The EXIT Project: Using U-STEP OUT Principles in Vehicle Accidents
Many patients will require extrication following a motor vehicle collision (MVC) however, little information exists on the time taken for the various stages of extrication. Dr. Tim Nutbeam, Rob Fenwick and their research team conducted research on the time it takes to extricate a patient and the positive results reducing time for extrication may have on their health.
The EXIT Project - Using U-STEP OUT Principles in Vehicle Accidents
by : Dr Tim Nutbeam and Rob Fenwick
In this article we will be taking a look at the USTEP Out protocol, which is a self-extrication practice. If you are unfamiliar with the EXIT Project watch this video and then continue reading here. Before discussing the USTEP Out protocol, we will look the supporting research. Recent research shows that rescuers should reduce extrication times. This can be done by recognizing that the old protocol (the absolute spinal movement minimization approach) was evolved due to a concern that excess movement may lead to avoidable secondary spinal injury, was never justified.
Further that this approach should instead be replaced – where it is in accordance with your rescue organization’s clinical governance – with:
1. an emphasis on rapid self or assisted extrication
2. and where this is not initially possible, the timely creation of minimum safe space through which the trapped person can subsequently self-extricate (or be extricated by rescuers focussing on the minimization of time rather than movement)
Process
With regard to rapid self or assisted extrication, the EXIT Project’s U STEP OUT protocol is detailed below, with example photos and commentary to follow:
1. U – Understand
While rescuer protection is paramount, if it is safe to do so a rescuer should raise their visor and lower any mask, thus facilitating effective communication with the patient. This is allow verification that the patient is fully responsive and that they understand their circumstance.
It is important that from the outset the rescuer allocated to support the patient explains to them what is going on and their method of extrication. The rescuer should listen to and manage the patients concerns and offer verbal guidance, as well as emotional and physical support as they leave the vehicle.
2. S - Support
Many patients who are capable of self-extrication will do so immediately after the collision. If they are capable but have chosen not to do this, then they will likely require a rescuer’s reassurance that they will be safe if they do so. The patient should agree to the plan, but the rescuers must be aware that they may change this preference and if so, be able to manage this.
3. T – Try moving
Ask the patient to move both their legs, if they cant they wont be able to self extricate
4. E – Egress
The door must be fully opened - consider the need to force it away from the patient if doing so will assist safe movement. Both the exit space and the identified egress path must be clear of all trip hazards and obstructions.
5. P – Plan
Determine where will the patient go on exit and ensure that a suitable means of support is available and nearby.
6. OUT
Offering an arm, with the patient using it to support their own movement is very low risk, compared to actively pulling the patient out of the vehicle.
Conclusion
The use of self or minimally assisted extrication will depend on the decision of the lead rescuers as to whether this option best suits their patient’s medical circumstances and needs.
The simple U STEP OUT protocol can be easily understood and used by all rescuers and will minimize patient entrapment time which will help ensure their earliest arrival to a medical care facility.