Priority Setting Workshop Booklet

PRIORITY SETTING WORKSHOP

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What is a Priority Setting Partnership?

What is a Priority Setting Workshop?

Workshop Participants Questions

What is Priority Setting Partnership?

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What is a Priority Setting Partnership A Priority Setting Partnership, or PSP, is a way to bring together people with real-life experience, like patients, carers, and healthcare professionals, to decide what questions future research should try to answer.

Instead of researchers guessing what matters most, a PSP asks the people who are directly affected:

“What do you think needs to be better understood, improved, or changed?”

By collecting and reviewing these questions, the PSP helps make sure that research focuses on the things that really matter to the people who live with the issues every day.

This Priority Setting Partnership has been modelled on the James Lind Alliance method.

“What do you think needs to be better understood, improved, or changed?”

What is Priority Setting Partnership?

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The Process Collect questions

Group similar questions and create themes

Have the questions already been answered?

Create a shortlist of questions

Hold a workshop to decide what ‘Top 10’ questions should be researched

Start Researching!

What is a Priority Setting Workshop?

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What is this workshop for?

The aim of the workshop is to decide the Top 10 questions for research on the ‘Road Injury Chain of Survival’, which begins at the moment a crash occurs and continues through rescue, care, transport, and rehabilitation.

We will be working with a list of questions that came from a survey we carried out.

The workshop is not about answering these questions; researchers can do that later. The workshop is about deciding what the most important questions are.

What will I have to do?

We would like you to talk about your opinions and experiences.

Everyone at the workshop will have different views and ideas, and they are all valid and important.

Everyone will be encouraged to share their views, but also to listen to each other. We want to know your personal views and experiences on which questions could really make a difference to those involved in road injury.

The workshop facilitators are there to support you and will make sure you have a chance to have your say in a safe and inclusive environment.

What is a Priority Setting Workshop?

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Who will be there?

There will be about 30 people at the workshop who will be: Patients/members of the public with lived experience Healthcare Professionals, such as doctors and nurses Other Professionals, such as police, fire and rescue, government

What will happen?

There will be an introduction at the start of the day to explain how the workshop will run and to answer any questions you might have.

You will then work in small groups to discuss the research questions.

With help from one of the facilitators, you will decide together the order of importance of the questions. Towards the end of the workshop, you will all look at the order of the questions as one large group and then discuss and agree the order of the top 10.

Do I need to prepare anything?

We will send you a worksheet nearer the time, showing the list of questions we will be discussing at the workshop.

Please read the list beforehand and decide which questions you think are most important for research, and which questions are less important, in your opinion.

Make a note of your choices on the sheet and bring it with you on the day. You won’t need to hand these in, but you will be asked about your choices.

Workshop Participants

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Who will be at the workshop?

This section introduces the diverse group of individuals who have come together to contribute to this Priority Setting Partnership. Each participant brings a unique perspective, shaped by their professional expertise, lived experience, and/or research background. Their collective insights are vital to ensuring that the priorities identified reflect what truly matters to those most affected.

We are grateful for their time, commitment, and support. Below, you’ll find brief biographies that highlight their roles, interests, and contributions to this important work.

Claire Baker IMPERIAL COLLEGE LONDON Research Fellow

Claire is a Schmidt AI for Science Fellow in Design Engineering. Her research uses smartphone and vehicle sensor data to predict severe injuries in road traffic collisions, aiming to improve emergency care through real-time, equitable triage. Her work has shaped international standards and influenced road safety policy in the UK and Sweden. She collaborates with industry, ambulance services, EuroNCAP, and the Parliamentary Advisory Committee for Transport Safety. Outside of work, Claire enjoys the outdoors and competes in ultimate frisbee.

Ed Barnard UK DEFENCE (RESEARCH & INNOVATION) AIR AMBULANCE Defence Professor of Emergency Medicine

Ed is a UK Defence academic and consultant in emergency and prehospital medicine, based in Cambridge. He has worked globally with the military and trained in emergency medicine across the UK. His research focuses on prehospital care, including blood products and trauma resuscitation. Ed is passionate about improving outcomes for seriously injured patients and co-founded the RAID research group. He lives in Cambridge with his wife and two daughters.

Workshop Participants

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Elizabeth Box RAC FOUNDATION Research Director

Liz is a behavioural science consultant, experienced in designing and evaluating road safety. She focuses on young drivers, parental influence, and education, contributing to research and policy. Liz presents at conferences, engages in media, and conducts training workshops. She is joining the PSP workshop to align research priorities with real-world safety challenges. Outside work, Liz enjoys countryside walks and time with family and friends.

