Improving the care of people trapped in vehicles after a crash: expert agreement on best practice
What is the problem?
Each year, thousands of people are seriously injured or killed in motor vehicle crashes. Some are left trapped inside their vehicles, which can delay treatment and lead to worse outcomes—both physically and mentally. Emergency teams often face complex decisions: should they remove the patient quickly, or wait until more support arrives to do it safely?
Despite this, there is no agreed national guidance on how best to care for patients who are trapped after a road crash.
What did we do?
We brought together 70 experts from across the UK, including ambulance staff, fire and rescue teams, doctors, nurses, and researchers. Using a structured method called a Delphi study, we asked them to agree on the most important principles for caring for trapped patients.
Over three rounds, they generated and then rated 75 statements based on current evidence, experience, and practicality.
What did we find?
The experts agreed on 73 statements, covering the whole journey of care—from the moment someone is found trapped, through their rescue, and into hospital.
Key points included:
- The importance of early communication between emergency services.
- A focus on safe but timely extrication—removing the patient from the vehicle as soon as it’s safe, rather than delaying care.
- The need to reassure and care for the patient while they remain trapped, including pain relief and emotional support.
- The use of triage tools to help make decisions and prioritise the most seriously injured.
These statements form the first national expert consensus on how to care for trapped patients in the UK.
Why does this matter?
Being trapped in a car after a crash is frightening, painful, and potentially deadly. This study creates a shared approach to improve care, speed up rescue, and reduce harm for trapped patients. It will help guide training, policies, and research—and ultimately, save lives.
What next?
We will work with emergency services and healthcare organisations to put this guidance into practice. Further research will also explore the psychological impact of entrapment and how to reduce long-term effects.
Study Team
Tim Nutbeam, Rob Fenwick, Ian Marritt, Brian Lee, Luke Staveley-Wadham, Nigel Lang, Louise Johnson, Nicolas Mattock, Jane Ogilvie, Emily Foote, Francis Screech, Lara Lebeau–Humarau, Caroline Leech
IMPACT Centre for Post-Collision Research, Innovation and Translation, University of Plymouth, Betsi Cadwaladr University Health Board, Wrexham University, United Kingdom Rescue Organisation, World Rescue Organisation, Humberside Fire and Rescue, University Hospitals Plymouth NHS Trust, Devon Air Ambulance, Leeds Teaching Hospitals NHS Trust, National Police Chiefs’ Council, Scottish Fire and Rescue Service, University Hospitals Coventry & Warwickshire NHS Trust, The Air Ambulance Service.
