Emegear Xcollar Setup guide

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Study&ManipulativeTrainingGuide
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WhatistheXCOLLAR?
TheXCollarisacompleteCervicalSpineSplintingSystemdesignedespeciallyforEMS.Itensuresthe
highestlevelofpatientsafetywhilesignificantlyreducingmovementoftheCervicalSpine.Ithelps
rescuersinthemanagementofpotentialCervicalSpinalinjuriesbysecuringtheheadtothetorsoatfour
points;twoposteriorandtwoanterioraboveandbelowC‐1andC‐7.Thisworkstoeliminateharmful
DistractionbyprotectingtheCervicalSpine.
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WhatistheXCOLLARPlus?
TheXCollarPlusintegratestheXCollarandanAdjustableHeadRestraintSystem(HRS).EachHRS
contains
a setoftwoVelcrostrapsdesignedtosecurethepatienttothespinalboardbypreventing
lateralandverticalmovement,whileallowinginlinemovementofthepatient’sheadwiththebody.The
HRSalsocontainsanAdjustableOccipitalSupportPadwhichensuresthatproperheightsupportis
providedforpatient’sspinalalignmenttobemaintained.TheAdjustableSupportPadiscapableof
allowingrescuerstoadjusttheheightofthesupportfortheOccipitalasneededfrom0to2”inheight
with4possible1/2”increments.
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ThisnewTechnologyallowsEMSresponderstoprovide:
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1. Betterpatientcareandsafety:EfficientlyprovidesahighlevelofCervicalSpinestabilizationfor
trauma
patientsregardless ofbodytype,age,orsize,whilealsocapableofimmobilizinginthe
“Position
ofComfort”. Additionally,theHRSwiththeXCollarPlusallowsrescuerstoprovide
supportfortheOccipitalregionwhileensuringHeadtoTorsounity.Thishelpstoavoidfurther
harmcausedbydynamicforcesduringtransportforinjuriestotheCervicalSpine.
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2. Fastertreatment:30SECONDAPPLICATION.Capabilityofmultiplepatientcarebyasingle
rescuer;reducingpatients’waittimeforinitialtreatment,andactingasaFORCEMULTIPLIER
duringMASSCASUALTYINCIDENTS(MCI).
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3. Thebesttreatmentrequiringlessequipment:Careforsmallpediatricthroughlargeadult
sizepatients(fromapprox.25‐30poundstoover360pounds)withthesamedevice.
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NEWTECHNIQUEOFAPPLICATION:S‐A‐X
•Setup(Deploypriortouse)
•Adjust(CircumferenceandHeight)
•X‐Straps(CompletetheSplint)

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3‐StepEasyApplicationin30seconds:
“S‐A‐X” (SETUP –ADJUST –X‐STRAPS APPLICATION) 
#1:SETUP
• ExtendtheXCollartoitslongestsetting.UnfoldtheBackSupportandlockitinplace.
#2:ADJUST
• Encirclethepatientandcapturethechinbeforeconnectingthebuckle.Notethatthechinistheanchor
point,soensurethatthechinproperlycapturedbetweentheChinStrap(infront)andtheFoam
Padding(below).
• Whileholdingthefrontofthedeviceinplace,usethe“push&pull”(OpposingForces)methodtoadjust
SideStrapsevenly(circumferenceadjustment).
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ExtendChestSupportPieceuntilfirmcontactwiththeuppersternumisobtained(heightadjustment).
#3:X‐STRAPSAPPLICATION
• ApplyX‐Straps,usingthe“push&pull”(OpposingForces)method,tothecorrespondingcolor‐coded
VelcroanchorpointswhileensuringtomaintaintensionontheX‐Straps.Thisintegratesanteriorand
posteriorpiecestosplintthepatient.
USEDIRECTOPPOSINGFORCESINEVERYSTEPOFAPPLICATION
Afteracompletedproperapplication,thefollowingcriteriamustbemet:
•Propercapturingofthechin.