Jennifer Buchanan FIELDFISHER Partner and Solicitor

Jennifer holds a law degree and a Master’s in biomedical sciences. She represents claimants in high-value personal injury and fatal accident cases, focusing on brain and serious orthopaedic injuries, including amputations. Jennifer is passionate about securing early financial support and rehabilitation for clients, and brings specialist insight to cycling claims as a competitive cyclist herself. She actively campaigns for safer roads in London and collaborates with clients to raise awareness through media. She is a member of APIL and recognised by Legal 500 as a ‘Next Generation Lawyer’.

Max Brown NATIONAL HIGHWAYS Head of Technical Services

Max brings 25 years of experience in major road design and operation.

He has played a key role in developing design standards for the motorway network in England and now oversees technical areas aimed at achieving zero harm on the strategic road network, including compliance, enforcement policy, and fatal collision investigations. Max is participating in the PSP workshop to explore how National Highways can contribute to improving outcomes following road traffic collisions.

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Nicola Brown MEMBER OF THE PUBLIC Family member of someone road injured and bystander

Nicola is joining us as a member of the public, and brings her lived experience as a family member of someone involved in a road collision, as well as a bystander at the scene.

Lisa Ann Challinor MEMBER OF THE PUBLIC Lived Experience of Road Injury

Lisa joins us as a member of the public, and as someone who has experienced significant road injuries as a result of a road collision.

Ellie Challinor-Hughes MEMBER OF THE PUBLIC Family member of someone road injured and bystander

Ellie joins us as a member of the public, and brings her lived experience as a family member of someone involved in a road collision, as well as a bystander at the scene.

Ross Chalmers POLICE SCOTLAND Roads Policing Officer

Ross is a Roads policing officer based in Glasgow that covers the west coast of Scotland. He deals with road traffic collisions from minor to fatal RTC on a weekly basis. He is passionate about reducing road deaths and educating drivers on how their behaviours can impact not just their life, but the life of everyone around them. Ross is keen to take part in this workshop to learn how other agencies deal with RTCs and other best practice, that can be utilised in a policing capacity. Ross has a love for anything motorsport.

Workshop Participants

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Andrea Connolly NHS LOTHIAN Major Trauma Mental Health Nurse

Andrea is a major trauma mental health nurse currently working in the South East Scotland Major Trauma Ward at the Royal Infirmary of Edinburgh. She supports patients and their families from the beginning of their admission and continues to offer outpatient support throughout their recovery. Andrea is trained in various psychological therapy modalities, which she integrates into each individual's recovery journey.

She has a longstanding interest in the relationship between physical and mental health. In her spare time, Andrea enjoys running, going for walks, and discovering new places to eat.

Laura Cottey (Workshop Chair) ACADEMIC DEPARTMENT OF MILITARY EMERGENCY MEDICINE Emergency Medicine Registrar

Laura is an Emergency Medicine Registrar and a Honorary Lecturer with the Academic Department of Military Emergency Medicine. She has been involved in Emergency Care research for nearly 10 years and completed her PhD in traumatic injury and haemorrhagic shock. Her postdoctoral research interests are in pain relief for patients with traumatic injury and she has previously been a steering group member for the Royal College of Emergency Medicine and James Lind Alliance PSP.

Lyndsay Downie MEMBER OF THE PUBLIC Lived Experience of Road Injury

Lindsay joins us as a member of the public, and as someone who has experienced significant road injuries as a result of a road collision.

Workshop Participants

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Ian Dunbar (OBE) IAN DUNBAR TRAINING AND CONSULTANCY Director

Ian Dunbar OBE is a global specialist in emergency response, technical rescue, and pre-hospital care, with over 30 years of frontline and leadership experience. Currently Product and Marketing Enablement Manager at IDEX Fire & Safety, he leads innovation and product development for global brands. A former Rescue Specialist with the FIA, Ian oversaw safety for Formula 1 and other international motorsport events. Ian runs a consultancy and training business, authored bestselling rescue texts, and was awarded the OBE in 2022 for services to technical rescue and emergency care.

Naomi Dodds FACULTY OF PRE-HOSPITAL MEDICINE (FPHC) Scottish Representative

Naomi is a final year Anaesthesia specialty trainee in Aberdeen, with interests in pre-hospital critical care, trauma and expedition medicine.

She is currently working with the Major Trauma team at Aberdeen Royal Infirmary, and has just completed a 6 month fellowship with EMRS North ScotSTAR. She is a BASICS Responder and mountain rescue team doctor. She has an interest in the PSP workshop as North of Scotland Representative for the Faculty of Prehospital Care.

