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Table 3 Principles: agreed by stakeholder organisations

From: A Delphi study of rescue and clinical subject matter experts on the extrication of patients following a motor vehicle collision

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, FRSs should where necessary assess patients, deliver clinical care and make and enact extrication plans (including self-extrication)1
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 instances2
Clinical care during entrapment:
-Can be delivered by FRS or clinical services1
-Should be limited to necessary critical interventions to expedite safe extrication3
-Rescuers should be aware that clinical observations may prolong entrapment time and as such should be kept to the minimum
-FRS and clinical personnel should be aware of the physical and observable signs of patient deterioration and if identified should make this known to the responsible clinician
Immobilisation:
-Longboards are an extrication device and should not be used beyond the extrication phase
-Kedrick Extrication Devices prolong extrication time and their use should be minimised
-Pelvic slings should not be applied to patients until they have been extricated
-Cervical collars should only be used following assessment and should be loosened or removed following extrication
Patient focused extrication:
-Build a connection with patients, explain actions, and use their name
-Where appropriate, reassure patients as to the safety of their co-occupants and others involved in the incident (including animals)
-Provide an ‘extrication buddy’
-Allow communication with family members or other close contacts
-Rescue teams should not publish extrication related imagery to social media or other outlets
-Minimise the ability of the public to view the accident, take photographs or record videos. Provide education to this effect
On initial call to Emergency Services
-Attempt to clarify entrapment status
-Attempt to identify patients who require disentanglement (and dispatch an appropriate priority senior2 response)
-A standard multi-agency MVC trauma message should be developed to ensure the correct resources are deployed
Multi-professional datasets should be developed with patient and public engagement and should include entrapment status, entrapment time, injuries, extrication approach, clinical care
Agreed nomenclature for categories of patient
Not injured, Minor injuries (evidence of energy transfer but no evidence of time-dependent injury), Major injury (currently stable but should be assumed to be time-dependent), Time critical injured (Time critical due to injury; use fastest route of extrication) m Time critical hazard (e.g. secondary to fire or other hazard)
  1. FRS Fire and Rescue Services, Disentanglement requires the use of cutting tools to free patient
  2. 1FRS clinical care should be standardised and delivered with appropriate training and clinical governance oversight
  3. 2A senior or enhanced clinical and operational response should be dispatched. This may include enhanced / critical care and will benefit from further consideration
  4. 3In-car interventions may include the administration of tranexamic acid, analgesia and oxygen. Interventions may include the management of compressible haemorrhage and decompression of suspected tension pneumothorax. Patients who require volume (fluid or blood product) resuscitation are likely to have time critical injuries and their removal from the vehicle should be prioritised. In the small number of patients who cannot be released quickly then ‘in vehicle’ fluids and /or blood products may be required