•FirmContactofChestSupportonUpperSternum.
•TensiononX‐Straps.
AfterXCollarapplication,youmayproceedtosecurethepatienttothe
spinalboard/vacuum mattress/rescue
basketbyapplyingtheHEADRESTRAINTSYSTEM
(HRS). 
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2‐STEP HRS APPLICATION: 
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1–STACK,SLIDEandSTICK–Oncepatientisonthespinalboard,STACKtheOccipitalSupportpiecestodesired
heightasneededtomaintainproperalignment.SLIDEtheOccipitalSupport
Pad underthehead.Pull the clearfilmstripto
STICKtheOccipitalSupportPadtothe
spinalboard. 
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2–SECURINGSTRAPS APPLICATION –RemoveoneX‐Strapwhilemaintainingtension,thenplacetheblack
sideofthesquareendtotheXCollarVelcroanchorpoint.ReattachX‐Strap.Wrapthesecuringstraptothespinalboardto
takeofftheslack.DONOTOVERTIGHTEN.Repeatonoppositeside.
Airway Management
1. LoosentheChinStrap,removetheX‐STRAPSandloosentheSideStrapsifnecessary.
2.Obtainairway.
3.Re‐tightenX‐StrapstosecureXCOLLAR.
***Forextra‐largepatientsitmaybenecessarytotemporarilyunclipthebuckletointubate***
www.training.xcollar.com

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Thesehands‐onstepsarerecommendedbyEmegear,LLCwhenapplyingtheXCollardevices.Youmustdemonstratetheseapplicationstoan
“Evaluator”priortoapplyingthedeviceonaninjuredpatient.Pleaseensurethatyoufeelcomfortableapplyingthedeviceinallsituations:
PracticeTips:
Duringapplication,useonehandontheXCollarfrontpiecetocontrolthepatient’sheadandavoidunwantedmanipulation.
DirectopposingforcesmustbeusedduringapplicationtocontrolC‐Spine.
Practicing“realfield”scenarioswillensureahighskilllevelandeaseofuseinthefield.
ResettingoftheXCollartothe“OriginallyPackagedConfiguration”mustbedonepriortoeveryapplication.
Afterapplication,tensionontheX‐StrapsandChinStrapmaybeloosenedtoincreasecompliantpatientcomfortatprovider’sdiscretion.
ApplicationGuide
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S–A– XNeutralPositionApplication
1.SETUP
ExtendtheFrontandBackPieces,thenunfoldandlocktheBackPieceintoplace.
2.ADJUST
CapturethechinbetweentheChinStrapandPadding,andproceedtoencirclingthepatienttoconnecttheBuckletotheBuckleReceiver.
Note:Toeasilyconnectthebuckle,grabthebucklebytheSideStrapandplaceflatagainsttheXCollartoslideitintotheBuckleReceiver.
AdjustSideStrapsevenlytopatientcircumferenceusingOpposingForces.
Note:ThefirstSideStrapadjustedshouldonlyreducethefreespacearoundtheheadsincepropertighteningwillbeachievedoncethesecond
SideStrapisadjustedtothepatient’scircumference.Asyouadjustthecircumference,propercapturingofthechinshouldbemaintained.
ExtendtheChestSupportPiecetotheuppersternumwhilecontrollingc‐spineandpinchLockingTabsintothelockposition.
Note:Justaswithanyothersplint,wearesimplyfillingthegapswithalladjustmentstocustom‐fittheXCollartothepatient.Thereshouldnotbe
patientmanipulationduringapplication.
3.X‐STRAPS
UsingOpposingForces,deploy,andconnectthecrossingX‐Strapstotheircorrespondingcolor‐codedVelcroanchorpoints.
Note:ApplyX‐Strapsthroughthe4guidesunderneaththepatient’schinwhileensuringtomaintaintensionontheX‐Straps.
