Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh

Consensus was achieved across a range of extrication related subject areas including: approach and targets, self-extrication, clinical care, immobilisation and delivering a patient-centred rescue. This statement offers a clear sense of direction and supports the ongoing paradigm shift away from absolute movement minimisation centred rescue to a patient and time focused evidence-based approach.

One of the key strengths of this study is it's foundation on a systematic scoping review and learning from the translation of findings from the EXIT project, which has driven significant change in extrication practices. The consensus approach, involving a wide range of stakeholders from prehospital emergency medicine, emergency medicine, and FRS and the inclusion of multiple SMEs representing various regions and organisations, strengthens the validity of the recommendations by incorporating diverse perspectives.

The limitations of the study lie in the inherent constraints of the data sources, particularly relying on retrospective reviews and the lack of randomised controlled trials in this subject area, which historically is typical for prehospital emergency care and areas of complexity such as extrication practice. The study focuses heavily on UK-based stakeholders, which may limit the generalisability of the findings to other international contexts where extrication practices and road traffic injury may differ. Additionally, while the consensus day achieved strong concordance, and the anonymised voting approach offered individual autonomy, it may have limited open debate: a more formal methodology such as a Delphi process could be considered for future FPHC consensus processes.

Compared to previous guidance and (historically) accepted practice in this area, this statement robustly challenges the long-held paradigm of ‘absolute movement minimisation’. This interpretation of the biophysical evidence, which supports self-extrication and use of the quickest extrication technique with appropriate gentle patient handling, represents a significant shift in extrication approach. The incorporation of the U-STEP OUT algorithm, which allows for self-extrication in many cases, empowers not only clinicians but also, subject to appropriate training, firefighters and other non-clinical responders to make decisions that reduce entrapment time and support optimal patient outcomes.

For policymakers, this statement promotes the need to support interdisciplinary training and collaboration between emergency services and complementary guidance in operational clinical practice. Ensuring that rescue personnel and prehospital clinicians work in unison, with shared language and decision-making tools, could lead to significant improvements in both survival rates and the quality of patient care. Policy-makers will need to consider what impact this statement has on enabling bystander and non-clinician led care for the trapped patient.

Despite the advancements provided by this consensus statement, there remain unanswered questions. One key area for future research is improving our understanding of the psychological impact of entrapment and extrication on patients, which, while acknowledged in the guidance, has not been extensively studied. Understanding how prolonged entrapment or self-extrication affects long-term recovery will provide a more holistic view of patient recovery.

Further consideration and evaluation is needed of the broader application of the U-STEP OUT algorithm and similar tools across a range of settings, especially internationally, including low and middle income countries where training levels, resources, and rescue techniques may differ. Additional work is needed in the approach to the physically trapped patient, the limits of self/assisted extrication and the role of non-clinical, non-FRS responders and bystanders in the early care of patients injured in MVC.

Additional research into the specific physiological mechanisms involved in handling during extrication, such as the impact on non-spinal injuries, will also be crucial in refining techniques. The role of technology, such as AI derived scene-specific guidance, could be explored to optimise patient-centred extrication further. We actively encourage the formation of multi-disciplinary/multi-professional data sets for audit and research purposes.

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