Cervical Collar Removal Form
Student Name
First Name
Last Name
Cervical Collar Removal
Omitted
Incorrect
Correct
Student voices that they will first log roll patient and evaluate lumbar spine prior to removing from long spine board
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Inquire about neck pain or paresthesia
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If no pain or paresthesia, palpate the C-spine spinous process
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Carefully remove the C-collar while inspecting for any obvious trauma.
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Have the patient attempt ROM, starting at 45 deg then full ROM
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Re-examine the neck (anterior and posterior), including the base of the head and top of shoulders with a detailed full exam
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Verbalize either using NEXUS criteria or Canadian C-spine rules for no imaging and state the criteria to your proctor.
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Faculty Name
First Name
Last Name
Faculty Signature
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