Decision-Making Frameworks for Vehicle Extrication in Prehospital Trauma Care: A Scoping Review.

INTRODUCTION

Vehicle extrication is a critical prehospital phase for patients trapped in motor vehicle collisions. Historically driven by rigid technical protocols, recent evidence suggests a shift toward clinically oriented, multidisciplinary decision-making. This scoping review aims to synthesize current evidence on extrication frameworks and their impact on clinical care.

METHODS

A scoping review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Major databases were searched for studies describing decision-making frameworks, algorithms, or clinical pathways for the extrication of trapped trauma patients.

RESULTS

Eleven key studies and frameworks were identified. Findings suggest an emerging transition from routine spinal immobilization to selective Spinal Motion Restriction. Biomechanical studies included in the review reported lower spinal movement during guided self-extrication in selected stable scenarios, although this evidence is mainly derived from experimental or simulation-based settings. Contemporary frameworks emphasize the roles of physiological and anatomical assessment, multidisciplinary coordination, and shared decision-making between clinical and technical rescue teams. Emerging themes include mitigating hypothermia risk and managing psychological sequelae following entrapment.

DISCUSSION: Extrication is evolving into a dynamic clinical intervention. Transitioning to evidence-based pathways requires integrating clinical triage, selective spinal motion restriction, and thermal protection. For emergency nurses, this implies a leadership role in field triage and patient advocacy, ensuring that technical procedures do not compromise clinical outcomes. Implementing patient-centered extrication frameworks may contribute to reducing scene times and secondary morbidity, although further prospective validation is required. Future research should focus on prospectively validating these algorithms in real-world trauma settings to confirm their impact on long-term survival.