Road traffic collisions are a leading cause of death and injury. 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 movement minimisation of potentially injured patients’ spine and has developed extrication techniques which prioritise this approach. Unfortunately, these techniques take significant amounts of time (30 minutes plus) which delays access to potentially lifesaving treatments for injuries.
In this Road Safety Trust funded project, the EXIT team reconsider extrication, uses the lens of evidence-based medicine (EBM).
The principles of EBM; consideration of the relevant scientific evidence, patient values and preferences and expert clinical judgement are used as a framework for this project.
The EXIT project is a successful research initiative which:
The EXIT project focuses on the 40% of patients who are trapped (remain in their vehicles) following a motor vehicle collision. These patients suffer more injuries and have worse outcomes. The EXIT project provided new scientific evidence across a series of peer-reviewed publications that:
Read the Report Now
EXIT in Action:
(shared with permission)
Freddie Vellacot was driving from his home in Somerset to complete some chores with his friends. As he pulled out of a junction he was hit by a lorry containing building supplies. The impact pushed his Toyota Hilux 200 metres up the carriageway. This massive transfer of energy caved in the B post and the whole of the offside of the car. Freddie rapidly lost consciousness as a result of massive blood loss secondary to internal bleeding.
Freddie was extricated using the EXIT principles - he was trapped in his vehicle for less than 8 minutes.
A “normal” extrication prior to the EXIT project would have taken on average 32 minutes. Freddie did not have this time - it is the universal opinion of clinical experts who have reviewed this case that Freddie would have died in the vehicle if he had spent any longer in the car.
Freddie received over 30 units of blood and made a full recovery.
Freddie is very grateful for the RST for supporting the work that saved his life.
You can hear more about Freddie’s story here. This podcast alone has >100,000 listens.
Conclusions:
This project considers current extrication techniques through the ‘lens’ of EBM. By systematically applying 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. The adoption of this fresh approach will reduce extrication times and may reduce morbidity and mortality.
The paradigm of absolute movement minimisation is without a justifiable evidence base; nonetheless it has been historically championed and adopted. Movement minimisation has remained unchallenged for at least four decades, during which time
the excess death associated with entrapment has not been investigated nor the paradigm reconsidered.
This project adds new knowledge and understanding through retrospective cohort studies and biomechanical work to fill the gaps in the ‘relevant scientific evidence’ component of the EBM triad. These studies demonstrate the low rate of spinal cord injury, the presence of other time dependent injuries and the failure of current, promoted extrication methods to minimise movements.
The patient perspective is now understood, the importance of communication in this environment is reinforced and patient values and preferences are incorporated into new principles that will improve their experience of entrapment and extrication.
Expert clinical and rescuer judgement has facilitated the development of consensus statements. The synthesis of these statements in collaboration with national level stakeholders into new principles will have significant implications for clinicians, rescuers, and patients.
The impact following the adoption of the principles resulting from this project on extrication type, time and patient outcomes will
be monitored through longitudinal analysis of national level data sets.
Impact:
These principles have been adopted by national level stakeholders in the UK and are being incorporated into national clinical and operational guidance.
This project has significant implications for patients, clinicians, and rescue teams. Rescue times will be reduced, resource will be more effectively utilised (and therefore available for other patients) and patient experience will be improved.
- An understanding of patient injuries and the differences that occur with age and gender will have implications for car design and clinical and rescue responders.
- The biomechanical data will inform and lead to changes in established national and international extrication practice. Reduced extrication times will lead to decreased time to life- saving treatment.
- Understanding the patient experience will lead to a patient centred extrication experience and reduce the psychological impact of entrapment.
- The cohesive, coherent, evidence-based principles will provide a framework for clinical and rescue practitioners to work together to reduce the morbidity and mortality associated with motor vehicle collisions.
- This project contributes towards and is a significant step forward in achieving the Road Safety Trust's vision of zero deaths and serious injuries on UK roads.
This project has significant implications for patients, clinicians, and rescue teams. Rescue times will be reduced, resource will be more effectively utilised and patient experience will be improved.
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