Statement | Level of evidence [15] | Key references |
---|---|---|
All patients with injury should be considered time dependent. Operational and clinical team members should work together to rapidly develop a bespoke patient centred extrication plan with the primary focus of minimising entrapment time | [IV D] | |
Non-clinicians should be empowered to decide on the extrication mode and deliver this before the arrival of the clinical team | [IV D] | [18] C |
Self-extrication or minimally assisted extrication should be the standard ‘first line’ extrication for all patients who do not have contraindications | [III D] | |
Self-extrication decision making for non-clinicians should use an appropriate tool, such as U-STEP OUT | [IV D] | C |
Patients who cannot independently self-extricate may benefit from assisted self-extrication | [IV D] | [8] C |
In fully conscious patients who do not have neurology it is not necessary to provide manual inline stabilisation in the vehicle | [IV D] | |
If hard neurological signs are present on initial assessment the patient should have a rapid extrication with gentle patient handling | [IV D] | [4] C |
Collars reduce neck movement. They should be applied prior to extrication when indicated and removal considered when the extrication phase is complete | [III D] | |
Vehicle relocation, including vehicles in which patients are trapped should be implemented if this will reduce entrapment time | [IV D] | [2] C |
Rescuers should be aware that clinical observations may prolong entrapment time and as such should be kept to a minimum | [IV D] | |
Clinical care during entrapment should be limited to necessary critical interventions to expedite safe extrication | [IV D] | |
If a pelvic binder is indicated this should be applied after the process of extrication is complete | [IV D] | S |
The psychological impact of extrication should be considered and support mechanisms implemented | [III D] | |
FRS services /brigades and ambulance trusts should ensure regular joint multidisciplinary learning, sharing and case review opportunities | [IV D] | C |