Lancashire Fire and Rescue Service

Physically trapped patients following motor vehicle collisions are at high risk of time-critical injuries and poor outcomes. Despite this, there is limited consensus on which injuries should be prioritised and which early interventions are both necessary and feasible in the prehospital setting. This study aims to develop expert consensus on injury categorisation and the delivery of early care interventions to guide clinical and operational decision-making at the scene. A modified Delphi method was used to gather consensus from a multidisciplinary panel of subject matter experts, including clinicians, paramedics, and members of fire and rescue services. In Round 1, participants contributed to the development of draft statements relating to injury time sensitivity, intervention prioritisation, and responder roles. In Rounds 2 and 3, participants rated their level of agreement with these refined statements. A final face-to-face consensus meeting was held to discuss statements that had not yet reached consensus, explore areas of disagreement, and conduct further voting where appropriate. Consensus was defined as ≥ 70% agreement. Consensus was achieved on 45 statements across the domains of injury categorisation, time-critical interventions, and multi-agency responsibilities. Participants strongly endorsed the early delivery of analgesia, tranexamic acid, and protection from environmental stressors, regardless of provider background, provided that appropriate training and governance are in place. There was broad support for expanding the scope of practice of non-clinical responders to meet urgent patient needs. This Delphi consensus provides a framework for prioritising early interventions in the care of trapped patients. It supports a patient-centred, capability-based approach to prehospital care, emphasising feasibility, urgency, and ethical responsibility. Findings should inform the development of standard operating procedures, triage tools, and training frameworks across emergency services, with further research needed to validate assessment heuristics and address barriers to implementation.

To assess the validity and reliability of a firefighting simulation test (FFST). Sixty-nine operational firefighters completed a best-effort FFST on one occasion and 22 participants completed a further FFST. All participants completed a maximal treadmill test to determine cardiorespiratory fitness (VO2max). Time to complete the FFST demonstrated a strong inverse relationship with VO2max (r = -0.73), although the prediction error was high. Reliability of the FFST was high (r = 0.84, P = 0.01), demonstrating a coefficient of variation of 4.5%. The FFST demonstrated reasonable validity as a surrogate assessment of cardiorespiratory fitness for firefighting. The FFST also demonstrated good reliability. Given the apparent magnitude of the prediction error, the FFST would be best used as a training tool, rather than as a primary means of assessing cardiorespiratory fitness for firefighting.

The aim of this study was to develop a systematic task analysis process for determination of minimum acceptable job performance in arduous safety-related occupations. A task analysis using modifications on established methods was completed in UK firefighters. Subject-matter experts (all male) identified critical, physically arduous tasks generic to all UK firefighters and developed individual, role-specific task simulations. Video footage and blinded voting were used to determine minimum acceptable task performance. Eight tasks were identified in combination with role-specific variations, task simulations suitable for use in a physical demands analysis, and corresponding minimum acceptable performance. The bespoke steps highlighted here allow structured identification of task-specific minimum performance standards and simulations from which physical employment standards could be based. However, including a more divergent expert panel with respect to age, sex, and race would strengthen the applicability of this framework in future practice.