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Tim Nutbeam and Clare Bosanko에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Tim Nutbeam and Clare Bosanko 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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Extrication

1:09:40
 
공유
 

Manage episode 341235627 series 165883
Tim Nutbeam and Clare Bosanko에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Tim Nutbeam and Clare Bosanko 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.

Road traffic collisions are a leading cause of death and injury. Following a road traffic collision many patients will remain trapped in their vehicle. Extrication is the process by which injured or potentially injured people are removed from their vehicle by the rescue services.

Rescue service training focuses on the absolute movement minimisation of potentially injured patients’ spine and has developed extrication techniques with the focus of movement minimisation. Unfortunately these techniques take significant amounts of time (30 minutes plus); this delays access to potentially lifesaving treatments for injuries.

In this Road Safety Trust funded project, the EXIT team across nine published academic studies reconsider extrication, provide evidence of harm, demonstrate that current techniques do not minimise movement as intended and provide a framework of principles for evidence-based extrication:

Operational and clinical team members should work together to develop a bespoke patient centred extrication plan with the primary focus of minimising entrapment time
Independent of actual or suspected injuries patients should be handled gently. A focus on absolute movement minimisation is not justified
When clinicians are not available, FRSs should where necessary assess patients, deliver clinical care and make and enact extrication plans (including self-extrication)1
Self-extrication or minimally assisted extrication should be the standard ‘first line’ extrication for all patients who do not have contraindications, which are:
-An inability to understand or follow instructions,
-Injuries or baseline function that prevents standing on at least one leg, (specific injuries include: unstable pelvic fracture, impalement, bilateral leg fracture)
All patients with evidence of injury should be considered time-dependent and their entrapment time should be minimised
Incidents where a patient may require disentanglement are complex and associated with a high morbidity and mortality. A senior FRS and clinical response should attend such instances2
Clinical care during entrapment:
-Can be delivered by FRS or clinical services1
-Should be limited to necessary critical interventions to expedite safe extrication3
-Rescuers should be aware that clinical observations may prolong entrapment time and as such should be kept to the minimum
-FRS and clinical personnel should be aware of the physical and observable signs of patient deterioration and if identified should make this known to the responsible clinician
Immobilisation:
-Longboards are an extrication device and should not be used beyond the extrication phase
-Kedrick Extrication Devices prolong extrication time and their use should be minimised
-Pelvic slings should not be applied to patients until they have been extricated
-Cervical collars should only be used following assessment and should be loosened or removed following extrication
Patient focused extrication:
-Build a connection with patients, explain actions, and use their name
-Where appropriate, reassure patients as to the safety of their co-occupants and others involved in the incident (including animals)
-Provide an ‘extrication buddy’
-Allow communication with family members or other close contacts
-Rescue teams should not publish extrication related imagery to social media or other outlets
-Minimise the ability of the public to view the accident, take photographs or record videos. Provide education to this effect
On initial call to Emergency Services
-Attempt to clarify entrapment status
-Attempt to identify patients who require disentanglement (and dispatch an appropriate priority senior2 response)
-A standard multi-agency MVC trauma message should be developed to ensure the correct resources are deployed
Multi-professional datasets should be developed with patient and public engagement and should include entrapment status, entrapment time, injuries, extrication approach, clinical care
Agreed nomenclature for categories of patient
Not injured, Minor injuries (evidence of energy transfer but no evidence of time-dependent injury), Major injury (currently stable but should be assumed to be time-dependent), Time critical injured (Time critical due to injury; use fastest route of extrication) m Time critical hazard (e.g. secondary to fire or other hazard)

These principles have been adopted by national level stakeholders in the UK are being incorporated into national clinical and operational guidance which will reduce entrapment time and may demonstrate morbidity and mortality reductions.

Links to papers:

  1. Nutbeam T, Fenwick R, Smith JE, Bouamra O, Wallis L, Stassen W. A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped. Scand J Trauma Resusc Emerg Medicine 29, 17 (2021).
  • Nutbeam, T. Fenwick R, May B, Stassen W,Smith JE, Bowdler J, Wallis L, Shippen J. Comparison of ‘chain cabling’ and ‘roof off’ extrication types, a biomechanical study in healthy volunteers. In press; Injury
  • Nutbeam T, Brandling J, Wallis L, Stassen W. Understanding people’s experiences of extrication whilst being trapped in motor vehicles: a qualitative interview study. In press; BMJ Open

  continue reading

48 에피소드

Artwork

Extrication

PHEMCAST

141 subscribers

published

icon공유
 
Manage episode 341235627 series 165883
Tim Nutbeam and Clare Bosanko에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Tim Nutbeam and Clare Bosanko 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.