Kerry Dungay (Workshop Facilitator) IMPACT Programme Coordinator

Kerry holds an MBA and has a diverse background in academia, NHS and project management, having led Student Support and Postgraduate Medical Education services in the NHS and higher education. Kerry has also worked with international organisations, including the World Health Organization, to establish research centres. Kerry enjoys playing piano, embroidery, and walking on the beach and moors with her family

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Melanie Elmer MEMBER OF THE PUBLIC Lived Experience of Road Injury

Melanie joins us as a member of the public, and as someone who has experienced significant road injuries as a result of a road collision.

Rob Fenwick IMPACT Consultant ED Nurse and ACP

Rob works as a Consultant Nurse and Advanced Clinical Practitioner in Emergency Medicine in North Wales, contributing to education and research. He is a Visiting Professor at Wrexham University and co-leads the UK Emergency Department ACP Research Network, focusing on advanced practice and patient-centered care. As a Senior Research Fellow with IMPACT, Rob co-founded the award-winning Extrication in Trauma (EXIT) project. He also co-hosts The Resus Room Podcast, promoting evidence-based medicine in pre-hospital and ED settings. In his free time, he enjoys family time and trail running.

Emily Foote (Workshop Facilitator) DEVON AIR AMBULANCE / NHS Emergency Medicine Doctor

Emily is a senior registrar in Emergency Medicine and a critical care doctor with the Devon Air Ambulance. Emily has been working with IMPACT on developing novel bystander led triage scores, assisting with the EXIT Project translation to practice work streams and most recently has developed an interest in the interaction between medical events at the wheel, injuries and outcomes.

Workshop Participants

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Els Freshwater SCOTTISH AMBULANCE SERVICE Advanced Practice Critical Care Lead

Els is a critical care paramedic and clinical lead for advanced practitioners (critical care) in the Scottish Ambulance Service. She has experience in both in-hospital and pre-hospital major trauma care and education. Els is a visiting professor at Buckinghamshire New University, lecturing mainly on paramedic and advanced practice, and is an instructor and examiner for several related courses. Her doctoral research evaluated a major trauma triage tool, and she continues to contribute to research in the field.

Iain Gibson SCOTTISH AMBULANCE SERVICE Paramedic

Iain has been a paramedic with the Scottish Ambulance Service for around 14 years. Due to the geography of the Scottish Borders, he is frequently tasked to road traffic collisions. His interest in the PSP workshop is to meet like-minded professionals, share ideas, and promote better patient outcomes through up-to-date care. He hopes to learn from the workshop and cascade discussions to peers and colleagues. Outside of work, he enjoys the outdoors and motorsports.

Shelley Gill BRAKE - ROAD SAFETY CHARITY Regional Manager - Scotland

Shelley brings over three years’ experience with the National Road Victim Service, supporting those bereaved, seriously injured, or first on scene after road traffic collisions. Previously, she worked in mental health support, providing compassionate, person-centred care. Shelley is passionate about making a difference and offering meaningful support during life’s most challenging moments.

Workshop Participants

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Ianto Guy TRANSPORT RESEARCH FOUNDATION (TRL) Principal Consultant - Collision Investigation

Ianto is a principal consultant in collision investigation at TRL. His background is in the off-highway vehicle industry, holding an MEng in Off-road Vehicle Design and PhD in 4x4 transmission behaviour from Harper Adams University, where he also taught for ten years. He is also a practicing paramedic, with the Welsh Ambulance Service but now primarily working in motorsport. At TRL he works across a diverse range of fields including collision investigation, micromobility, automation for on and off-highway vehicles and vehicle restraint systems (crash barriers).

Pamela Hardy FACULTY OF PRE-HOSPITAL CARE (FPHC) FPHC Chair

Pam is a founding member of the FPHC and has represented FPHC and RCPCH on the Intercollegiate Board for Training in Pre-hospital Emergency Medicine since 2009. As an Emergency Medicine Consultant, she is a dedicated pre-hospital provider, working in a primary response role and as a retrieval consultant with the Emergency Medical Retrieval Service (North) in Scotland's Highlands and Islands. Passionate about collaboration across diverse providers, Pam aims to shape research priorities through her experience and that of the Faculty to enhance integration at all levels.

Sharron Huddleston MEMBER OF THE PUBLIC Family member of someone road injured

Sharron is joining us as a member of the public, and brings her lived experience as a family member of someone involved in a road collision.

Workshop Participants

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Saul Jeavons ASSOC. FOR ROAD RISK MANAGEMENT (ARRM)/TRANSAFE NETWORK

ARRM Chair / Director Transafe / Trustee Road Victims Trust

Saul is a road safety consultant with 30 years experience who has worked in more than thirty countries on six continents. He has an interest in work related road safety and the role of professional drivers as first responders in the UK and overseas, as well as post crash response as part of the Safe System strategies of Road Safety Partnerships.

