The Motorsport Medicine and Rescue Mastery Podcast

Key messages

Exrtication modalities: Self – Rapid – Programmed

Balance patient needs with the time available

Know your equipment, your team and your options

As the clinical condition changes, extrication tactics may need to change


Related to making a rapid clinical assessment and early code communication, is the decision on how best to get the competitor out of their vehicle. This decision requires a balance of the patient's clinical needs and the time available. And keep in mind that those needs may change over a period of time, especially where the responding crew can be on site very quickly.

Some guiding principles are that the extrication decision should be:

  • Context specific

  • As safe as possible

  • As quick as is practical

  • Don't sacrifice yourself or your team

  • Know your equipment

  • Know your team

  • Know your options

  • Communicate clearly, directly and regularly

  • Watch for both clinical and scene evolution

Taking the simplest approach, there are three ways to get a competitor out:

  • Self extrication – This is the easiest, the quickest and the most clinically reassuring strategy. It implies that the person is conscious, oxygenating, perfusing, has intact cognition and is not trapped. Self extrication is usually associated with non-life threatening nor time critical injury, but this is not always true, especially where the medical response team is on scene very quickly before any pathology has had time to manifest (e.g. circuit response can often be measured in seconds).

  • Emergency or Rapid extrication – Speed of extrication is the priority here due to the presence of an imminent life threat, which may be clinical or environmental. Rigorous control of the spine is sacrificed for that speed, though it is not necessarily completely ignored.

  • Programmed or Controlled extrication – This is the strategy that often takes the most time and consumes the most resources. Controlled extrication is not a great term as all forms of extrication, even emergent, should have an element of control. The term programmed extrication is better as it alludes to the multi-step, sequential approach that this strategy often employs

(Editor's note: Have a listen to Part I of the Episode 5 Mastery Podcast below where Mark Brennan further subdivides extrication into Immediate, Rapid and Urgent)

The ATACC Group ( in the UK have proposed a rescue extrication A.B.C. strategy which both puts a structure on an extrication plan and provides a shared language for the individuals involved, not all of whom may have a rescue background. It is directed at civilian and industrial vehicles, rather than race cars, so not every element will necessarily be applicable. It's a good basis to work from however. The concept is fully explained in their Rescue Trauma & Casualty Care RTACC Manual:

Image: SAMURAI LASER extrication mnemonic from ATACC

Let's take a more detailed look at each of these modes of extrication before exploring how they fit into the decision making process at the trackside.

Self extrication

There is not a huge amount of clinical literature targeting motorsport so almost all practice is based on extrapolation from other areas of medicine, particularly emergency medicine, pre-hospital medicine and tactical/combat medicine. Mechanism of injury has traditionally been a major driver for roadside intervention decision making. This probably works for motorsport in categories where the vehicles have minimal modification of standard road cars. Once safety equipment such as a helmet, frontal head restraint, window nets, race harness, roll cage and wraparound seat elements are in place, along with the higher speeds and greater deceleration forces, it becomes harder to be sure about applying the same conclusions.

A race car may look irreparably damaged following a collision. Indeed, top tier race cars are designed to crumple and fragment in predictable patterns in order to lower deceleration forces. As a result competitors may have little or no injury despite the apparent mechanism.

Novikov's rolled rally car - WRC Rally Australia 2011

Fernando Alonso's Australian F1 GP crash
(Formula 1 YouTube Channel)

While there is work being done to build up an evidence database in various parts of the world, it is largely in the early phases and no clear evidence based recommendations are currently forthcoming. Most of the resulting information is being plugged into engineering developments to prevent harm, which is a good thing, but there is not much available to help us with decision making on the scene of a crash. So the best we have to work with currently is a mixture of anecdotal experience and drawing on non-motorsport trauma evidence.

C-spine collar practice

Where the evidence gap causes the most controversy is spine injury management, particularly cervical spine injury potential. The topic continues to ignite debate in pre-hospital and critical care circles and it is something that we will dive deeper into in a later article. If you can't wait until then and want to read a bit more about this then check out these resources:

Ultimately, if the competitor can get themselves out of the race car, that will usually be the most efficient method and the likelihood of exacerbating an existing injury is probably small. If the person is unable or unwilling to self-extricate, that may be a clue towards entrapment or more significant injury.

Rapid extrication

Also called emergency extrication, the intent is to get the competitor out of their vehicle as fast as possible. The reason to choose this approach is imminent threat to life, either clinical or environmental.

