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Introduction
Extrication is the process of removing injured or potentially injured patients from vehicles involved in motor vehicle collisions (MVC). MVC are the commonest cause of major trauma in the UK. 1 Of these patients approximately 12% are trapped. 2 An additional large number of injured patients not fulfilling major trauma criteria will also require extrication. 3
Timely and aggressive care for trauma patients is associated with improved outcomes. 4-6 Prehospital time consists of extrication, additional on-scene time and transport time; extrication makes up a significant but unknown proportion of this. The time taken for extrication has not been adequately studied, although prolonged extrication (>20 min) has previously been a feature of accepted major trauma triage criteria. 3 Prolonged extrication may be associated with worse outcomes. 7-9 The process of both entrapment and extrication may prevent or significantly limit any required medical interventions.
There are a number of necessary steps undertaken by fire crews before patient extrication. During training the fire personnel are taught the 'crew approach', which provides a standard methodology to the extrication process. 10 Utilisation of this approach provides team synergy in time-critical situations. Traditionally, these teams consist of only fire and rescue personnel with little integration or joint training between fire and rescue teams and the prehospital healthcare response.
The six elements of extrication addressed by the crew approach are: Scene assessment and safety
Stabilisation
Glass management
Initial access
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Patient immobilisation and final extrication.
Scene assessment and safety
The scene of MVC is inherently dangerous for both patients and emergency services personnel. A safe scene is therefore the first priority for a rescue or medical response at an MVC. Dangers include those that may be immediately apparent; for example, fire or ongoing traffic movements, and those that may be more subtle; for example, chemical spills, undeployed airbags, etc. These hazards will be addressed by fire and rescue personnel before extrication commences. The time it takes to address safety issues will be dependent on the scene and can be as simple as the application of correct personal protective equipment or as complex as the closure of multiple highways.
Stabilisation
The purpose of stabilisation is to offer a stable platform for extrication and the delivery of care. Stabilisation reduces the potential...