Dr Alex Shaw, Dr Neil Thomson, Dr Mardi Steer
1RFDS SA/NT
Biography:
Dr Alex Shaw is a Rural Generalist and Retrieval Consultant with the Royal Flying Doctor Service (RFDS) SA/NT. He is a Fellow of the Australian College of Rural and Remote Medicine (FACRRM) with advanced skill training in remote medicine and Rural Generalist Anaesthesia (RGA). Dr. Shaw has significant experience as a Rural Generalist and works as a General Practitioner Anaesthetist and Emergency Doctor in rural New South Wales. In addition to his clinical roles, he serves as a Medical Educator for the Australian College of Rural and Remote Medicine, contributing to the training and development of future rural healthcare professionals.
Abstract:
Background:
Spinal motion restriction (SMR) practices have evolved, with increasing evidence favouring flexible, patient-centred extrication over traditional rigid immobilisation. In 2024, the UK Faculty of Pre-Hospital Care released national guidance supporting supported self-extrication and selective use of immobilisation devices. Australian ambulance services are similarly transitioning towards risk-based SMR approaches, particularly relevant in remote and retrieval contexts.
Objective:
To compare the UK’s 2024 SMR and extrication guidance with current Australian jurisdictional guidelines, identifying opportunities to support non-paramedic clinicians involved in remote and aeromedical retrieval.
Methods:
A comparative analysis was conducted of the UK FPHC guidance and spinal care protocols from Queensland, New South Wales, Victoria, and Western Australia. Key domains included extrication strategies, equipment, clinical decision-making, and relevance to remote, interdisciplinary teams.
Results:
Australian jurisdictions demonstrate increasing alignment with international evidence regarding SMR and have been amongst prime movers in this field. Queensland and New South Wales have adopted soft collars and selective immobilisation, with Victoria and Western Australia applying similar patient-centred, risk-based models. The UK’s structured U-STEP OUT framework offers additional decision support, particularly valuable in remote settings where retrieval teams may include doctors, nurses, or other non-paramedics without on-site paramedic backup.
Conclusion:
UK and Australian SMR practices are converging toward flexible, evidence-based care. A nationally consistent, context-sensitive guideline could enhance decision-making and safety for non-paramedic-led retrieval teams across Australia, without compromising jurisdictional autonomy. This paper advocates for collaborative discussion on developing consensus-based guidance to strengthen remote trauma care.
Keywords: Spinal motion restriction, extrication, retrieval medicine, remote trauma, interdisciplinary teams, SMR, Australia, UK