Alongside his other roles, Saul currently advises on the development of Post-Collision Review Boards.

Danny Kerr SCOTTISH AMBULANCE SERVICE Paramedic / Clinical Effectiveness Lead: Major Trauma

Danny has over 25 years’ experience in the Scottish Ambulance Service, holding roles such as HEMS Paramedic Team Leader and Clinical Effectiveness Lead for Major Trauma. He spent a year on Helimed 2 in Inverness, facing the challenges of rural pre-hospital and post-collision care with limited resources. Specialising in major trauma and postcollision care, Danny has over 10 years in the Emergency Medical Retrieval Service. He is dedicated to applying evidence-based care to improve patient outcomes.

Ian Maritt UNITED KINGDOM RESCUE ORGANISATION (UKRO) Director of Education and Development/Station Manager

Ian specialises in operational learning and tactical incident command.

He also volunteers for UKRO and the World Rescue Organisation (WRO), leading programmes to enhance responder performance in RTCs globally. Ian designs training through the UKRO and WRO Academy elearning platform and provides international support on extrication and trauma care. Based in East Yorkshire, he works to translate research into practice, improving patient outcomes and rescuer safety.

Workshop Participants

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Douglas Maxwell NHS GREATER GLASGOW & CLYDE/EM RETRIEVAL SERVICE Emergency Medicine Consultant

Alongside his other roles, Doug is the chair of the writing group for their operational guideline on entrapment and extrication and has a particular interest in teaching and training within the service. He leads a simulation programme which feeds into clinical governance systems and is passionate about delivering training to enhance the care given to patients. He is participating in the workshop to ensure the most current practices are reflected in future service guidelines. Outside of work, Doug is a keen rower with a local club.

Alison Moggach - ‘Moggie’ SCOTTISH AMBULANCE SERVICE Advanced Nurse Practitioner

Alison has been nursing for 36 years, the last 21 years, as an Advanced Nurse Practitioner, in a variety of clinical/leadership roles and settings including Nurse Consultant, Governance Manager and Clinical Lead for Advanced Practice. She is known as ‘Moggie’ all over Scotland and also volunteers as a Nurse instructor/Responder for BASICS Scotland.

Tim Nutbeam IMPACT Director / Prof Emergency Medicine and Post-Collision Care

Tim is a Consultant in Emergency Medicine and a Professor of Prehospital Critical Care at the University of Plymouth. He serves as the Director of IMPACT - the Centre for Post-Collision Research, Innovation, and Translation - focusing on improving outcomes after road traffic collisions. Tim has been actively involved in developing the Priority Setting Partnership and looks forward to supporting the workshop and observing which priorities emerge. Outside of work, Tim enjoys running, camping, and spending time with his four children in the beautiful Devon countryside.

Workshop Participants

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Jane Ogilvie SCOTTISH FIRE AND RESCUE Watch Commander- Training

Jane has worked with the Scottish Fire and Rescue Service for 23 years, the last five focused on training firefighters to respond to road traffic collisions. She has gained expertise in multi-agency response and practical rescue skills. She is participating in the PSP workshop to help shape research priorities and develop training that reflects the realities faced by emergency responders. Outside of work, Jane enjoys hill running, cycling, horse riding, and dog walking.

Ann Ralli PUBLIC / DEVON AIR AMBULANCE Lived Experience (family member and Bystander)

Ann is the founder of DAA, established following the tragic death of her son in a road collision, at which she was also a bystander. Driven by a deep commitment to saving lives, Ann brings both her personal lived experience and professional expertise to her work. She holds a PhD in Educational Psychology and contributes a unique and powerful perspective that bridges academic insight with profound personal resilience.

Alastair Richards PROJECT PACKINGTON / MOD Civilian Paramedic / Paramedic Military Vehicle Specialist

Alastair is also an instructor at the Defence Medical Academy, UK Cyber and Specialist Operations Command. Having a personal history of rescue from an ambulance response car, he has a strong interest in vehicle rescues. He leads Project PACKINGTON, which aims to enhance the experience for occupants of crashed military vehicles, bystanders, and rescuers. As a proud Ambassador for IMPACT, Alastair has partnered Project PACKINGTON early on. He is also the Clinical Lead for Staffordshire Search & Rescue and tolerates the cat that lives in his house.

