Extrication

Despite all the improvements that we have seen in trauma care over the past 20 or more years, RTCs are still, sadly a really common cause of both death and disability, with the number of deaths annually in the UK sitting somewhere between 1500-1900 per annum.

Survivors, who have serious injuries and are left with ongoing disabilities, total 22,000 people per year. So anything we can do to improve care to these patients is definitely worth looking at and learning about!

Extrication is the process of injured (or potentially injured) patients being removed from vehicles involved in road traffic collisions. The fundamentals behind extrication have been based upon protecting the spine and not worsening an injury of it but at the potential cost of other time critical injuries and with limited to no sound evidence base.

The EXIT project brings evidence to the practice of extrication and in this podcast we discuss the findings and implications for practice with the lead author Tim Nutbeam, Clare Bosanko (an EM & PHEM consultant) along with the three of us.

We also get the opportunity to hear from Freddie, a patient extricated from a high energy RTC and hear his perspective on Extrication.

Enjoy!

Simon, Rob, James, Tim & Clare

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References

Nutbeam T, Fenwick R, Smith JE, Bouamra O, Wallis L, Stassen W.  A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped. Scand J Trauma Resusc Emerg Medicine 29, 17 (2021).

Nutbeam T, Kehoe A, Fenwick R, Smith JE, Bouamra O, Wallis L, Stassen W. Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN). Scand J Trauma Resusc Emerg Medicine 30, 14 (2022).

Nutbeam T, Weekes L, Heidari S, Fenwick R, Bouamra O, Smith JE, Stassen W et al. Sex-disaggregated analysis of the injury patterns, outcome data and trapped status of major trauma patients injured in motor vehicle collisions: a prespecified analysis of the UK trauma registry (TARN). BMJ Open 2022;0:e061076. doi:10.1136/ bmjopen-2022-061076

Nutbeam, T. Fenwick R, May B, Stassen W, Smith JE, Wallis L, Dayson M, Shippen J. The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision – a biomechanical study using healthy volunteers. Scand J Trauma Resusc Emerg Medicine 29, 108 (2021).

Nutbeam, T. Fenwick R, May B, Stassen W, Smith JE, Shippen J. Maximum movement and cumulative movement (travel) to inform our understanding of secondary spinal cord injury and its application to collar use in self-extrication. Scand J Trauma Resusc Emerg Medicine 30, 4 (2022).

Nutbeam, T. Fenwick R, May B, Stassen W, Smith JE, Bowdler J, Wallis L, Shippen J. Assessing spinal movement during four extrication methods: a biomechanical study using healthy volunteers. Scand J Trauma Resusc Emerg Medicine 30, 7 (2022).

Nutbeam T, Brandling J, Wallis L, Stassen W.  Understanding people’s experiences of extrication whilst being trapped in motor vehicles: a qualitative interview study.  In Press BMJ Open

Nutbeam T, Fenwick R, Smith JE, Dayson M, Carlin B, Wilson M, Wallis L, Stassen W. A Delphi Study of Rescue and Clinical Subject Matter Experts on the Extrication of Patients Following a Motor Vehicle Collision Scand J Trauma Resusc Emerg Med 30, 41 (2022)