Chain of Survival in Road Trauma: A New Model to Improve Prehospital Management

Road traffic accidents still represent a significant global public health problem, with approximately 1.3 million deaths per year and between 20 and 50 million people suffering injuries. A recent editorial published in Injury proposes an interesting conceptual framework that extends the "Chain of Survival" model, traditionally used for cardiac arrest, to the specific context of road traffic injuries.

The Conceptual Model of the Chain of Survival

The authors, Tim Nutbeam and Willem Stassen, propose a systematic structuring of rescue divided into five main phases:

• Early recognition and request for help

• Initial aid

• First aid interventions

• Transport

• Hospital care and rehabilitation

This setting allows you to analyze the different stages of post-accident assistance in an organic and interconnected way.

Chain of survival

Innovative Aspects

Early Recognition Technologies

The article highlights the importance of automatic accident notification systems, integrated into modern vehicle technologies. These systems allow for the transmission of real-time data on the severity of the accident and its location, allowing for a faster and more proportionate response. They are not yet perfectly integrated with all Operations Centers and, speaking from direct experience, sometimes create false alarms, but they represent a potential turning point for early warning.

The sBATT Score: Potential and Limitations

Of particular interest is the development of the sBATT ( Simplified Bleeding Audit Triage Trauma ) score, a simplified tool for the early assessment of hemorrhagic trauma.

Analyzing in more detail the scientific evidence available on sBATT ( Nutbeam T, Stassen W, Foote E, et al) , some important considerations emerge:

• The score was derived and validated in a specific context of motor vehicle crashes.

• It represents an attempt to standardize trauma assessment for lay or first responders.

• It could be particularly useful in settings with limited resources or where complex triage systems are difficult to implement.

Although the article does not specifically address the aspect of telephone triage , sBATT could represent an interesting decision support tool for control center operators . However, further studies are needed to validate its effectiveness in this specific context.

The UTSTEIN Registry: Standardization and Research

A crucial methodological aspect underlined by the authors is the need to create a standardized registry based on the UTSTEIN model for the collection of data on road injuries.

The main features of this approach include:

• Definition of a shared data dictionary

• Using standardized templates for information collection

• Facilitating international comparison

• Supporting research through comparable data

The aim is to overcome the current fragmentation in the collection and analysis of data on trauma, creating a framework that allows on the one hand to create comparisons between different geographical and healthcare realities and on the other to identify best practices and a more careful direction of investments in research and training.

Self-extrication and Triage

Another point of interest concerns the management of potential spinal injuries in the pre-hospital setting. The recent WHO guidelines (2024) recommend a more selective approach to immobilization, reducing the systematic use of the rigid cervical collar in favor of manual stabilization and patient comfort, especially in low-resource settings. These indications integrate well with the concept of 'Early Rescue' proposed in the Chain of Survival of road trauma.

Final Reflections and Implications for Practice

The editorial proposes a systemic approach to the management of road accident trauma, which goes beyond the logic of individual interventions to embrace an integrated vision of assistance.

Although it does not represent a revolution, the work offers interesting methodological ideas for:

• Improving the care response

• Standardize interventions

• Supporting scientific research in a crucial sector for public health

The authors hope that the international community will take up this proposal, starting a process of sharing, improving and implementing the model.

We will be back soon with a discussion about the use of the sBATT score . Bibliography

1. Tim Nutbeam and Willem Stassen, “The Road Injury Chain of Survival: A Framework for Improving Trauma Outcomes,” Injury (March 1, 2025): 112285.

2. Nutbeam T, Stassen W, Foote E , et al Derivation and validation of the simplified BleedingAudit Triage Trauma (sBATT) score: a simplified trauma score for major trauma patients injured in motor vehicle collisions. BMJ Open 2024; 14: e090517. doi:10.1136/bmjopen-2024-090517 Chain of Survival in road trauma: a new 5-step framework to improve care response, from early recognition to rehabilitation.