Supine Position Application
1.SETUP
ExtendtheFrontandBackPieces,thenunfoldandlocktheBackPieceintoplace.
2.ADJUST
SlideBackPieceata45°angletomidlineunderneaththepatient’sshoulderbladeswhileemployinga“Push‐and‐Pull”(OpposingForces)method.
Note:“Push&Pull”forcesentailpullingupontheclothingasyoupushintheXCollar.BesuretoplacethebucklebetweentheXCollarandthe
floortofacilitateeaseofentryandpositioning.Ideallyyoushouldcomefromthepatient’srightshouldertopreventheadmovement.
PivottheBackPiecetobein‐linewiththespineandensureproperplacementoftheoccipitalpaddirectlyundertheoccipital.
Note:Lookforsymmetryoftheoccipitalfoampaddingonbothsidesofthepatient’sheadforproperplacementandalsoensurethatthesidesof
theXCollararelyingdirectlyunderneaththepatient’searlobes.
CapturethechinbetweentheChinStrapandPadding,andproceedtoencirclingthepatienttoconnecttheBuckletotheBuckleReceiver.
Note:Toeasilyconnectthebuckle,grabthebucklebytheSideStrapandplaceflatagainsttheXCollartoslideitintotheBuckleReceiver.
AdjustSideStrapstopatientcircumferenceusingOpposingForces.
Note:ThefirstSideStrapadjustedshouldonlyreducethefreespacearoundtheheadsincepropertighteningwillbeachievedoncethesecond
SideStrapisadjustedtothepatient’scircumference.Asyouadjustthecircumference,propercapturingofthechinshouldbemaintained.
ExtendtheChestSupportPiecetotheuppersternumwhilecontrollingc‐spineandpinchLockingTabsintothelockposition.
Note:Justaswithanyothersplint,wearesimplyfillingthegapswithalladjustmentstocustom‐fittheXCollartothepatient.Thereshouldnotbe
patientmanipulationduringapplication.
3.X‐STRAPS
UsingOpposingForces,deploy,andconnectthecrossingX‐Strapstotheircorrespondingcolor‐codedVelcroanchorpoints.
Note:ApplyX‐Strapsthroughthe4guidesunderneaththepatient’schinwhileensuringtomaintaintensionontheX‐Straps.

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SupineApplicationwithHeavyClothing
1.SETUP
ExtendtheFrontandBackPieces,thenunfoldandlocktheBackPieceintoplace.
2.ADJUST
InserttheXCollarbetweenclothinglayersandslideBackPieceata45°angletomidlineunderneaththepatient’sshoulderbladewhileemploying
a“Push‐and‐Pull”(OpposingForces)method.
Note:YouwillneedtointermittentlypullonbothlayersofclothingwhilepushingintheXCollar.
ContinueproperapplicationasperSupineApplication.
InPositionofComfort&Prone Application 
ProperlycompletetheXCollarSETUP,thencapturethechin,encirclethepatient,andconnecttheBuckletotheBuckleReceiver.
TightenLateralSideStraponthesidethepatientisfacingfirstandthencompletetheotherSideStrapsecond.
ExtendandlockAdjustableChestSupportasymmetricallyensuringpaddinghasgoodcontactonsternum.
Note:EnsuretoobtainfirmcontactwiththeuppersternumandpresstheLockingTabstopreventlosingtheobtainedadjustment.
UsingOpposingForces,secureX‐Straponthesidethepatientisfacingfirst,thenfollowwiththeotherX‐Strapsecond.
Note:BesuretomaintaintensionontheX‐Strapsduringapplication.
SpecialCircumstances
Extra‐largepatients:BesuretoloosenthechinstrapandextendthebuckleSideStrappastitsnormalsetting.
Note:WhenyoumovetheBuckleontothehooksoftheVelcroyoumustensurethereisenoughVelcromattingthatitwillstillholdsecurely.
