UL/UCD research challenges global car crash extrication protocols
An award winning study aimed at examining the techniques used by emergency services the world over to extricate a trapped car crash victim, while minimising the potential for spinal injury, is underway in a collaborative research project involving the University of Limerick, University College Dublin and Emergency Services in the Mid-West. It is estimated that up to 20, 000 cases of spinal cord injuries occur annually in Northern Europe and the USA with road traffic collisions (RTCs) the main cause of cervical spine injuries in most countries. The collaborative research project between the Centre for Prehospital Research (CPR) located within the Graduate Entry Medical School (GEMS), the Biomechanics Research Unit within the Physical Education and Sport Sciences (PESS) Department at the University of Limerick and the Centre for Emergency Medical Science (CEMS, UCD) won the award for Best Scientific Presentation at the National Association of Emergency Medical Services Physicians (NAEMSP) Annual Meeting in Bonita Springs, Florida this year. The project entitled "Biomechanical Analysis of Spinal Immobilisation during Prehospital Extrication: A Proof of Concept Study" was presented by Mark Dixon at the conference.
Global emergency services use a variety of techniques to enable onsite extrication of an entrapped patient from an RTC. The pilot research project found that existing protocols in relation to spinal immobilisation are based on custom and practice only, rather than on robust scientific evidence, therefore the research team set out to challenge some of the conventional wisdom around caring for patients of road traffic collisions. The results show that conventional extrication techniques may be improved for certain categories of patients. The evidence suggests that for certain groups of stable patients verbal extrication instructions provided by qualified paramedics may be more effective than utilising complicated extrication equipment and uncomfortable rescue hardware. The preliminary findings demonstrate that while seriously injured patients will still require the conventional technical approach certain groups of patients may have potential neck injuries reduced by following simple orchestrated steps narrated by suitably trained rescue personnel.
The researchers stated "If the findings of the preliminary trial are confirmed on a larger scale then this could have implications in the future for more comfortable, less complicated extrications of stable patients in road traffic collisions".
The research was conducted in collaboration with National Ambulance Service paramedics and Limerick Corporation fire-fighters. A male volunteer (weight 80 kg, height 180cm) was fitted with a cervical collar and underwent controlled extrications from a prepared motor vehicle with roof removed and standard safety procedures in place. A rescue crew consisting of four firefighter first responders and two paramedics performed eight different extrication techniques and cervical spine movement was measured throughout using 12 infrared motion analysis cameras for biomechanical analysis. Control measurements were taken from the patient during self-extrication under verbal instruction and a total movement of 6.6 degrees was recorded. In comparison, techniques using a long spinal board with or without an extrication device resulted in total movement ranging from 11.7 degrees minimum to 26.1 degrees maximum.
The findings of the research have been so compelling that a second phase of testing has now been funded by the Pre-hospital Emergency Care Council in Ireland and the European Falck Foundation with a view towards changing the current national and European extrication protocols.
The research has also recently been published in the Emergency Medicine Journal. Phase 2 of the Project is currently in development and will commence in early 2014.