There are plans for a major overhaul of how people are rescued from car accidents amid growing evidence that current methods where people expect to be cut can be detrimental.
Last year there were 127,967 casualties and 1,560 deaths in England caused by motor vehicle collisions. During the same period, more than 7,000 patients needed help getting out of the vehicle through a process known as extrication, where rescue teams use “Jaws of Life” and other tools to separate the remains and then lift people carefully.
Although in some cases, patients’ limbs are trapped or unable to move because their injuries are so severe, in most cases, they can climb free with minimal care, for example, after unlocking a locked door, but remain to their vehicles because of the pain. and / or concern that moving them may aggravate their injuries, especially spinal injuries.
“Since the 1980s, firefighters have been trained with movement minimization as an absolute paradigm,” said Dr Tim Nutbeam, an NHS emergency medicine consultant and medical officer in Devon’s air ambulance. “They’ve been told that a millimeter of movement could turn someone into a wheelchair user, so they’ll often disassemble the car around the patient, to prevent neck movement.”
However, doing so takes time (30 minutes on average) and if that person has another serious injury, such as an injury to their head, chest or abdomen, every minute counts.
Nutbeam began investigating the problem after noticing a disconnect between concerns about spine movement and injuries he was seeing in his patients, including the experience of people dying in their vehicles or shortly after being removed.
He found that trapped patients were almost twice as likely to die as those who were quickly released from the wreckage. In addition, the prevalence of spinal cord injuries among these patients was, in fact, extremely low (only 0.7%), and in approximately half of these cases, they had other serious injuries that needed urgent medical attention.
“Our absolute focus on movement minimization works perhaps for 0.3% of patients, but it lengthens trapping time for 99.7% of them,” Nutbeam said. “Potentially, hundreds of people in this country have died as a result of prolonged trapping times, and if you multiply it worldwide, there are many, many people.”
Nutbeam and colleagues fixed motion sensors on healthy volunteers and measured their neck and spine movements as they were extracted from various vehicle accident scenarios, using different techniques.
Although these experiments are ongoing, early results have suggested that the movements of the spine associated with assisted abstraction are much greater than when volunteers are allowed to get out of the wreckage, and that assisted extraction techniques rapid produced movements similar to the slower ones intended to minimize movement. .
In other words, the more movements a patient can make on their own, the less movement of the spine is likely to be associated with it. While patients with genuine spinal cord injuries will still require a gentle approach, “probably self-stretching when possible will be better, regardless of the type of injury,” Nutbeam said.
Currently, only around 3% of UK fire and rescue services use self-extension on a regular basis, but this is likely to change as a result of these studies.
In a consensus paper, UK stakeholders, including the National Fire Chiefs Council (NFCC) and the College of Paramedics, reviewed existing evidence and agreed on a set of principles for future guidance.
These include a recommendation that automatic or minimally assisted extraction should be the standard “first line” for trapped patients who are aware and likely to be able to stand with care, and that the goal for all patients should be of being to minimize trapping time.
“This research will reduce both deaths and disabilities and help us achieve our vision of zero deaths and serious injuries on UK roads,” said Sally Lines, CEO of Road Safety Trust, which funded the study. “We hope that the practical application of this research will be used by the emergency services.”
The UK Rescue Organization (UKRO) has already adopted the new principles for its extrication challenge in September 2022, in which UK rescue teams and firefighters compete to free people from various difficult scenarios.
They should also allow fire crews to develop new extraction techniques, such as dragging vehicles out of obstacles, with victims still inside them, said James Coomber, a traffic collision instructor for UKRO. “Without 360-degree access, ambulance staff often struggle to fully expose and assess patients, resulting in significant injuries or delays in treatment being lost. Adopting these new principles and reconsidering techniques such as relocation of the vehicle, we can [potentially] reduce this extraction time, increasing your chances of survival. “
The NFCC is also planning more testing, in light of Nutbeam’s research. “The main goal of the UK Fire and Rescue Service is to save lives and prevent injuries, so we will always seek to update and change guidelines,” said Chris Lowther, chairman of the NFCC operations committee. “As a result of this research, more work will be done on what extrication might look like [performed]. Once we have that, we will look at how any changes could be made to our national operational guide. “