Research recommends safer approach to removing casualties from car accidents

Medical Xpress / Univ. of Plymouth / Scand. Jrnl. of Trauma, Resuscitation and Emerg. Med / BMJ Open ^ | August 8, 2022 | Tim Nutbeam et al

[ConservativeMind]

A revised approach to how emergency services respond to motor vehicle collisions (MVCs) could help to save lives.

In 2021 a total of 127,967 casualties and 1,560 deaths were caused by MVCs in England. Of these, more than 7,000 patients needed to be assisted to leave their vehicle. This often involves trained Fire and Rescue personnel using the "Jaws of Life" (a hydraulic apparatus) and other similar tools in order to free people. During this process, patients remain in their vehicle for an average of 30 minutes while slow, careful movements are used, in an attempt to avoid spinal injuries.

However, this approach of "movement minimization" is in fact rather outdated and could be causing more harm to patients.

In recent studies utilizing the Trauma Audit Research Network (TARN) database, Professor Tim Nutbeam suggested together with colleagues that spinal cord injuries after MVCs are actually quite rare, only affecting around 0.7% of all extrications. The benefit of current methods used for extrication may therefore be outweighed by the additional time taken to perform these maneuvers, and for the 99.3% of patients who do not have a spinal injury, spending unnecessary time trapped in a car is linked to increased mortality rates due to other time-critical injuries.

The early results also show that casualties who are able to climb out of the wreckage themselves are more likely to be able to lessen their spinal movement, thus reducing the potential for spinal injury.

Nutbeam said: "Firefighters have been trained in the approach of absolute 'movement minimization' since the 1980s, having been told that just 1mm of movement could turn someone into a wheelchair user. So understandably, crews will often disassemble a car around a patient. But this can actually cause more harm to those trapped, due to the length of time taken.

[ConservativeMind]

This is something that should be immediately shared with emergency crews, especially paramedics.

[ConservativeMind]

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[Delta 21]

The only time you use the Jaws is if the people can not be extracted by lesser means.

[TexasGator]

“The only time you use the Jaws is if the people can not be extracted by lesser means.”

The problem is not with the use of the Jaws but with excessive intent on minimizing movement of the victim leading to delayed treatment of injuries.

“A new set of principles are now recommended, including that self or minimally assisted extrication should be the standard first line approach for patients who are conscious and likely to be able to stand without assistance, and minimizing entrapment time should be the goal for all patients.

“A new set of principles are now recommended, including that self or minimally assisted extrication should be the standard first line approach for patients who are conscious and likely to be able to stand without assistance, and minimizing entrapment time should be the goal for all patients.”

[moovova]

[Albion Wilde]

Various articles about the loon Anne Heche opined that her body was literally cooked, being inside the burning car for 30 minutes.

[The Great RJ]

I received my original EMT certification 50 years ago and back in the good old days we were taught to use cervical collars, long spine boards and the devilishly hard to use short spine boards. Over 20 years as an EMT, I saw better extrication technologies, but the rule was always to immobilize before moving accident victims. I think this research is very helpful to Improving pre hospital emergency care. That said we were alway conscious of our on scene time. Research on casualty management in the Viet Nam war revealed the “golden hour” where survival of serious trauma victims was optimized when they could be gotten to a trauma specialty center within one hour. Only a few times in my two decades of being an EMT did I see serious extrication in an auto accident. However, there were numerous times when extrication was not needed and we took all the precautions about spine immobilization and increased our time on scene as a result. I am happy that this research will lead to better extrication protocols and possibly simpler extrication technologies.