Speed freeing people from accident wreckage more important than limiting movement
Rescuers are currently trained to prioritise 'movement minimisation' when they are freeing someone to protect against possible spinal injuries which, if exacerbated, can cause paralysis.
Last year, there were 127,967 casualties and 1,560 deaths in England caused by motor vehicle collisions, with more than 7,000 patients needing to helped out of the vehicle through extrication, where rescue crews use 'Jaws of Life' and other tools to pry apart the wreckage, then carefully lift the person out.
But research by Dr Tim Nutbeam, an NHS emergency medicine consultant, and medical lead for the Devon air ambulance, has discovered that actually a delay in getting someone out of a vehicle makes them as twice as likely to die from their injuries as those who were freed quickly from the wreckage.
Although people's limbs can be trapped or they are unable to move because of severe injury, most are actually able to climb free with minimal assistance, such a door being unjammed, but are encouraged to stay in their vehicles to await further assistance because of the fear that moving them may further injure them – particularly with spinal injuries.
Dr Nutbeam found that the prevalence of spinal injuries among collision victim patients was, in fact, very low – just 0.7% – and in around half of these cases, they had other serious injuries needing urgent medical attention.
In other words, delays in cutting people free rather than spinal injuries are more likely to prove fatal in road accidents. "Potentially, hundreds of people in this country have died as a result of extended entrapment times," Dr Nutbeam said.
Early results from the research suggests that the spinal movements associated with assisted extrication are much larger than when volunteers are allowed to climb out of the wreckage themselves, and that rapid assisted extrication techniques produced similar movements to slower ones aimed at movement minimisation.
This means that the more movements a patient can perform for themselves, the less spinal movement actually occurs. Although patients with genuine spinal injuries still need a gentle approach, self-extrication where possible will be better, regardless of the type of injury, Dr Nutbeam said.
In terms of guidelines, currently, only around 3% of UK fire and rescue services use self-extrication regularly, something that is likely to change as a result of Dr Nutbeam's study.
Interested parties, including the National Fire Chiefs Council and the College of Paramedics, reviewed the evidence, and agreed the principles for future guidance.
These include recommending that self- or minimally assisted extrication should be the standard 'first line' for trapped patients who are conscious and likely able to stand with assistance, and that minimising entrapment time become the goal for all patients.