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Lauren Rodgers (Facilitator) IMPACT Senior Research Coordinator

Lauren Rodgers is a senior research fellow and experienced statistician with over a decade of expertise across academia and industry. Her work spans post-collision care, child health, diabetes, women’s health, vaccination, pregnancy, and global health, applying advanced statistical methods to inform clinical practice and policy. Lauren combines methodological innovation with real-world impact, mentors junior researchers and PhD students, and collaborates with multi-disciplinary teams to improve healthcare outcomes.

Connor Russell SCOTTISH AMBULANCE SERVICE Technician

Connor has worked as a Technician with the Scottish Ambulance Service since 2021. Road traffic collisions are among the most challenging and complex incidents they attend, which is why he is always looking to expand his knowledge, shape his practice, and to contribute to a higher standard of care and improved patient outcomes. His favourite activity outside of work is walking his 1 year old cockapoo in the beautiful Scottish Borders where he lives.

Zoe Smeed BASICS SCOTLAND Senior Medical Advisor

Zoe is an Emergency Medicine, PHEM, and Retrieval Consultant working in Clyde Emergency Departments and EMRS West. She wrote the new extrication consensus statement for BASICS Scotland and oversees educational material for instructors and responders. Zoe is also part of a multi-agency group developing a Scotland-wide guideline on pre-hospital extrication. Zoe is participating in the PSP workshop, to collaborate and support improvements in patient outcomes after RTCs.

Workshop Participants

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Carl Smith COLLEGE OF PARAMEDICS Head of Clinical Development Emergency and Critical Care / ACP

Carl has 30 years Pre Hospital care experience and is employed by the East of England Ambulance as well as flying with East Anglian Air Ambulance, a position he’s held for 15 years. He is also an on call Firefighter within Norfolk Fire and Rescue Service. Carl’s current role enables him to examine the Diploma in Immediate Medics Care and the Diploma in Major Incident Management at the faculty of Pre Hospital Care.

Andrew Smith FACULTY OF PRE-HOSPITAL CARE, ROYAL COLLEGE OF SUGEONS Honorary Secretary - Chair Elect

Andy is a Consultant in Emergency Medicine, Pre-Hospital Immediate Care, and Sport & Exercise Medicine. He also directs the Crowd Doctor’s and Practitioner’s Course. His roles include BASICS doctor, Programme Director for Pre-Hospital Immediate Care in Sport, and Immediate Care Lead at Twickenham Stadium. He also works with World Rugby as Medical Compliance Manager and Immediate Care Lead. Andy joins the PSP workshop to help ensure future research priorities reflect frontline clinical realities.

Matt Staton AGILYSIS Head of Consultancy

Matt is a road safety expert with broad knowledge across the sector, particularly in developing partnerships and supporting policy. He specialises in systems thinking and applying system-based approaches to road safety management and collision investigation. His work focuses on translating research into practice, with an emphasis on delivery, evaluation, and knowledge sharing. At the PSP workshop, Matt contributes a wider road safety policy perspective.

Workshop Participants

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Paul Steinberg THE ROAD SAFETY TRUST Director of Communications and Engagement

Paul joined The Road Safety Trust as Director of Communications and Engagement in July 2024. With a background in journalism, health promotion, and social marketing—including work at the BBC and leading the award-winning “Do It London” HIV campaign—he brings extensive experience in public health communications. Paul is a strong advocate for applying multi-faceted public health approaches to road harm reduction.

Paul Trafford MOTORSPORT UK Chief Medical Officer

Trained as an anaesthetist but spent a significant time working with many car manufacturers and race series around the world including Formula 1, and the World Rally Championship etc. Medical Director of the British Touring Car Championship since 1990 and medical advisor to the FIA the governing body of world motorsport. Worked with the FIA Institute for many years involved in research into motorsport safety and accidents. Chief Medical Officer and Medical Advisor to Motorsport UK the governing body of motorsport in the UK.

Mark Wilson GOODSAM / IMPERIAL COLLEGE Medical Director / Neurosurgeon

Mark is a Consultant Neurosurgeon at Imperial and Air Ambulance Doctor with Kent, Surrey and Sussex Air Ambulance. He is co-founder / medical director of GoodSAM. Page 17

Workshop Participants

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Margaret Winchcomb THE PARLIAMENTARY ADVISORY COUNCIL FOR TRANSPORT SAFETY Deputy Executive Director

Margaret Winchcomb is a Chartered Civil Engineer with a passion for people-focused transport. Since joining PACTS in 2021, she has led research and policy work, becoming a recognised expert on e-scooter safety and winning a Prince Michael International Road Safety Award.

Now Deputy Executive Director, she leads technical engagement with over 150 member organisations and contributes to national advisory panels. Margaret joins the workshop to support stronger post-collision response within the Safe System approach.

