the channel fnrm.-1 hv fnirlinri nvr th nrhired indicia panel 10 as described earlier.

Also not shown but important to the invention is a marking on each post 5 which can be seen through the apertured indicia panels 10 as each post moves through its respective channel. Such a marking could be, for example, a white reflective dot slightly recessed in the post 5 to avoid contact with the channel. The apertured indicia panels 10 and the posts 5 in this instance could be a contrasting darker plastic.

Figs. 8A and 8B illustrate how the second hinge 33 on the post 5 deforms as the collar is hinged from a starting position shown in Fig. 8A to a larger setting of the front section 1 of the collar as shown in Fig. 8B.

In order to apply the collar shown in the figures, one first flexes the front section 1 so that it more easily adopts the shape as shown in Fig. 3. The front section 1 is then offered up to the patient, the sternum-engaging portion 3 is applied to the sternum and the side parts of the front section 1 slid to the sides of the patient's neck. The chin engaging portion 2 is pivoted at hinges 4 until the chin of the patient is firmly but comfortably received in the chin cup 6.

As the pivoting takes place at hinges 4, the posts 5 slide through channels behind the apertured indicia panels 10 and a marking on each post aligns with an aperture to give a size reading. The hinges 32 and 33, which secure the posts 5 to the chin engaging portion 2, allow the posts 5 to slide in the channels behind the apertured indicia panels without undue sideways forces due to the hinges 32, 33 moving rearwardly relative to the channels behind the apertured indicia panels 10.

As with the front section 1, it is desirable to introduce some curvature to the rear section 13 before application to a patient, as both sections are relatively flat before deployment. The size readings from the front section 1 of the collar are used to set the size or the rear section 3 as follows. It will be noted in Fig. 1 that numerals are used on the left apertured indicia panel 10 and letters on the right. These numerals and letters have corresponding marking on the rear section 3. Each lockable clip 18 on the rear section 13 is aligned with the corresponding marking for the setting of the front section 1 and is then pushed trMrr1 th inri,ru tn inr.k it in nic.e with the teeth 31 on the rear of the indicia panels 24. The rear section 13 of the collar is then offered up to the rear of the patient and the fastening straps 19 secured to the hook areas 9 on the front section thus providing a custom, secure and comfortable fit. Moreover, good access is provided at the front of the collar for tracheal inspection and at the rear for palpation of the cervical vertebrae, It is envisaged that there is sufficient give in the material of the rear section 13 of the collar to allow it to flex and accommodate different size settings on the left and right. If by some chance the setting of the rear section is inappropriate, the or each lockable clip can be disengaged from the teeth 31 and re-set to a more appropriate position.

An elasticated strap [not shown] may be attached to one end of the front section 1 of the collar, the free end of the strap having hook and loop fastenings. Such a strap may aid retention of the front section 1 of the collar on a patient while a sole paramedic adjusts the rear section 13 and then applies same to the patient and secures it to the front section.

There is described with respect to Figs. 10 to 12 a one-way adjustment mechanism which can be used in accordance with embodiments of the present invention. As shown in Figs. 10 and 11, the collar 1 comprises a neck encircling band 2, a chin support 3, and a sternum engaging portion or gorget 4. Hook and loop fastening 5 is attached to the free ends of the neck encircling band 2 and, as shown in Fig. 11, is used to secure the free ends of the band 2 together. It should be noted that Fig. 11 is based on a photograph and the resilience of the neck encircling band 2 has led to the ends of the band 2 not sitting exactly together. The chin support 3 comprises a tongue 6 which engages in a slot 7 in the band 2. Four posts 8 form part of a one way adjustment means between the band 2 and the gorget 4.

Fig. 12 shows the one way adjustment means in greater detail. The post 8 passes through a channel 9 which contains a pawl 10. The pawl 10 is flexibly secured to a wall of the channel 9 by a resilient neck 11 so that it can move to allow teeth 12 on the post 8 to move past the pawl 10. The pawl 10 is shown havinq several teeth which co-operate with the teeth 12 on the post 8. The gorget 4, shown here with a foam sheet 13 to rest on a patient, has upstanding lugs 14 which clasp the distal end of the post 15, which is semi spherical. The lugs 14 snap fit around the end of the post 15 and allow the gorget 4 to move and conform to the patient. Towards the other end of the post 8 is another lug [not shown] which will not pass through the channel 9.

In order to deploy the collar 1, one simply places the posterior part of the neck encircling band 2 around the patient's neck. The chin support 3 is located against the patient's chin and the hook and loop fastener 5 is adjusted for an appropriate circumferential fit The fit at the front of the collar 1 is gained by pulling the gorget 4 down onto the patient's sternum and collar bones. The posts 8 move through the channel 9 and the pawl 10 stops retrograde movement. Although not shown, size indicating means can be provided on the front section of the collar and the illustrated front section may be used with a rear section having related size indicating means, as described above, to form a two-piece collar. Additionally or alternatively, the one way adjustment means may be used in the rear section of a cervical collar. An aperture may be defined at its upper and lower margins by occipital and thorax engaging portions, respectively, instead of by the chin support and gorget as shown.

Claims

Claims 1 A two-piece cervical collar comprising a front section having a chin engaging portion and a sternum engaging portion and a rear section having an occiput engaging portion and a trunk engaging portion, means for releasably securing the front and rear sections together, both sections comprising size indicating means, wherein both front and rear sections are adjustable for size and the size indicating means on the front section are related to the size indicating means on the rear section such that, in use, the setting of the front section indicates the desired related setting of the rear section 2 A two-piece collar according to claim 1, wherein left and right sides of the front and rear sections of the coDar are independently adjustable and have respective sizing indicia 3 A two-piece collar according to claim 1 or 2, wherein the chin-engaging portion has a cup to receive the chin and jaw supporting arms either side of the cup 4 A two-piece collar according to claim 3, wherein the arms are pivotally mounted on the rest of the front section of the collar and the material from which the collar is made allows for slight torsion along the arms and thereby accommodation of side bending of a patient's neck.

A two-piece collar according to claims 3 or 4 comprising a pair of posts hingedly attached, one to each side of the chin-engaging portion, laterally to the cup and each is received by the front section 6 A two-piece collar according to claim 5, wherein the posts and their hinging are moulded as part of the chin-engaging portion 7 A two-piece collar according to claim 6, wherein each hinging comprises two hinges generally perpendicular to each other and include flexible elements allowing movement of the posts relative to the rest of the chin-engaging portion 8 A two-piece collar according to claim 7, wherein lockable ratchet and pawis cooperate between the posts and the front section to maintain the relative position of the chin engaging portion and the sternum-engaging portion 9 A two-piece collar according to any one of claims 5 to 8, wherein the indicia are inked to the posts and show the adjustment.

A two-piece collar according to any preceding claim, wherein the front section provides an unobstructed aperture of sufficient size to allow a clear view and access to the trachea 11 A two-piece collar according to any preceding claim comprising a rear section having an unobstructed aperture which allows palpation of the cervical spine 1 2 A two-piece collar according to any preceding claim comprising an occipital engaging portion hinged to the rear section 13 A cervical collar wherein a rear section comprises a thorax engaging portion and an occipital engaging portion, the distance between the portions being adjustable and means being provided for securing the portions in their adjusted position, wherein an unobstructed aperture is present for examination of a patient's cervical spine, upper and lower margins of the aperture being defined respectively by the occipital engaging and the thorax engaging portions 14 A cervical collar according to any preceding claim comprising a pair of lugs which act as tie-off points for an endotracheal tube, laryngeal mask, and/or oxygen mask A cervical collar substantially as herein described with reference to the accompanying drawings.