Environmental threat

  • Fire

  • Imminent or actual submersion

  • Unstable local hazards

Clinical threat

  • Unconscious and not breathing (BLS trigger - )

  • A clinical intervention to save life that cannot be effectively delivered while the patient is still in the vehicle; e.g. CPR, rapid sequence intubation, massive haemorrhage from a source that is difficult to access while inside the vehicle

Rally car submerged at Rally Australia 2017

Inherent in this is a lower prioritisation of spinal alignment in the interest of saving life.

There are a number of ways of achieving a rapid extrication, from simply grabbing whatever part of the person is available and hauling them out to something like the Rautek Maneuver.

Rautek video – Frog Racing YouTube channel

It's important to practice several different options as different race car structures and seating configuration make the different techniques more or less manageable. For instance, the Rautek Maneuvre is easily practiced in a chair in the middle of an open room and operable for a competitor in a relatively upright car seat with an open roll cage aperture. It becomes impossible to perform safely for a driver in a semi recumbent position in a low slung open cockpit race car that has a rigid cockpit protection device such as the Halo.

Regardless of which rapid extrication technique is used, it is important to free up the competitor from their race harness and helmet tethers and quickly sweep for entrapment, especially in the foot well, so that you don't suddenly get stuck halfway through the lift.

Major deformation of the vehicle that results in entrapment of a patient with an imminently life threatening injury is the worst situation and requires a combined effort by the medics to to buy enough time for the rescue technicians to free the person without injuring anyone involved. It is an extremely challenging scenario with a high probability of not succeeding. Having good interspecialty relationships is critical and can be promoted through team cross training.

Programmed extrication

Programmed extrication is a methodical, step wise form of assisted extrication employed when a competitor is unable to get out of the vehicle by themselves, either due to clinical injury or entrapment. Implicit in choosing this strategy is that there is not an imminent life threat, as programmed extrication takes the longest of all three forms. It may be triggered by a Code 2 or 3 injury (Link to Scramble to Turn 1 - PART 4 - Initial assessment and communication) where the person is unable or unwilling to get out by themselves; e.g. long bone fracture, spinal injury, pelvic fracture, chest or abdominal injury.

Programmed extrication can be conducted in a variety of ways depending upon the situation and the equipment available and it follows a series of steps or phases:

Stabilisation – Liberation – Binding – Lifting

FIA F1 Extrication exercise 2019

1) Stabilisation 

  • Of the vehicle, making sure that it is not going to move during proceedings, that the electrics have been isolated and the engine has been immobilised.
  • Of the patient, in terms of a primary survey (A Code 1 injury generally triggers a Rapid Extrication.).

2) Liberation

This phase involves detaching anything that tethers the competitor to the vehicle and includes:
  • taking down window nets 
  • opening or cutting the race harness 
  • removing the quick release steering wheel 
  • removing the cockpit surround of an open cockpit race car; e.g. F1, 2, 3 and 4, Formula E. 
  • unclipping helmet tethers such as communication wires, drink tubing and air flow tubing removing or cutting arm tethers (often found in speedway, drag racing and off-road buggies)

If there is space to do so and it has not already been done, now is a reasonable time to remove the competitor's helmet, frontal head restraint device and balaclava. It is also the time to consider whether the extrication would be assisted by the use of hydraulic rescue tools to create more operating space. (We'll explore the specifics of using these tools, such as cutters, spreaders, rams and saws, in a separate article.)

3) Binding

This step may be skipped if the relevant equipment is not being used. During this phase the patient is secured to some form of spine movement restriction device, like a KED or a short board or in the case of some FIA open cockpit categories, to the removable portion of the driver's seat (Lear seat). Even if they are available, it can be difficult to apply some of these devices depending upon the race seat shape and how the competitor is positioned in it. (We'll cover the intricacies of these extrication aids in a later article.)

4) Lifting

The patient is removed from the vehicle, either in one single movement or via a series of movements, often to get them onto an extrication board and finally onto an ambulance stretcher. Exactly how this is achieved is again dependent upon the type and structure of the race car.

Spine management during extrication and transport has gone through some significant evolution over the past 5 – 10 years. We'll take a deep dive on this topic in the future but briefly here are the bits that generate the most heated debates.

Increasingly, ambulance services will not routinely use a semi-rigid cervical spine collar unless patient movement is difficult to control and they may remove the cervical collar once the extrication has been completed. Some services apply a soft collar as a reminder that the cervical spine has not yet been formally cleared of injury, while others use manual in-line stabilisation or sandbags placed on either side of the person's head.

Regardless of how the competitor was extracted from their vehicle, the person should not be transported on a hard extrication board. Most modern stretchers are approved for spinal injury transport, but this is service dependant and should be checked as part of the event planning.