Questions

Questions

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Here is the list of questions and plain English summaries. These summaries provide an overview of the background information and what the question is asking.

Question A: What makes people hesitate or delay calling emergency services straight after a road traffic collision, and what kinds of changes - like education, laws, or system improvements can help people call for help faster, especially in different communities?

People often hesitate to call emergency services after a road crash.

Some don’t know what to do, fear legal trouble, or worry about police, cost, or immigration issues. In busy or confusing crash scenes, it can be hard to describe the location or situation. To help, public education campaigns and first aid training can build confidence. Legal protections like Good Samaritan laws can ease fears. Improving dispatch systems - like clearer instructions and GPS - can speed up response. However, we still don’t know how well these solutions work long-term or across different countries. More research is needed to test combined, practical approaches.

Question B: How safe, effective, and acceptable is it for members of the public, with no medical training, to give tranexamic acid (TXA) to people who may be bleeding after a road traffic collision?

Tranexamic acid (TXA) is a medicine that helps stop severe bleeding after injury and is one of the few treatments proven to save lives. It works best when given early—ideally within three hours. New research shows that TXA can be safely and quickly given by injection into a muscle, which means it might soon be possible for trained bystanders or first responders to give it before emergency services arrive. This could be especially important for people hurt in road crashes, helping to reduce deaths while waiting for hospital care.

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Question C: What are the best ways to teach people in the community how to give first aid after serious injuries, and can training everyone help save lives in road traffic collisions?

Teaching first aid to people in the community helps save lives after road crashes, especially in places where ambulances take time to arrive. Training includes how to stop bleeding, open airways, and treat serious injuries. In South Africa, local volunteers trained as Emergency First Aid Responders kept their skills and used them to help crash victims. In Indonesia, police officers given first aid training became better at helping after road accidents. Studies show that building first aid knowledge across a community, especially when linked with local emergency services, can reduce deaths and improve how quickly and safely people are helped after crashes.

Question D: Can using technology, such as mobile apps, video calls, or live coaching, help people give better first aid and improve outcomes for those injured in road traffic collisions, when compared to just using a phone call for guidance?

New technology like apps, video calling, and real-time coaching can help bystanders give better first aid in emergencies. These tools have been shown to improve survival after cardiac arrest by helping people start CPR quickly and do it properly. However, most tools focus on heart-related emergencies, not the kinds of injuries seen after road crashes. For trauma, evidence is still limited. Some studies show dispatcher help by phone may support life-saving actions, but results are mixed. More research is needed to develop technology that works in crash situations and gives clear, fast help for bleeding, airway problems, and other trauma injuries.

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Question E: When is it better for someone involved in a collision to get out of the vehicle themselves or with help from bystanders, rather than waiting for emergency services?

New research recommends a shift in how people are rescued from crashed vehicles. If safe, patients should be encouraged to get out by themselves—called self-extrication—as it’s quicker and reduces harm. A new tool, the U-STEP OUT algorithm, helps responders decide whether this is safe. If patients can’t get out on their own, especially older adults, a gentle, low-movement rescue is best.

Experts also stress the importance of teamwork between medics, fire crews, and other responders. Joint training helps everyone work better together. Overall, the focus is now on safer, faster, and more coordinated rescues tailored to the patient’s needs.

Question F: At what point does taking longer to free someone from a vehicle lead to worse physical or mental health outcomes, and how do different rescue methods affect this?

Studies show that people trapped in cars after crashes are more seriously hurt and more likely to die than those who aren’t trapped.

Long delays before they are rescued may make things worse, but research hasn’t yet found the exact amount of time after which harm increases. Most studies look only at death rates and not other problems like long-term pain or emotional trauma. It’s also unclear which rescue methods are safest and quickest. More research is needed to understand how long is too long to be trapped, and whether faster, simpler rescue techniques could improve recovery and save lives.

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Question G: What crash details should automatically be sent from a vehicle after a collision to help emergency services respond faster and more accurately, without sending false alerts? eCall and Advanced Automatic Crash Notification (AACN) systems help emergency services respond quickly to serious road crashes.

They work by automatically sending key information—like crash severity, seatbelt use, airbag deployment, and exact location—to dispatch teams. This helps decide what level of help is needed, even if the people involved can’t call for help themselves. Research shows these systems can reduce missed serious injuries and improve response. However, they can also send too many false alarms. To improve, systems must reliably send data, even in rural areas, and use smarter algorithms that learn from past crashes to better predict who needs urgent care.

Question H: What kinds of training, tools, and guidelines help emergency call handlers (dispatchers) better recognise serious injuries from road traffic collisions and send the right help quickly?

