
The PACTS 32nd Westminster Lecture on Transport Safety was delivered by Professor Tim Nutbeam on 4th of December 2024 at the Wellcome Collection.
Professor Tim Nutbeam is a Consultant in Emergency Medicine and a renowned expert in trauma care. Throughout his career, he has combined clinical practice with pioneering research to address critical issues in road safety and emergency response. His work on extrication techniques and the identification and treatment of non-compressible haemorrhage has significantly influenced both medical and transport safety practices.
Professor Tim Nutbeam delivered a compelling lecture on challenging dogmas in road safety, focusing on three primary dogmas challenged through research:
Dogma 1: Slow and steady extrication improves patient outcomes by reducing spinal injury:
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- Being trapped is an independent risk factor for death. Something about being trapped kills you.
- Spinal cord injury rates are low, at only 0.7% of motor vehicle collision victims.
- Different extrication methods (roof off, side extrication, rapid extrication) were all found to cause similar spinal movement
- Surprisingly, patients who could self-extricate caused the least spinal movement, whereas prolonged extrication (32 minutes) offers no benefit in reducing spinal cord movement compared to rapid techniques.
Dogma 2: Slow and steady reduces spinal movement:
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- Slow and steady causes the same amount of spinal cord movement as the rapid techniques and, as a result, it’s a surrogate for potentially worsening of other injuries
- Patients initiating their own movement (if possible) causes the least spinal movement.
Dogma 3: Equitable trauma care is provided:
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- Women, especially older women, are approximately half as likely to receive life-saving treatments like tranexamic acid compared to men for similar trauma levels, despite its proven efficacy.
Research Methodology
Professor Nutbeam used a metaphorical “nail and hammer” approach to illustrate research complexity, where the nail represents the problem’s complexity and the hammer represents the scientific methodology used to address it. He recommended challenging existing research practices by:
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- Moving away from randomised control trials (expensive, very specific and not always appropriate for the context) to other methods such as REMAP (Randomised, Embedded, Multi-factorial, Adaptive Platform trials) to enable efficient and cost-effective research.
- Making use of existing vast datasets and AI’s capacity for potentially transformative data analysis.
Conclusion:
The lecture’s core message is that dogmas – unchallenged beliefs persisting despite changing evidence – can be harmful. By systematically examining and breaking down these dogmas through rigorous research, it is possible to save lives and improve emergency response strategies.
Next steps:
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- Identify dogmas and challenge them with the right tools and approaches.
- Move beyond RCTs and share findings, including failures.
- Ensure research findings are implemented in real-world settings.
- Keep patients or casualties at the heart of all efforts and decisions.
The lecture served as a powerful call to continuously question, research, and improve our understanding of road safety and trauma care.
The lecture has been published and can be accessed here.