Smallpatients:Pre‐adjusttheChinStraptoitssmallestsettingandpre‐adjusttherightSideStrap(slidingpiece)oftheXCollartothesmallest
setting.
Note:Thisisashortcutthatwillbecomemoreevidentwithexperienceofwhatsizescanbepre‐adjusted.
Limitedaccessandlow‐visibility:Applicationsrequirefamiliarityoftexturedtabs,straps,andconfidenceobtainedwithexperienceduseofthe
XCollar.
Itisuptotheprovider’sdiscretiontodecidetoapplytheXCollarwhentreatingapatientwithseverefacialtrauma.
Note:IftheXCollarcannotbeappliedwithoutmanipulatingthepatient,followlocalprotocolsandmaintainmanualc‐spineuntilproper
applicationispossible.
Airway Management 
BLSAirway:LoosentheChinStraptoallowpropersealingofaBVM.Use“ECclamp”holdingtechniquemakingtheEundertheXCollarChinPiece.
ALSAirway:RemoveX‐Straps,loosenBuckleSideStraptoallowmodifiedJawThrustandproceedwithintubation.
Note:ForALSairwaymanagement,thegoalistogetthechinsupportoftheXCollarawayfromunderneaththechin,sothatwemayopenthe
patient’sairwayasneeded.Alsonotethatforextra‐largepatients,itmightberequiredtouncliptheSideStrapBuckletoobtainanairway.
AfterALSairwayissecuredretightenXCollartohelpmaintainasecuredairwaybyminimizingmovementofthehead.
HeadRestraintSystem Application 
Buildthecorrectamountofpaddingforoccipitalsupporttomaintainanin‐lineposition,andthenstickthepadtothecarryingdevice.
TemporarilydetachX‐StrapandattachSecuringStrap(blacksidefacingdown)ontheXCollarVelcroanchorpoints,thenreattachtheX‐Strapand
repeatonoppositeside.
AttachSecuringStrapstothecarryingdevicewithoutapplyingtension.
Note:IfthereistoomuchslackontheSecuringStraps,itmaybenecessarytowrapanotherlooparoundthecarryingdevicetoadjustproperly.
XCollarRemoval
•UndotheX‐Straps.
•LoosentheBuckleSideStrap.
•UnclipandPivottheBuckletoremove.
www.training.xcollar.com

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Skills Verification Shee
t
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Name:Agency:Date:
General XCollar Application
S–A– XNeutralPositionApplication
1.SETUP
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ExtendstheSidePieces;UnfoldsandLockstheBackPiece.
2.ADJUST
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EncirclesthepatientandconnectstheBuckle,whilemaintainingthechinsecuredbetweentheChinStrap(front)andPadding(below).
AdjustsSideStrapstopatientcircumferenceusinga“push&pull”(OpposingForces)method.
ExtendstheanteriorChestPiecetoupperchestwithoutdistractingthec‐spineandlocksitinplace.
3.X‐STRAPS
DeploystheX‐Straps,placesthembetweenthe4guidesmaintainingtension,usinga“push&pull”(OpposingForces)method.
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AttachestheX‐StrapstothematchingcolorcodedVelcro.
EnsurestheXCollarissecurelyandproperlyapplied.
InPositionofComfort&Prone Application 
ProperlycompletestheS‐A‐XpointsofGeneralXCollarApplication.
TightensLateralSideStraponthesidethepatientisfacingfirstandtheotherSideStrapsecond.
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ExtendsandlocksAdjustableChestSupportasymmetricallyensuringpaddinghasgoodcontactonuppersternum.
SecuresX‐StraponthesidethepatientisfacingfirstandthentheotherX‐Strapsecond.
SupinePosition Application 
ProperlycompletestheS‐A‐XpointsofGeneralXCollarApplication.
SlidesBackPieceata45degreeangletomidlinebetweenshoulderblades.
