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Copyright (c) 2025 Tariq Mohammed Algaith, Ahmad Mohammed Alhajouj, Ayidh Mohammed Faraj Alghlfas, Sanad Burayk Aldawsari, Fahad Ali Mohammed Ghonemi, Ibrahim Mohsen Ali Khormi, Abdulaziz Abdullah Ibrahim Hamzi, Nawdh Mutair Almajdi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Emergency Medical Services Access and Patient Extrication: Operational, Safety, and Administrative Considerations for Health Security and Healthcare Leadership
Corresponding Author(s) : Tariq Mohammed Algaith
Saudi Journal of Medicine and Public Health, Vol. 2 No. 2 (2025)
Abstract
Background: Emergency medical services (EMS) frequently operate in unstable, confined, and hazardous environments where rapid access and extrication are essential to patient outcomes and responder safety.
Aim: To synthesize operational, clinical, and administrative considerations for safe patient access and extrication across diverse settings, and to outline evidenceinformed practices for EMS, health security leadership, and system administrators.
Methods: Narrative integration of scene safety principles; environmental hazard mitigation; graded access techniques; delivery of medical care during entrapment (airway, circulation, spinal motion restriction, analgesia, hypothermia prevention); and highrisk, specialcircumstance procedures (crush injury protocols, early blood, impalement management, and lastresort field amputation).
Results: Effective operations hinge on disciplined scene sizeup, stabilization of vehicles/structures, and interagency coordination to balance urgency with provider safety. Early, ongoing medical interventions during extrication—airway protection, ventilation, hemorrhage control, spinal alignment, analgesia, thermal management—reduce secondary injury. Crushinjury protocols prioritize prerelease fluid resuscitation and hyperkalemia mitigation; when available, early blood products should be initiated even during rescue. Automotive entrapments may require dash displacement or roof removal performed by trained teams adhering to standardized rescue practices. Postextrication, risks of hypothermia, metabolic derangement, hemorrhage, and airway compromise persist, necessitating vigilant reassessment and structured handover to receiving facilities.
Conclusion: Treating extrication as a timesensitive medical intervention embedded within a highrisk operational context improves survival and safeguards responders. Systemlevel preparedness—policies, training, equipment, interagency agreements, and EMS physician engagement—underpins consistent, highquality performance.
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- Pietsch U, Strapazzon G, Ambühl D, Lischke V, Rauch S, Knapp J. Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training. Scand J Trauma Resusc Emerg Med. 2019 Feb 13;27(1):17.
- Vincent-Lambert C, Mottershaw T. Views of emergency care providers about factors that extend on-scene time intervals. Afr J Emerg Med. 2018 Mar;8(1):1-5.
- Nutbeam T, Fenwick R, Haldane C, Leech C, Foote E, Todd S, Lockey D. Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Scand J Trauma Resusc Emerg Med. 2025 Jan 06;33(1):3.
- Koser BW, Siddiqui DI, Kropp AM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 14, 2023. EMS Care In A Hostile Environment.
- Bosson N, Abo BN, Litchfield TD, Qasim Z, Steenberg MF, Toy J, Osuna-Garcia A, Lyng J. Prehospital Trauma Compendium: Management of the Entrapped Patient - a Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. 2024 Oct 24;:1-13.
- Issa SF, Nour MM, Field WE. Utilization and Effectiveness of Harnesses and Lifelines in Grain Entrapment Incidents: Preliminary Analysis. J Agric Saf Health. 2018 May 07;24(2):59-72.
- Jawaid S, Cody D. Crowbar impalement: the PHEM perspective. BMJ Case Rep. 2018 Dec 09;11(1)
- Corsa JG, Brown JO, Fleming RM, Bergmann RT, Henning JA, Monson JT. Wilderness Rescue of a Hiker with Multiple Trapped Limbs by a Combined Wilderness and Urban Rescue Team Using High-Pressure Airbags. Wilderness Environ Med. 2023 Sep;34(3):377-382.
- Ashkenazi I, Isakovich B, Kluger Y, Alfici R, Kessel B, Better OS. Prehospital management of earthquake casualties buried under rubble. Prehosp Disaster Med. 2005 Mar-Apr;20(2):122-33.
- Stroop R, Schöne C, Grau T. Incidence and strategies for preventing sustained hypothermia of crash victims during prolonged vehicle extrication. Injury. 2019 Feb;50(2):308-317.
- Chiapuzio C, Dang T, Meagher S, Woodward B, Neeki M. The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation. Cureus. 2020 Sep 12;12(9):e10405.
- Reay G, Rankin JA, Smith-MacDonald L, Lazarenko GC. Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting. BMC Emerg Med. 2018 Nov 15;18(1):42.
- Li T, Cushman JT, Shah MN, Kelly AG, Rich DQ, Jones CMC. Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care. Prehosp Disaster Med. 2018 Oct;33(5):501-507.
References
Pietsch U, Strapazzon G, Ambühl D, Lischke V, Rauch S, Knapp J. Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training. Scand J Trauma Resusc Emerg Med. 2019 Feb 13;27(1):17.
Vincent-Lambert C, Mottershaw T. Views of emergency care providers about factors that extend on-scene time intervals. Afr J Emerg Med. 2018 Mar;8(1):1-5.
Nutbeam T, Fenwick R, Haldane C, Leech C, Foote E, Todd S, Lockey D. Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Scand J Trauma Resusc Emerg Med. 2025 Jan 06;33(1):3.
Koser BW, Siddiqui DI, Kropp AM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 14, 2023. EMS Care In A Hostile Environment.
Bosson N, Abo BN, Litchfield TD, Qasim Z, Steenberg MF, Toy J, Osuna-Garcia A, Lyng J. Prehospital Trauma Compendium: Management of the Entrapped Patient - a Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. 2024 Oct 24;:1-13.
Issa SF, Nour MM, Field WE. Utilization and Effectiveness of Harnesses and Lifelines in Grain Entrapment Incidents: Preliminary Analysis. J Agric Saf Health. 2018 May 07;24(2):59-72.
Jawaid S, Cody D. Crowbar impalement: the PHEM perspective. BMJ Case Rep. 2018 Dec 09;11(1)
Corsa JG, Brown JO, Fleming RM, Bergmann RT, Henning JA, Monson JT. Wilderness Rescue of a Hiker with Multiple Trapped Limbs by a Combined Wilderness and Urban Rescue Team Using High-Pressure Airbags. Wilderness Environ Med. 2023 Sep;34(3):377-382.
Ashkenazi I, Isakovich B, Kluger Y, Alfici R, Kessel B, Better OS. Prehospital management of earthquake casualties buried under rubble. Prehosp Disaster Med. 2005 Mar-Apr;20(2):122-33.
Stroop R, Schöne C, Grau T. Incidence and strategies for preventing sustained hypothermia of crash victims during prolonged vehicle extrication. Injury. 2019 Feb;50(2):308-317.
Chiapuzio C, Dang T, Meagher S, Woodward B, Neeki M. The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation. Cureus. 2020 Sep 12;12(9):e10405.
Reay G, Rankin JA, Smith-MacDonald L, Lazarenko GC. Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting. BMC Emerg Med. 2018 Nov 15;18(1):42.
Li T, Cushman JT, Shah MN, Kelly AG, Rich DQ, Jones CMC. Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care. Prehosp Disaster Med. 2018 Oct;33(5):501-507.