Organisation
National Fire Chiefs Council
Amount awarded
£62,242.48
Completed
2022
Uploaded to Knowledge Centre
18 January 2023
Following a road traffic collision many patients will remain trapped in their vehicle. Extrication is the process by which injured or potentially injured people are removed from their vehicle by the rescue services.
Rescue service training focuses on the absolute minimisation of movement of potentially injured patients’ spine and has developed extrication techniques which prioritise this approach.
Unfortunately, these techniques take a significant amount of time (over 30 minutes) which delays access to potentially lifesaving treatments for injuries.
In this Road Safety Trust funded project, the EXIT team reconsidered extrication. The primary aim of this work was to develop evidence-based guidance for the extrication of patients trapped in motor vehicles.
The project considers current extrication techniques through the ‘lens’ of EBM. The principles of EBM are; consideration of the relevant scientific evidence, patient values and preferences and expert clinical judgement.
By systematically applying Evidence Based Medical (EBM) principles to this focused area of practice the current approach to extrication is successfully challenged and new, original evidence-based guidance for clinicians and rescuers is offered.
This guidance states:
- Operational and clinical team members should work together to develop a bespoke patient centred extrication plan with the primary focus of minimising entrapment time.
- Independent of actual or suspected injuries, patients should be handled gently. A focus on absolute movement minimisation is not justified.
- When clinicians are not available, Fire & Rescue Services (FRS) should where necessary assess patients, deliver clinical care and make and enact extrication plans (including self-extrication).
- Self-extrication or minimally assisted extrication should be the standard ‘first line’ extrication for all patients who do not have contraindications, which are:
- An inability to understand or follow instructions.
- Injuries or baseline function that prevents standing on at least one leg (specific injuries include: unstable pelvic fracture, impalement, bilateral leg fracture).
- All patients with evidence of injury should be considered time-dependent and their entrapment time should be minimised.
- Incidents where a patient may require disentanglement are complex and associated with a high morbidity and mortality. A senior FRS and clinical response should attend such instances.
The adoption of this fresh approach will reduce extrication times and may reduce morbidity and mortality.
Click below to read the full report:
https://www.roadsafetytrust.org.uk/funded-projects/17/national-fire-chiefs-council