Rethinking Extrication

Dr. Tim Nutbeam, a consultant and professor of emergency and prehospital medicine at a major trauma center in Plymouth, UK, explains evidence that should change how teams manage vehicle entrapment. Key takeaways from the EXIT research program: self extrication often produces less spinal movement than complex “slow and steady” techniques; minimize entrapment time because clinical observations poorly predict rapid deterioration; pelvic binders mainly help rare open book fractures and may be unhelpful or contraindicated for the common lateral compression patterns; long spine boards are for extrication/transfer only; cervical collars can be removed or loosened once a conscious patient is ready to self move, but use briefly for rapid extrication of unconscious patients. Dr. Nutbeam also stresses the human side: assign an extrication buddy, explain noisy steps, hold a hand, and prioritize analgesia and oxygen.