ORCID

Abstract

Background Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuriesand poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which earlyinterventions are both necessary and feasible in the prehospital setting. This study aims to develop expert consensuson injury categorisation and the delivery of early care interventions to guide clinical and operational decision-makingat the scene.Methods A modified Delphi method was used to gather consensus from a multidisciplinary panel of subjectmatter experts, including clinicians, paramedics, and members of fire and rescue services. In Round 1, participantscontributed to the development of draft statements relating to injury time sensitivity, intervention prioritisation, andresponder roles. In Rounds 2 and 3, participants rated their level of agreement with these refined statements. A finalface-to-face consensus meeting was held to discuss statements that had not yet reached consensus, explore areas ofdisagreement, and conduct further voting where appropriate. Consensus was defined as ≥ 70% agreement.Results Consensus was achieved on 45 statements across the domains of injury categorisation, time-criticalinterventions, and multi-agency responsibilities. Participants strongly endorsed the early delivery of analgesia,tranexamic acid, and protection from environmental stressors, regardless of provider background, provided thatappropriate training and governance are in place. There was broad support for expanding the scope of practice ofnon-clinical responders to meet urgent patient needs.Conclusions This Delphi consensus provides a framework for prioritising early interventions in the care of trappedpatients. It supports a patient-centred, capability-based approach to prehospital care, emphasising feasibility, urgency,and ethical responsibility. Findings should inform the development of standard operating procedures, triage tools,and training frameworks across emergency services, with further research needed to validate assessment heuristicsand address barriers to implementation.

Publication Date

2025-08-19

Publication Title

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Volume

33

Issue

1

ISSN

1757-7241

Acceptance Date

2025-08-01

Deposit Date

2025-10-10

Funding

This study is funded by a charitable grant from the Road Safety Trust. The Road Safety Trust had no role in the design, data collection, analysis or writing of this manuscript.

Keywords

Emergency Medical Services, Extrication, Prehospital Care, Rescue, Road injury, Trapped

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