EXIT: Vehicle Extrication

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In recent years there have been huge advances in the evidence base surrounding vehicle extrication, that is, extrication of patients from vehicles.

A lot of that work has been done by the EXIT Project; a group of researchers based in the UK. Their goal, in summary, was to:

Apply scientific rigour and

trial methodology to the field of Post Collision Response.

And through a cluster of studies, they were able to do this, and as a result change the way in which we approach an injured (or uninjured) patient in a vehicle.

The EXIT Team outline their work in this 18 minutes video:

For those of you with shorter attention spans, here is a 1 minute summary of their findings!

The main take home messages (as summarised on this great page at St Emlyn’s) from the EXIT Project are:

  • Assisted extrication does not result in a reduced spinal movement as compared to self extrication and may even result in more spinal movement
  • Many patients can self extricate
  • Self extrication is faster than assisted extrication
  • Unstable spinal injury is relatively rare
  • If spinal cord injury is to occur then it will probably have occured at the point of impact and during extrication which inevitably has a lower kinetic energy peak

Therefore, it is safe to apply the following principles:

  1. Self extrication (where practicable) is the appropriate first line method for patients who are:
    • Awake & able to follow instruction
    • Able to stand on (at least) one leg
  2. Aim for gentle handling rather than strict immobilisation if assistance needed during extrication.
  3. Inappropriate spinal immobilisation risks delayed diagnosis of other time critical conditions.
  4. Interventions when entrapped should be minimised to those that are absolutely essential.
  5. Entrapment times should be minimised.
  6. Patients who need to be disentangled are at high risk of time critical injury and therefore they are also at risk if extrication is delayed.

The National Fire Chiefs Council phrased it slightly differently:

“Self-extrication or minimally assisted extrication should be the standard ‘first line’ extrication, unless one or more of the following contraindications are present:

  • An inability for the casualty to understand or follow instructions
  • The casualty is unable to stand, or it is suspected they would be unable to stand, either due to injury or another condition, for example:
    • Suspected pelvic fracture
    • Impalement
    • Suspected or confirmed Leg fractures
    • Signs of dizziness or confusion in the casualty”