PushesontheXCollarandpullsonclothingtoproperlypositionBackSupport.
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Ensuresproperplacementoftheoccipitalpadwithoutpatientmanipulation.
Airway Management 
LoosenstheChinStraptoallowpropersealingofaBVMmaskusing“ECclamp”holdingtechniquemakingtheEundertheXCollarChin
Piece.
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Demonstratesthestepsofremovalinreverseapplicationordertoallowadvancedairwayinsertion.
HeadRestraintSystem Application 
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Usesthecorrectamountofpaddingforoccipitalregiontokeeppatientinproperin‐lineposition.
DetachesX‐StrapandattachesSecuringStrapontheVelcroandreattachestheX‐Strap(repeatonoppositeside).
AttachesSecuringStrapstothecarryingdevicewithoutpullingtension.
Evaluator’sName:
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Bysigningthisform,the“Evaluator”isverifyingthattheProvidernamedatthetopofthispagehassuccessfullydemonstratedall
manipulativeskillsrequiredbythistrainingcourseandthisSkillsVerificationSheetinaccordancewiththemanufacturer
recommendations.Emegear,LLCmaynotbeheldliableforanyhands‐onskillsverificationsincetheyarenotbeingverifiedby
manufacturer‐approvedinstructors.
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Signature:
Date:
www.training.xcollar.com

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ManipulativeTrainingStandards
InstructorandOperatorManipulativeSkillsEvaluationCriteria
1.FollowtheOperatorortheInstructorManipulativeSkillsCheckList.
2.Aminimumof80%ofthetotalpossiblescoremustbeobtainedinordertopass.
3.Timelyapplicationisrequiredinordertodemonstratethestudent’sproperskilllevel:
Thefollowingtimelimitsmustbeusedasareferencetoevaluatethestudents:
a‐XCollarapplicationinNeutralPositionwiththepatientseated.Maxtime:1.0min.
b‐XCollarapplicationinNeutralPositionwiththepatientsupine.Maxtime:1.5min.
c‐XCollarapplication“InPositionFound”withthepatientsupine.Maxtime:2.0min.
d‐XCollarapplicationinNeutralPositionsupinewithheavyclothing.Maxtime:3.0min.
e‐XCollarandHeadRestraintSystem(HRS)applicationonSpinalBoard.Maxtime:4.0min.
f‐FullspinalimmobilizationwithXCollar,HRSandSpinalBoard(Straps).Maxtime:5.0min.
Criteriaforimmediatecorrectiveaction:
a‐Unevenbilateraladjustment:ifsidestrapshavebeenadjustedunevenlythestudentmaycorrectby
looseningonesideandtighteningtheothertoimprovesymmetry.
b‐Toomuchpressureortensiononthestrapsmakingthepatientuncomfortable:looseningslightlyonthe
strapsasnecessarywouldbeappropriate.
c‐ChestPieceadjusteddowntoomuch:WhentheChestPiece(CP)isadjusteddownwardsthepaddingmust
alwaysprotectthepatient’sskin.IftheCPhasbeenadjustedtoofardowntheedgesoftheplasticmay
applypressureontheClavicles.Theusermayreleasethelocksbyholdingthemupandretractingthechest
pieceupwards.
d‐IftheXCollarhasbeenappliedwithnotenoughtension,thelevelofimmobilizationobtainedisreduced.
Theusermayretightenanyofthestrapstosecurethesplintfirmly.
Criteriatodetermineifadditionalpracticeisneededpriortocompletionoffinalmanipulativeevaluation:
a‐ChinhasnotbeenproperlycapturedbetweenpaddingandChinStrap.
b‐Timelyapplicationisnotachieved(morethan20%overreferencedtimelimit).
c‐Excessivemanipulationofthepatientduringapplication.
d‐Notbeingabletodemonstrateairwaymanagementmaneuvers.
e‐Failuretocompletethefinalmanipulativeevaluationwithaminimumscoreof80%