When someone is badly hurt in a road crash, emergency call handlers (dispatchers) must quickly decide what help to send.

Current systems often miss serious injuries or send too much help.

Some new tools, like computer programmes that analyse what callers say, can support dispatchers, especially when they are unsure. Training and clear protocols also help, but many are not specific to road crashes. Most research comes from wealthy countries, so we don’t know what works best elsewhere. More research is needed to create simple, road-specific tools that help dispatchers send the right help, quickly and reliably, every time.

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Question I: What signs of serious injury and collision features can bystanders and first responders reliably recognise without medical equipment, and what are the most effective ways to teach them to identify these signs quickly?

Teaching bystanders to spot life-threatening injuries after a crash such as confusion, rapid heartbeat, heavy bleeding, or airway issues - can save lives. While some evidence shows untrained people can recognise key signs, they often misjudge severity, and most tools lack real-world testing or consideration of crash scene clues. More research is needed to understand what bystanders can reliably assess.

Question J: Which urgent treatments work best for people trapped after a collision, and how can non-medical responders safely provide them?

Entrapped patients are at higher risk of severe injuries that require urgent treatment. There is, however, little high-quality evidence for which interventions are more effective in this group. Current practice relies on wider trauma evidence and expert consensus, focusing on early fluid resuscitation and medication to mitigate the consequences of muscle breakdown. Bystanders may have a role in initial management, but evidence is lacking. Further research is needed to identify the most effective interventions and improve survival in this group.

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Question K: In road traffic collisions, how do factors such as age, gender, and background influence the types of injuries people get and the care they receive, and what can be done to reduce inequalities?

Who you are can affect how you're treated after a car crash. Older people often get hurt more easily, even in low-speed crashes, and women are more likely to be trapped in vehicles and have different types of injuries than men. People with lower income or education may also face delays in getting help. Current triage systems don’t always account for these differences, which can lead to unfair care.

To fix this, we need better tools that consider age, gender, and background when making emergency decisions—and safer vehicles designed with all types of people in mind.

Question L: Should injured people go to hospital in a police or private car instead of waiting for an ambulance, and how does this affect their recovery or survival?

Some studies show that people with penetrating injuries who arrive by police car or private vehicle, reach hospital faster and may survive as well as, or better than, similar patients brought in by ambulance. Older and newer analyses support this finding, though differences often reduce after adjusting for how sick the patients were. For blunt trauma, recent studies suggest outcomes are similar whether patients are brought by police or ambulance. Overall, the evidence suggests that non-ambulance transport can shorten the journey to hospital and may be safe in some situations, but we still need stronger research across different countries and types of emergencies to be sure.

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Question M: What psychological effects do bystanders face after helping at the scene of a road traffic collision, and how can support be designed to encourage action while protecting their mental health?

People who stop to help after a road crash can be deeply affected by what they see and do. Some feel proud of helping, but others may struggle with distress, guilt, or even post-traumatic stress. Research shows that even witnesses who do not suffer injuries themselves can experience lasting emotional effects. At present, there are very few formal systems to support these bystanders. Simple steps such as follow-up contact, reassurance, and access to peer or professional support could help protect their well-being, while encouraging safe intervention opportunities, and recognition of their role. More research is needed on how best to protect and support these everyday helpers.

Question N: What does a ‘successful recovery’ after a road injury really mean, and are researchers measuring what matters most to patients?

Many outcome measures for defining “successful outcomes” following trauma but the outcome measures which exist are not universally applied in research. Further the commonly used outcome measures have not been developed in line with what patients consider to be successful outcomes which is largely around their subjective assessment and sense of self rather than the degree of functional disability. More work is needed to define a suitable outcome measure and align research with consistently applying it in studies.

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Question O: How safe and effective are basic spinal care techniques, such as helmet removal or casualty rolling, when done by bystanders at the scene of a collision, and do step-by-step instructions help reduce the risk of injury?

Casualties of road traffic collisions may sustain injuries to their spine. If a spinal injury is suspected, professionals will aim to protect the spine and prevent further damage by using careful handling when moving them. This includes a two-person technique to remove the helmet of an injured motorcyclist, and a five-person technique to roll a person onto their side if required. There is currently no evidence exploring whether bystanders can safely perform these procedures if required before professional help arrives, or what instructions could be given by an emergency call handler. This is a potential area for new research.

Question P: What are the most reliable signs, at the scene of a road traffic collision, for spotting hidden life-threatening injuries such as internal bleeding or brain trauma?

