Self-extrication in road traffic collisions: do we really need to cut the roof off?

Abstract

Road traffic collisions are commonly encountered in the pre-hospital environment, and extrication of vehicle occupants can be challenging. Allowing a person to self-extricate from the vehicle, rather than using the process of prolonged mechanical extrication (the process of removing a vehicle from around a person), can be beneficial to the patient in a number of ways. The chance of catastrophic spinal injury (in this case taken to mean ‘any spinal injury that results in permanent disability, long-term medical problems or shortened life expectancy’) is low, and self-immobilisation during the extrication process will mean the patient is capable of protecting any injury they may have, without making it worse in any way. This is supported when the physiology of the spine, and the kinetics involved in road traffic collisions are considered. In addition, the self-extrication method is likely to reduce the time to definitive care, potentially improving the outcomes for many patients. It will also reduce anxiety, mental trauma and an unnecessary use of resources. Inviting a patient to remove themselves from a car is not a declaration of an uninjured cervical spine, and so immobilisation must still be used, in line with local policy, once the patient is out of the vehicle. The author presents an algorithm to assist the pre-hospital clinician in deciding if self-extrication is appropriate. It is based on the alert, systemically well patient agreeing to the plan and being aware that they may change their mind at any time. The need for focused research on the mechanics of extrication, rather than methods of immobilisation, is encouraged with a view to a validated algorithm in the future.