Since the arrival of social media and the almost instantaneous exchange of thoughts, values and ideas, is it time to adopt a more global approach to the subject of vehicle extrication? Surely it should be the same all over the world and an international standard should be the future?
If we believe that an international standard should be no more than a framework which can be adopted by any rescue agency worldwide then my short answer is that this already exists for vehicle extrication and has done so for some considerable time.
The Team Approach was developed in the late 80s and early 90s as a result of research done by London HEMS (Helo Emergency Medical Service). It was really a multi-agency concept but proved to be extremely efficient for road traffic collisions, and I believe this is the most widely adopted and successful standard. Why do I think this? Well, over the last ten years I have travelled to over 100 countries and witnessed first-hand the use of the Team Approach. I have worked with rescue teams who have never heard of the Team Approach and yet carry out rescue as if they have always used this method; this cannot be coincidence and in my view that says everything about the validity and relevance of the concept. In addition, there are places I have visited where no standard approach had previously been adopted. The Team Approach allowed me to easily provide a structure to their extrication activities and training, allowing them to become safer and more efficient, casualty-centred rescuers. There is no doubt that this doctrine requires an update for modern day practice, and I have conceived, written and presented ‘The Team Approach v2.0’ (see link at end of article), but the original concept has served us well for some considerable time.
If, however, we believe that an international standard should be fully prescriptive and detail each element of extrication, using perceived (or agreed) best practice, then we are a long way from realising this and we probably never will. Whilst I have my own views on the best methods of stabilisation, glass management and space creation, vehicle extrication is about having as many options as possible. Prescribing the best methods and implementing them into an international standard is at best restrictive and at worst potentially dangerous. In addition, a fully prescriptive approach will never be able to take into account local practices and available equipment.
An international standard is only adopted if it is of mutual benefit
Any international standard is something that is extremely difficult to realise. Historically such moves have been borne out of the desire to trade across borders and make commerce and industry more global. An early example of such a standard was the agreement of screw-thread types and sizes during the industrial revolution. This was a huge benefit to mass production as it allowed rapid replacement of machine parts and maintained output. International standards are often created and then adopted, rather than being imposed, i.e. non mandatory; this is why we see so many differences in anything from electrical sockets, units of weights and measures and even which side of the road we drive on, all around the world. So an international standard is only often adopted if the result is of mutual benefit. If there is little or no mutual benefit, then a country will tend to ‘go its own way’.
There are examples of this when you look at extrication globally. In areas of Norway, rescuers have developed a technique for creating space following a frontal impact by using chains (anchored to rescue vehicles) to pull the front of the vehicle whilst at the same time making relief cuts. Likewise in Sweden ‘centre ramming’ is a popular technique (using a single hydraulic ram to push from the rear seat through the central area of the front dash) and is adopted to create space following a frontal impact. We can see from these examples that there is a huge benefit of not having a fully prescriptive international standard; going you own way promotes innovation and can be advantageous.
Who would establish and maintain such a standard?
The important thing about a standard is that it has to be established and, crucially, maintained. This begs the question of who would be responsible for this. The World Rescue Organisation (WRO) would be a logical starting point and indeed the 13 countries that are members of WRO each use standardised marking sheets when assessing teams in the road-rescue challenges across the world. However, the marking sheets are principally a guide and there are different interpretations based on local custom and practice leading to assessors expecting different things from rescuers depending upon their location. This is advantageous to the competitors who will receive feedback that is relevant to their local working practices. So with this in mind, who would establish and maintain such a standard? Who would be responsible?
Medical aspect
In my view the issue that makes the adoption of a fully prescriptive international standard most difficult is the medical aspects of the rescue. Whilst technical rescue practices around the world vary very little, the medical elements of extrication differ massively. There are so many levels of medical response available globally that this is where an international standard becomes impractical and possibly prohibitive. When we consider that successful vehicle rescue is based on a viable extrication plan requiring technical and medical information, we start to see that being prescriptive becomes unfeasible. In addition, medical aspects of rescue evolve more quickly than the technical side. For example, very recently, medics in the Bergen area of Norway stopped the use of cervical collars for conscious trauma patients in the pre-hospital environment and simply advocate the use of manual inline stabilisation (MILS). Even though this is based on solid, evidence-based medical research, I do not think this would freely be adopted internationally any time soon (although my feeling is that in the next 3–5 years, most will follow suit).
Summary
Before deciding whether there should be an international standard for extrication, we must define what the standard is: a framework allowing the application of local custom and practice or a fully prescriptive approach based on best practice. In my view, the former already exists successfully (although requires modernisation) and the latter is unachievable and may inhibit future innovation and progress. Any standard is difficult to establish and maintain and will only be adopted if clear benefits can be delivered. There are too many variables involved in the process of vehicle rescue to be fully prescriptive and the provision of a basic framework, such as the Team Approach v2.0, allows rescuers to think global and act local by adopting best practices that are relevant to their local custom, practice and equipment. Finally, let’s remember that regional, national and international differences in approach to vehicle extrication always promote discussion. This discussion forms the basis of new ideas, concepts and innovation. Wouldn’t a widely adopted international standard dilute this discussion and therefore inhibit progress?
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