Trapped and traumatised: a scoping review of the psychological sequelae of entrapment following motor vehicle collision.

backgroundMotor vehicle collisions (MVCs) are a significant public health challenge, resulting in substantial mortality and morbidity. Entrapment occurs in 12-33% of all MVCs and is associated with greater injury severity, longer on-scene time, and increased mortality. However, the psychological consequences of entrapment remain poorly characterised.

objectivesThis scoping review seeks to establish the current understanding of the psychological sequelae of entrapment following MVCs and draws on insights from related fields of study in order to inform future research and clinical practice.

methodsA scoping review was undertaken following established methodological guidance. Searches were completed on NHS Knowledge and Library Hub, Proquest, and Ovid. Eligible studies reporting psychological outcomes in casualties trapped following MVCs were included, with no restrictions to publication date. Secondary searches were also undertaken to explore psychological outcomes in the related contexts of MVCs more generally and entrapment in non-MVC settings, with salient findings presented to contextualise the primary search within more established literature.

resultsSeven studies were included from the primary search. One additional study from the secondary searches was included in the primary research discussion due to a high degree of specificity to that topic. No study directly compared psychological outcomes in trapped versus non-trapped casualties. Reported experiences highlighted themes such as perceived threat to life, loss of control and the importance of supportive human contact. Some individuals experienced clinically significant mental health outcomes including post-traumatic stress disorder (PTSD), Acute Stress Disorder (ASD), anxiety, and depression. Secondary evidence supports the likelihood of increased psychological morbidity associated with MVC-entrapment.

conclusionDirect evidence on the psychological sequelae of MVC-entrapment is limited. Available findings suggest entrapment may heighten psychological risk through a range of factors, but prospective cohort studies comparing trapped vs non-trapped MVC casualties are needed to determine causal pathways. Further research should also explore rescue-based interventions such as facilitated self-extrication and deployment of extrication buddies, as well as appropriate trauma-informed psychological interventions in the immediate hospital setting and beyond.