Vehicle extrication in road traffic crashes: a descriptive analysis of an advanced medical rescue service in South Africa.

Introduction: Road Traffic Crashes (RTCs) represent a significant global health challenge, with a disproportionate burden on low- and middle-income countries. Vehicle extrication is a critical Emergency Medical Service (EMS) intervention enabling early assessment and treatment of entrapped patients but remains understudied in resource-limited settings despite its potential impact on patient outcomes. This study describes the RTC extrication burden managed by a public sector EMS in the Western Cape, South Africa.

Methods: We conducted a retrospective review of Computer-Aided-Dispatch (CAD) and a paper-based rescue case record data related to the extrication practises of 97 Advanced Medical Rescuers stationed across 25 rescue stations throughout the Western Cape of South Africa. Standard descriptive statistical procedures were applied to all variables.

Results: Of 2,587,979 EMS activations during the study period, 23,899 (0.9 %) required specialised medical rescue activations, and 11,699 (0.5 %) were for transport-related emergencies. Of these, 719 (6.1 %) cases necessitated vehicle extrication. Light motor vehicles accounted for most extrications (78.2 %, = 562), while heavy motor vehicles showed higher proportional extrication rates (127.5 vs. 75.8 extrications per 1,000 RTCs). Peak rescue activations occurred between 08h00 and 20h00 (11.9 %, = 1,388). The predominant extrication techniques were vehicle stabilisation (24.9 %, = 501), third-door conversion (23.9 %, = 482 ), and dashboard lift (13.9 %, = 282). Most patients (83.1 %, = 24,588) presented with routine (green) or non-urgent (yellow) acuity, though rural areas exhibited a higher proportion of high-acuity cases.

Conclusion: This first comprehensive analysis of the RTC extrication burden in a South African province reveals significant spatial and temporal variations in rescue needs and techniques. Our findings provide valuable extrication-related data to inform targeted training programs, standardised extrication protocols, and strategic resource allocation to enhance EMS capabilities in resource-limited settings. These insights provide a foundation for workforce planning and specialised training to improve outcomes for entrapped RTC patients in similar contexts.