Road traffic collisions are a leading cause of death and injury. Following a road traffic collision many patients will remain trapped in their vehicle. Extrication is the process by which injured or potentially injured people are removed from their vehicle by the rescue services.

Rescue service training focuses on the absolute movement minimisation of potentially injured patients’ spine and has developed extrication techniques with the focus of movement minimisation. Unfortunately these techniques take significant amounts of time (30 minutes plus); this delays access to potentially lifesaving treatments for injuries.

In this Road Safety Trust funded project, the EXIT team across nine published academic studies reconsider extrication, provide evidence of harm, demonstrate that current techniques do not minimise movement as intended and provide a framework of principles for evidence-based extrication:

Operational and clinical team members should work together to develop a bespoke patient centred extrication plan with the primary focus of minimising entrapment time
Independent of actual or suspected injuries patients should be handled gently. A focus on absolute movement minimisation is not justified
When clinicians are not available, FRSs should where necessary assess patients, deliver clinical care and make and enact extrication plans (including self-extrication)1
Self-extrication or minimally assisted extrication should be the standard ‘first line’ extrication for all patients who do not have contraindications, which are:
-An inability to understand or follow instructions,
-Injuries or baseline function that prevents standing on at least one leg, (specific injuries include: unstable pelvic fracture, impalement, bilateral leg fracture)
All patients with evidence of injury should be considered time-dependent and their entrapment time should be minimised
Incidents where a patient may require disentanglement are complex and associated with a high morbidity and mortality. A senior FRS and clinical response should attend such instances2
Clinical care during entrapment:
-Can be delivered by FRS or clinical services1
-Should be limited to necessary critical interventions to expedite safe extrication3
-Rescuers should be aware that clinical observations may prolong entrapment time and as such should be kept to the minimum
-FRS and clinical personnel should be aware of the physical and observable signs of patient deterioration and if identified should make this known to the responsible clinician
Immobilisation:
-Longboards are an extrication device and should not be used beyond the extrication phase
-Kedrick Extrication Devices prolong extrication time and their use should be minimised
-Pelvic slings should not be applied to patients until they have been extricated
-Cervical collars should only be used following assessment and should be loosened or removed following extrication
Patient focused extrication:
-Build a connection with patients, explain actions, and use their name
-Where appropriate, reassure patients as to the safety of their co-occupants and others involved in the incident (including animals)
-Provide an ‘extrication buddy’
-Allow communication with family members or other close contacts
-Rescue teams should not publish extrication related imagery to social media or other outlets
-Minimise the ability of the public to view the accident, take photographs or record videos. Provide education to this effect
On initial call to Emergency Services
-Attempt to clarify entrapment status
-Attempt to identify patients who require disentanglement (and dispatch an appropriate priority senior2 response)
-A standard multi-agency MVC trauma message should be developed to ensure the correct resources are deployed
Multi-professional datasets should be developed with patient and public engagement and should include entrapment status, entrapment time, injuries, extrication approach, clinical care
Agreed nomenclature for categories of patient
Not injured, Minor injuries (evidence of energy transfer but no evidence of time-dependent injury), Major injury (currently stable but should be assumed to be time-dependent), Time critical injured (Time critical due to injury; use fastest route of extrication) m Time critical hazard (e.g. secondary to fire or other hazard)

These principles have been adopted by national level stakeholders in the UK are being incorporated into national clinical and operational guidance which will reduce entrapment time and may demonstrate morbidity and mortality reductions.

Links to papers:

  1. Nutbeam T, Fenwick R, Smith JE, Bouamra O, Wallis L, Stassen W. A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped. Scand J Trauma Resusc Emerg Medicine 29, 17 (2021).
  • Nutbeam, T. Fenwick R, May B, Stassen W,Smith JE, Bowdler J, Wallis L, Shippen J. Comparison of ‘chain cabling’ and ‘roof off’ extrication types, a biomechanical study in healthy volunteers. In press; Injury
  • Nutbeam T, Brandling J, Wallis L, Stassen W. Understanding people’s experiences of extrication whilst being trapped in motor vehicles: a qualitative interview study. In press; BMJ Open

  continue reading

48 에피소드

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