Table 2 Statements considered and SME voting
Statement | Yes (%) | No (%) | Opt Out (%) |
|---|---|---|---|
Is self-extrication appropriate if the casualty is experiencing neck or back pain | 92 | 3 | 5 |
Is self-extrication appropriate if there are soft neurological signs (e.g. non-dermatomal tingling) | 92 | 0 | 8 |
Is self-extrication appropriate if central cord signs? | 74 | 9 | 17 |
Actions if hard neurological signs present on initial assessment (e.g. patient unable to move legs) (1) Aim for rapid extrication with gentle patient handling (not absolute movement minimisation) | 92 | 0 | 8 |
Actions if neurological signs evolve during self-extrication: (1) Provide immediate support/assisted self-extrication (2) Continue with self-extrication if possible (3) If not possible: Aim for rapid extrication with gentle patient handling (not absolute movement minimisation) | 100 | 0 | 0 |
Empowerment of FRS personnel to risk stratify and deliver self-extrication: (1) FRS personnel should be enabled (with appropriate training and governance structures) to deliver self-extrication and assisted self-extrication across all patients. FRS should ensure that this assessment and delivery skill-set is widely available to their patients (2) The U-STEP OUT algorithm can be used by all FRS personnel | 97 | 0 | 3 |
Empowerment of lay persons on scene to deliver self-extrication and define limits of this practice (1) The U-STEP OUT algorithm in various forms (app/visual prompt/telephone guided) can be used by lay members of the public and other responding professional groups (e.g. police) following further translational work | 100 | 0 | 0 |
Communication on scene/development of shared language/tools. A standardised, national, multi-professional communication tool should be developed, disseminated and appropriate training and oversight provided to ensure adoption into practice | 100 | 0 | 0 |
Location of patients post-extrication (1) All patients should be moved to an environmentally safe location (e.g. away from an active highway/under appropriate cover) (2) Patients who self-declare as uninjured or minor injuries and able to meet their own needs should be identified as not requiring further clinical assessment and their details passed to NHS Ambulance service control centre (3) Communication between FRS and clinical response prior to arrival should occur and look to: (A) Optimise patient outcome/experience (B) Optimise the use and availability of clinical and operational resource | 100 | 0 | 0 |
Training: The U-STEP OUT algorithm in various forms (app/visual prompt/telephone guided) can be used by lay members of the public and other responding professional groups (e.g. police) following further translational work A multi-disciplinary training package should be developed and made available which empowers clinicians and FRS to deliver self-extrication and assisted self-extrication | 97 | 0 | 3 |
The U-STEP OUT tool could be applied to a person of any age who is able to understand | 100 | 0 | 0 |
Ratification of Figure: Extrication Decision Tool | 94 | 0 | 6 |