The Faculty of Pre-Hospital Care (FPHC) has released their latest consensus statement on extrication following motor vehicle collisions (MVCs), marking a significant evolution in our approach to post-collision care. This comprehensive guidance, including authors from the IMPACT team including Rob, Emily and Tim challenges traditional practices and presents evidence-based recommendations that prioritise patient outcomes over historical assumptions.
The Evolution from EXIT to Evidence
The new consensus statement builds directly upon the groundbreaking findings of the EXtrication In Trauma (EXIT) Project, which fundamentally challenged our long-held beliefs about post-collision care. For decades, the prevailing doctrine emphasised absolute movement minimisation during extrication, based on theoretical concerns about secondary spinal injury. However, rigorous biomechanical research and clinical outcome studies have revealed that this approach may actually compromise patient care by extending entrapment times and delaying critical interventions.
Research Findings Driving Change
The evidence supporting this paradigm shift is compelling.
Biomechanical studies have provided important insights. Self-extrication produces the smallest anterior-posterior cervical spine movement, measuring just 2.6mm, whilst traditional “careful” extrication techniques show no significant advantage in reducing spinal movement compared to more rapid approaches. This evidence strongly suggests that the time cost of movement minimisation techniques cannot be justified by their biomechanical effects.
Studies have shown that merely 0.7% of trapped patients have spinal cord injuries that influence extrication technique, while trapped patients consistently demonstrate significantly higher injury severity scores compared to their non-trapped counterparts. Perhaps most crucially, research has demonstrated that extended entrapment times directly correlate with increased morbidity and mortality.
The Human Element
Patient experience research has revealed the profound importance of clear communication and psychological support during extrication. The presence of an “extrication buddy” – a dedicated responder who stays with the patient throughout the process – significantly reduces distress and improves cooperation. This research emphasises that patient dignity and autonomy should be prioritised whenever clinically appropriate.
A New Framework for Practice
The consensus statement advocates for several fundamental changes to current practice. Firstly, every trapped patient should be considered time-dependent until proven otherwise, representing a shift from the traditional “stay and play” mentality to a more nuanced “release and respond” approach. This change acknowledges the critical importance of rapid access to definitive care.
Self-extrication has emerged as the preferred approach for patients who can understand and follow instructions and have sufficient physical capability to participate. This represents a significant departure from traditional practice but is strongly supported by the biomechanical evidence.
Immobilisation protocols have been refined considerably. Cervical collars should be used selectively rather than universally, and Manual In-Line Stabilisation (MILS) is no longer considered necessary for conscious patients without neurological symptoms. Pelvic binders, when indicated, should be applied post-extrication rather than in-vehicle, as this approach reduces entrapment time without compromising care.
Clinical interventions during entrapment should be limited to critical procedures that are either immediately life-saving, will facilitate faster extrication, or cannot safely be delayed until after extrication. This focused approach helps prevent unnecessary delays in reaching definitive care.
Implementation Through Collaboration
The successful implementation of these guidelines depends heavily on strong interdisciplinary collaboration. Regular joint training sessions between ambulance services and fire/rescue teams are essential, as is the development of standardised communication protocols. Clear clinical governance frameworks and regular case reviews will help monitor outcomes and drive continuous improvement.
The IMPACT Ambassador Scheme offers an excellent opportunity for professionals to engage with this evolving evidence base and contribute to the ongoing refinement of post-collision care practices. (LINK HERE)
Looking Forward
This consensus statement represents a fundamental shift in how we approach trapped patients. By prioritising rapid, patient-centred extrication over absolute movement minimisation, we have the potential to significantly improve outcomes for the millions affected by MVCs globally each year.
For practitioners, the key message is clear: while maintaining our focus on careful, professional practice, the evidence now strongly supports more rapid extrication approaches that prioritise overall patient outcomes over theoretical spinal protection. This balanced approach, combining speed with appropriate care, represents the future of post-collision response.
The full consensus statement, including detailed evidence grades and specific clinical recommendations, is available through the Faculty of Pre-Hospital Care and should be essential reading for all professionals involved in post-collision care.
