Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study
Abstract Background Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuries and poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which early interventions are both necessary and feasible in the preho...
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BMC
2025-08-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01451-x |
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| author | Tim Nutbeam Rob Fenwick Ian Marritt Brian Lee Luke Staveley-Wadham Nigel Lang Louise Johnson Nicolas Mattock Jane Ogilvie Emily Foote Francis Screech Lara Lebeau–Humarau Caroline Leech |
| author_facet | Tim Nutbeam Rob Fenwick Ian Marritt Brian Lee Luke Staveley-Wadham Nigel Lang Louise Johnson Nicolas Mattock Jane Ogilvie Emily Foote Francis Screech Lara Lebeau–Humarau Caroline Leech |
| author_sort | Tim Nutbeam |
| collection | DOAJ |
| description | Abstract Background Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuries and poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which early interventions are both necessary and feasible in the prehospital setting. This study aims to develop expert consensus on injury categorisation and the delivery of early care interventions to guide clinical and operational decision-making at the scene. Methods A modified Delphi method was used to gather consensus from a multidisciplinary panel of subject matter experts, including clinicians, paramedics, and members of fire and rescue services. In Round 1, participants contributed to the development of draft statements relating to injury time sensitivity, intervention prioritisation, and responder roles. In Rounds 2 and 3, participants rated their level of agreement with these refined statements. A final face-to-face consensus meeting was held to discuss statements that had not yet reached consensus, explore areas of disagreement, 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-critical interventions, and multi-agency responsibilities. Participants strongly endorsed the early delivery of analgesia, tranexamic acid, and protection from environmental stressors, regardless of provider background, provided that appropriate training and governance are in place. There was broad support for expanding the scope of practice of non-clinical responders to meet urgent patient needs. Conclusions This Delphi consensus provides a framework for prioritising early interventions in the care of trapped patients. 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 heuristics and address barriers to implementation. |
| format | Article |
| id | doaj-art-2e2229cb411c4d958837d754f348e8cf |
| institution | Kabale University |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-2e2229cb411c4d958837d754f348e8cf2025-08-24T11:47:48ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-08-0133111110.1186/s13049-025-01451-xPrioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi studyTim Nutbeam0Rob Fenwick1Ian Marritt2Brian Lee3Luke Staveley-Wadham4Nigel Lang5Louise Johnson6Nicolas Mattock7Jane Ogilvie8Emily Foote9Francis Screech10Lara Lebeau–Humarau11Caroline Leech12IMPACT; Centre for Post-Collision Research Innovation and TranslationIMPACT; Centre for Post-Collision Research Innovation and TranslationUnited Kingdom Rescue Organisation, World Rescue Organisation, Humberside Fire and RescueIMPACT; Centre for Post-Collision Research Innovation and TranslationUniversity Hospitals Plymouth NHS TrustDevon Air AmbulanceLeeds Teaching Hospitals NHS TrustNational Police Chiefs’ CouncilScottish Fire and Rescue ServiceUniversity Hospitals Plymouth NHS TrustUniversity Hospitals Plymouth NHS TrustUniversity of PlymouthUniversity Hospitals Coventry & Warwickshire NHS TrustAbstract Background Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuries and poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which early interventions are both necessary and feasible in the prehospital setting. This study aims to develop expert consensus on injury categorisation and the delivery of early care interventions to guide clinical and operational decision-making at the scene. Methods A modified Delphi method was used to gather consensus from a multidisciplinary panel of subject matter experts, including clinicians, paramedics, and members of fire and rescue services. In Round 1, participants contributed to the development of draft statements relating to injury time sensitivity, intervention prioritisation, and responder roles. In Rounds 2 and 3, participants rated their level of agreement with these refined statements. A final face-to-face consensus meeting was held to discuss statements that had not yet reached consensus, explore areas of disagreement, 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-critical interventions, and multi-agency responsibilities. Participants strongly endorsed the early delivery of analgesia, tranexamic acid, and protection from environmental stressors, regardless of provider background, provided that appropriate training and governance are in place. There was broad support for expanding the scope of practice of non-clinical responders to meet urgent patient needs. Conclusions This Delphi consensus provides a framework for prioritising early interventions in the care of trapped patients. 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 heuristics and address barriers to implementation.https://doi.org/10.1186/s13049-025-01451-xRoad injuryEmergency Medical ServicesRescueExtricationTrappedPrehospital Care |
| spellingShingle | Tim Nutbeam Rob Fenwick Ian Marritt Brian Lee Luke Staveley-Wadham Nigel Lang Louise Johnson Nicolas Mattock Jane Ogilvie Emily Foote Francis Screech Lara Lebeau–Humarau Caroline Leech Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Road injury Emergency Medical Services Rescue Extrication Trapped Prehospital Care |
| title | Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study |
| title_full | Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study |
| title_fullStr | Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study |
| title_full_unstemmed | Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study |
| title_short | Prioritising time-critical injuries and interventions for trapped motor vehicle collision patients: a Delphi study |
| title_sort | prioritising time critical injuries and interventions for trapped motor vehicle collision patients a delphi study |
| topic | Road injury Emergency Medical Services Rescue Extrication Trapped Prehospital Care |
| url | https://doi.org/10.1186/s13049-025-01451-x |
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