Patient-Centred Extrication Planning
A Modern Approach to Road Traffic Collision Rescue
The Paradigm Shift
Extrication is now viewed as a complex medical intervention, not just a technical rescue. This approach prioritizes the patient's clinical needs, safety, dignity, and preferences over rigid, vehicle-focused procedures. The goal is to reduce preventable deaths, mitigate harm, and provide safer, faster, and more compassionate extrications.
"Moving away from rigid protocols to dynamic risk assessment and shared decision-making."
Evolving Practices: Then vs. Now
Traditional Approach (Historically)
- Focus on spinal immobilisation (often invasive).
- Overestimation of unstable spinal injuries.
- Potential delays in critical care.
- Procedure-led and tool-dominated.
- Rigid protocols.
- Spinal protection-focused.
Patient-Centred Approach (Now)
- Prioritises patient's clinical needs & self-extrication.
- Evidence-informed, dynamic risk assessment.
- Reduces harm and respects dignity.
- Patient-led, clinically & biomechanically informed.
- Time-conscious and urgent.
- Harm minimisation and outcomes-focused.
Why Prioritise a Patient-Centred Approach?
Supports Time-Critical Interventions
Reduces delays for life-saving care.
Prevents Secondary Harm
Minimises risks of further injury or deterioration.
Prioritises Patient Needs & Voice
Considers dignity, comfort, and self-extrication potential.
Enables Safe Systems of Work
Coordinates actions in complex environments.
Facilitates Coordination
Supports command, control, and multi-agency collaboration.
Supports Learning & Investigation
Aids post-incident review and improvement.
Core Pillars of Patient-Centred Extrication
Patient-Led
Focus on individual clinical needs and capacity.
Clinically Informed
Decisions guided by medical assessment & biomechanics.
Time-Conscious
Urgent action to minimise delays to definitive care.
Harm Minimisation
Focus on best outcomes, reducing physical & psychological harm.
The Patient-Centred Extrication Process
1. Scene Survey & Dynamic Risk Assessment (DRA)
Establish command, assess hazards, initial plan feasibility.
2. Assess Casualty (Triage Sieve)
Prioritise based on clinical urgency (P1, P2, P3), note red flags.
3. Determine Entrapment Type (Extrication Decision Tool)
Classify as Physical, Medical, or Psychological entrapment.
4. Assess Self-Extrication Potential (U STEP OUT Model)
If not physically trapped, use criteria to check if patient can self-extricate safely.
5. Confirm/Develop Final Extrication Plan
Choose method: Self-extrication, Minimally Assisted, or Tool-Based. Brief team.
6. Implement & Continuously Monitor
Execute plan, reassess patient, monitor risks, maintain communication.
7. Document, Debrief & Justify
Record rationale, conduct hot debrief, support learning.
Essential Decision-Making Tools
Dynamic Risk Assessment (DRA)
Continually evaluate benefit vs. harm throughout the operation.
Vehicle Data Sheets
Identify vehicle-specific hazards (Moditech, Euro NCAP).
Triage Sieve
Prioritise casualties based on clinical urgency.
Extrication Decision Tool (Exit Project)
Standardise decision for safest, fastest, most appropriate removal method.
U STEP OUT Model
Assess if a casualty is safe and suitable to self-extricate.
"These tools empower all personnel on scene to contribute to the extrication strategy, moving beyond 'one-size-fits-all' models."
Collaborative Team Roles & Responsibilities
Incident Commander
Leads & coordinates. Ensures safety, effective communication, and proportionate decision-making. Facilitates use of decision tools. Balances safety with clinical need. Liaises with other agencies.
Focus: Safety, Scene Control, Coordination, Justification.
Medic / Clinical Lead
Assesses & manages clinical needs. Applies Triage Sieve. Advises on contraindications to movement. Supports U STEP OUT. Recommends extrication method based on clinical status. Provides care & reassurance.
Focus: Clinical Urgency, Trauma-Informed Care, Timing, Risk of Deterioration.
Tool Operator / Technician
Provides technical capability. Conducts vehicle risk assessment. Consults data sheets. Advises on technical options for space creation & stabilisation. Applies tools safely and proportionately.
Focus: Technical Safety, Tool Efficiency, Casualty Protection, Hazard Control.
Success depends on effective communication and mutual respect between all roles.
The Future of Extrication
Patient-centred extrication planning is a progressive shift. By embedding these principles and tools into training and operations, emergency services can deliver safer, faster, and more human-centred rescues, ultimately improving casualty outcomes and upholding the values of dignity and professionalism.