Abstract
Background Motor vehicle collisions (MVCs) are a leading cause of injury and death worldwide. Up to 40% of
casualties may become trapped and entrapment is associated with delayed care and worse outcomes. There is little
national or international consensus guiding the care of physically trapped patients who cannot self-extricate. This
study aimed to develop multidisciplinary consensus-based principles to optimise clinical and operational care for
trapped patients following MVC.
Methods A three-round Delphi study was conducted from January to March 2025, following the CREDES framework.
A multi-professional steering group developed preliminary statements informed by literature review and expert
consultation. Subject matter experts (SMEs) with operational experience in extrication, prehospital, and trauma
care were recruited through stakeholder organisations. Statements were refined iteratively through SME feedback.
Consensus was defined as ≥ 70% agreement or disagreement. Statements reaching consensus were removed from
subsequent rounds; others were revised based on free-text feedback.
Results Sixty-six SMEs participated, with high engagement across all three rounds. Consensus was achieved for 104
statements covering standardised extrication terminology, prioritisation of time-sensitive extrication for critically
injured patients, minimisation of unnecessary on-scene interventions, emphasis on early psychological support for
trapped casualties, and the importance of interdisciplinary communication and coordination. The consensus supports
a paradigm shift towards rapid, patient-centred extrication, balancing clinical needs, operational realities, and
psychological welfare.
Conclusions This Delphi study establishes expert-endorsed principles for the care of physically trapped patients
following MVCs. Adoption of these principles could reduce delays, strengthen multi-agency response and improve
patient outcomes. Further work is required to validate the impact of these recommendations on clinical outcomes
and to support their integration into practice through policy development, training, and evaluation.
casualties may become trapped and entrapment is associated with delayed care and worse outcomes. There is little
national or international consensus guiding the care of physically trapped patients who cannot self-extricate. This
study aimed to develop multidisciplinary consensus-based principles to optimise clinical and operational care for
trapped patients following MVC.
Methods A three-round Delphi study was conducted from January to March 2025, following the CREDES framework.
A multi-professional steering group developed preliminary statements informed by literature review and expert
consultation. Subject matter experts (SMEs) with operational experience in extrication, prehospital, and trauma
care were recruited through stakeholder organisations. Statements were refined iteratively through SME feedback.
Consensus was defined as ≥ 70% agreement or disagreement. Statements reaching consensus were removed from
subsequent rounds; others were revised based on free-text feedback.
Results Sixty-six SMEs participated, with high engagement across all three rounds. Consensus was achieved for 104
statements covering standardised extrication terminology, prioritisation of time-sensitive extrication for critically
injured patients, minimisation of unnecessary on-scene interventions, emphasis on early psychological support for
trapped casualties, and the importance of interdisciplinary communication and coordination. The consensus supports
a paradigm shift towards rapid, patient-centred extrication, balancing clinical needs, operational realities, and
psychological welfare.
Conclusions This Delphi study establishes expert-endorsed principles for the care of physically trapped patients
following MVCs. Adoption of these principles could reduce delays, strengthen multi-agency response and improve
patient outcomes. Further work is required to validate the impact of these recommendations on clinical outcomes
and to support their integration into practice through policy development, training, and evaluation.
| Original language | English |
|---|---|
| Article number | 137 |
| Journal | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Volume | 33 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 11 Aug 2025 |
ASJC Scopus subject areas
- Emergency Medicine
- Critical Care and Intensive Care Medicine
Keywords
- Emergency medical services
- Extrication
- Prehospital care
- Rescue
- Road injury
- Trapped