‘Occult’ injuries are serious internal injuries from car crashes that are not obvious at first glance. A person might look fine at the scene, but still have life-threatening damage—especially to the head or abdomen. Researchers have developed scoring tools, like the Occult Score and Transfer Score, to help identify these hidden injuries and decide who should go to a trauma centre. These tools use crash details, not just visible injuries or vital signs. However, more work is needed to test these tools in real-life settings, especially in rural or lower-income areas, and to help dispatchers and bystanders use this knowledge effectively.

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Question Q: How can police, fire, and medical teams work better together at the scene of a road traffic collision to speed up rescue and improve patient outcomes, and what training or systems support this best?

When someone is trapped in a vehicle after a crash, police, fire, and medical teams all need to work together quickly. Research shows that delays often happen when roles are unclear or when too many responders crowd the scene. Newer strategies, like the EXIT method and joint training between fire crews and paramedics, can make rescues faster and safer. However, these approaches are not used everywhere, and still lack strong evidence on how they affect patient survival. More real-world testing and better coordination policies are urgently required.

Question R: What risks do rescuers and bystanders face when helping at the scene of a collision, and how can we protect their physical and mental wellbeing?

People who help at the scene of a road traffic crash - whether trained rescuers or bystanders - can face physical dangers like sharp metal, fire, or infection, and emotional impacts such as shock, anxiety, flashbacks, or guilt. Some take simple safety steps like turning off the car ignition or making the scene visible to other drivers, but many are unsure what to do or worry about legal risks.

There’s little data on injuries to bystanders, and few support systems exist to help them cope afterwards. Talking about the experience can help, but formal debriefing is rare. More research is needed to understand how to keep rescuers and bystanders safe and support their wellbeing.

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Question S: How do tools like checklists, real-time guidance, or dashboards affect the speed, quality, and fairness of trauma care delivery before patients reach hospital?

Tools such as checklists, electronic prompts, and performance dashboards can help paramedics give more consistent and timely care after a crash. Research shows these approaches make it less likely that key steps are missed and may speed up life-saving treatments. They might also reduce unfair differences in care between patients by standardising practice. However, most studies come from simulations or general emergency care, not specifically road injuries, so more research is needed to know their exact impact on trauma outcomes.

Question T: How does linking road traffic collision, emergency, and rehabilitation data nationwide, using tools like telematics, patient IDs, and shared records, help improve tracking, care quality, research, and recovery after road injuries?

At present, ambulance, hospital, and rehabilitation data are often kept separate, making it difficult to see the whole patient journey after a crash. Linking these data nationally could improve care by helping hospitals and services learn from patterns, share best practice, and support research. Although we do not yet have proof that this directly saves lives, the evidence suggests it strengthens system monitoring and helps identify ways to improve outcomes.

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Question U: How does using telemedicine to guide trauma care, especially in rural areas, affect triage decisions, patient outcomes, costs, and how efficiently patients are transferred?

Using telemedicine, ambulance teams can connect directly with hospital doctors while treating crash patients. This support may help paramedics make better triage choices, such as whether to call a helicopter or take a patient straight to a trauma centre. Early evidence suggests this approach could reduce unnecessary transfers, save money, and speed up care in rural areas. However, strong research proving that it improves survival or recovery in trauma is still limited, so more studies are needed before it can be widely adopted.

Question V: After a road traffic collision, which types of deaths could potentially be avoided with the right help at the right time and when are those critical moments where quick action can make the biggest difference?

Among people injured in road traffic crashes, head injuries are the leading cause of death, followed by heavy bleeding. Other injuries, like to the chest, abdomen, or spine, also matter but are less common causes. Many of these deaths could be prevented, especially if care is faster. Some studies suggest only a small number (4–17%) of deaths are preventable, while others say it could be much higher (up to 80%), depending on how preventability is measured. A large number of deaths happen within the first hour, especially the first 15 minutes, making fast action—like stopping bleeding or opening airways—vital. Understanding how and why people die after RTCs requires precise, detailed information about injury mechanisms, patterns, and physiological consequences.

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Question W: Do tailored training programmes for bystanders improve care and outcomes at the scene of a collision, and how can we measure the benefits?

Trauma focussed training programmes for members of the public are available globally. There is a small amount of evidence, from low-middle income countries, that these programmes may reduce deaths amongst casualties of traumatic injury, however there is no evidence available from high-income countries with established emergency care services. Furthermore, there is some evidence to suggest increased levels of first aid training increase the likelihood of first-aid being delivered, and delivered correctly, by members of the public. Further research is required to establish if these training programs reduce non-fatal injury, or offer other benefits to emergency care systems.

If you should have any further questions or queries please contact: Email: kerry.dungay@post-collision.com For more information on IMPACT and the work we do, you can visit our website. www.post-collision.com