In this opinion piece, Tim Nutbeam, outlines how the concept of a Road Injury Chain of Survival could be the next game-changer in saving lives on UK roads.
Tim is a consultant in Emergency Medicine and Prehospital Emergency Medicine based at Plymouth Hospitals NHS Trust and the Devon Air Ambulance. Tim is Professor of Emergency Medicine and Post-Collision Care at the University of Plymouth. Tim has worked on extrication and post-collision research for the last decade and is the lead for the EXIT project and director at IMPACT. IMPACT the Centre for Post-Collision Research Innovation and Translation is supported by The Road Safety Trust and Vision Zero South West.
Every year, road traffic collisions claim the lives of approximately 1.3 million people worldwide, while a further 20 to 50 million suffer injuries—many of which lead to long-term disability.
Despite significant advances across many of the pillars of road safety, gaps in post-crash care remain stubbornly unaddressed.
In other areas of emergency medicine, such as cardiac arrest management, the adoption of the ‘chain of survival’ concept has led to dramatic improvements in survival rates. This structured approach ensures that patients receive the right care at the right time by strengthening each critical link in the response chain. If we want to improve outcomes for road traffic collision victims, we need to take a similar approach.
The Road Injury Chain of Survival
Much like the well-established model for cardiac arrest, a Road Injury Chain of Survival would provide a structured framework to optimise patient outcomes. This consists of five key links, all of which must function effectively to maximise survival and recovery.
- Early Recognition and Calling for Help
The first few minutes after a crash are critical. Bystanders, fellow road users, and emergency services call handlers play a vital role in recognising life-threatening injuries and ensuring an appropriate emergency response. Delays—particularly in rural or resource-limited settings—can result in significantly worse outcomes.
Encouraging rapid emergency activation, with clear guidance for bystanders on what to report and how to assist, is an essential first step.
- Click here to learn more about the Bystander project, via The Road Safety Trust
- Early Rescue
Once help is on the way, the rescue phase becomes the next priority. Being trapped in a vehicle is linked to poor outcomes, not just because of injury severity, but due to delays in assessment, treatment, and transport.
Techniques for extrication have advanced significantly, with fire and rescue services moving away from outdated assumptions—such as prolonged immobilisation or unnecessary vehicle dismantling—that may inadvertently prolong entrapment and delay critical interventions. Modernising rescue strategies, ensuring rapid access to the patient, and integrating medical decision-making into extrication efforts can all improve survival rates.
- Click here to learn more about the EXIT project, via The Road Safety Trust
- Early Initial Care
Not all road traffic collision deaths occur immediately on impact. Many are preventable with simple, timely interventions. Bystander-administered CPR is now widely recognised as a life-saving measure for cardiac arrest, but when it comes to trauma, basic first aid knowledge among the public is sorely lacking.
Teaching civilians to manage catastrophic bleeding, airway obstruction, and non-compressible haemorrhage—as has been successfully done in military and hostile environment settings—could dramatically reduce fatalities. Equipping police officers and community responders with road-injury specific first aid skills and interventions is another intervention that can save lives.
- Early Transport
Getting critically injured patients to the right hospital at the right time is key to survival. Many trauma systems have moved towards a ‘bypass’ model, where patients are taken directly to major trauma centres rather than the nearest hospital. However, transport times must be weighed against the need for urgent interventions—particularly for non-compressible haemorrhage, the leading treatable cause of trauma death.
Helicopter emergency medical services (HEMS) play a crucial role here, but only if activated early enough. Clear triage tools that help paramedics, dispatchers, and others on scene such as police officers recognise which patients will benefit from direct transport to major trauma centres or HEMS activation could improve both efficiency and outcomes.
- Early Hospital Care and Rehabilitation
Survival alone is not enough. The long-term impact of road injuries on patients, families, and society is often overlooked in discussions on road safety. Early access to specialist trauma care, rehabilitation, and mental health support is essential to improving quality of life for survivors.
Countries with well-developed trauma networks have demonstrated the importance of integrating rehabilitation into acute care pathways, yet many road injury survivors face fragmented, inconsistent, or inadequate follow-up. Without structured rehabilitation, survivors can face lifelong disability, chronic pain, and reduced social or economic participation.
Why This Framework Matters
The Road Injury Chain of Survival is more than just a theoretical model—it provides a roadmap for governments, emergency services, and road safety advocates to focus on the most impactful interventions. By identifying key weaknesses in each link, policymakers and healthcare leaders can target investment where it will make the greatest difference.
For example, strengthening public first aid knowledge through Stop the Bleed-style campaigns could help reduce preventable trauma deaths. Training emergency dispatchers to better triage road traffic collision calls could ensure resources are deployed more effectively. And ensuring that fire and rescue services adopt modern, medically informed extrication strategies could significantly reduce entrapment times.
While prevention is undeniably crucial, we must also acknowledge that some collisions will always occur, and our responsibility is to ensure that those involved have the best possible chance of survival and recovery.
By embedding the Road Injury Chain of Survival into trauma care policies and emergency response frameworks, we can close the gaps that currently cost lives. This requires investment in research, training, and inter-agency collaboration.
We call on policymakers, road safety professionals, and trauma care providers to adopt and refine this approach. By doing so, we can ensure that every person who experiences a road traffic collision has the best possible chance of not only surviving—but living well after their injury.
If we take this challenge seriously, the Road Injury Chain of Survival could be the next game-changer in saving lives on our roads.
Contact Tim on: tim.nutbeam@post-collision.com
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