As there is the potential for vomiting while lying supine, there are some ambulance services who will transport a possible spine injured patient in a neutral left lateral position rather than try to perform a log roll or leave the person on a hard board. Vacuum mattress transport is another viable option.

During a programmed extrication particularly, it is important to regularly reassess the patient's status and keep a regular flow of communication with race control, highlighting the current patient code, what stage you are at in proceedings and how much longer you anticipate being on scene. This helps the key players at the scene and in race control to work along the same trajectory (Shared mental model).

Implicit in considering extrication decision making is that first response crew members need to have a good understanding of potential pitfalls. Each crew member needs to know how the equipment works. You may not be the one using it, but it pays to understand how it works as this will assist communication and work flow.

Race car safety equipment

  • Electrical isolation switch

  • Fire suppression activation switch or ring pull

  • Door opening

  • Window net detachment

  • Quick release steering wheel removal

  • Cockpit surround

  • Cockpit Halo

  • Roof plate (if fitted)

  • ERS warning lights (F1, Formula E)

  • Helmet-FHR assembly

  • Helmet tether detachment (communications, drink, cooling tubes and cables)

Extrication equipment

  • KED (Kendrick Extrication Device)

  • Vacuum mattress

  • Lear seat extrication tools

  • Short board

  • Basic rescue tools

  • Hydraulic rescue tools


  • With the patient

  • Between your crew members

  • Between other responding crews (e.g. sector officials, vehicle recovery)

  • With race control

The take home from all of this is that the extrication strategy that is chosen has consequences for time taken to completion, complexity and potential for error, and outcome pros and cons. In general, the decision process could look something like this:

  • Code 1 → Rapid extrication. (If the patient is conscious it is possible that they might self extricate, but this would be the exception rather than the rule.)

  • Code 2 or 3 → Self extrication where feasible is preferable, especially for a Code 3 injury. If the patient is unable or unwilling to self extricate then programmed extrication will be the strategy. This may include the need for deploying specialised tools such as hydraulic rescue tools or Lear seat tools.

Once the patient has been extricated from their vehicle it is important to reassess them clinically for any deterioration or previously unnoticed injuries. On scene clinical management and disposition will be the topic of the next article and podcast.

The Rescue Masters

Rickard Johansson (Sweden)

Mark Brennan (Ireland)

The Podcasts


Part 1 contents

General intro

Key messages

Mark Brennan's introduction

Rickard Johanson's introduction

Clarifying extrication versus extraction versus disincarceration

When does planning for extrication strategies start?

Tips on how to tell if your rescue crew are well prepared and reliable

The overall extrication approach structure

Mark's rescue team extrication approach

- The windscreen survey

- The outside survey

- The inner survey

- Fire suppression

- Vehicle stabilisation

- The medical assessment

- Regroup and task prioritisation

How much medical information does the extrication-rescue team need?

Immediate, Rapid and Urgent identification

We troubleshoot a two car rescue scenario

Jamie's baby boy gets in on the action

The role of the rescue team in preserving property (De-escalating the trigger happy car cutters)

Balancing scene safety and rapid medical assessment


Part 2 contents

Rickard's rescue team approach to identifying extrication approach for a given vehicle

- Colour coded structural diagram database for various racing categories

- Not everything needs to be cut. Sometimes unbolting is quicker and less destructive

- Digital or paper copies of the database along with regular familiarisation is a major time saver

- The potential role for AR rescue technology

- Building relationships with teams, manufacturers and event promoters

Tackling the wall of manufacturer secrecy - Asking for the vehicle blueprints versus walking to the pit garages.

Should ASNs have an obligation to require certain elements of race car structure to be disseminated to motorsport rescue agencies?

Racesuit versus fire fighter turnout gear- What should the minimum accepted rescue PPE be for motorsport?

The attitudes and practices of fire-fighters and medics towards environmental PPE often seem quite different.

We have specific needs and should probably push to have customised motorsport rescue PPE rather than making do racesuits that are designed for competitors. And if we want to wear the racesuit, we should also be wearing the gloves, footwear, balaclava, some form of helmet and perhaps a respirator, especially if there is a substantial risk of exposure to fire.

Answering the question "Is the scene safe" is not just about what you are seeing but also what you are wearing and what equipment and skills you are bringing.

Contamination management

- Control scene exposure and crew deployment as much as possible

- Ideally contamination should not be brought back into the interior of the response vehicle

- Clean your PPE after an incident and consider having spares

Balancing best practice and financial constraints is tricky but needs to be addressed


Mark Brennan's resources

Rickard Johansson's resources

Literature resources for further reading