Scramble to Turn 1

Incident safety and logistics - PART 3 - Approaching the scene safely


Personal safety comes before patient safety.

Safety is a responsibility of all crew members.

Zero point survey & S.T.E.P. U.P. strategy


As medical professionals we are all aware of the need to approach a critical scene safely. It's drilled in from Basic Life Support ( training right up the chain.


D = Danger – Check for it!

It's easy to forget this basic process when responding to an adrenalin-soaked scene of race car carnage. Throw in a few thousand smart phone and TV cameras being pointed at you, along with a voice from race control on your radio demanding a SitRep and that you clear the scene as quickly as possible and before you know it, you've leapt out of the MIV, dropped your radio whose microphone cord tangles around your knees, stumbled across the gravel trap and thrust your top half in the window of the crashed car to grab the driver's jaw line just as the two lapped race cars fly past and you think you might be able to smell burning.

It's hard to render assistance if you in turn become a casualty. Even worse, you have now possibly doubled the number of injured persons needing help.

Arriving safely at an incident scene is something that paramedics (EMTs) and fire-rescue technicians are far more aware of and get more training for than doctors, particularly doctors who have little or no pre-hospital experience.  

Jamie's 3 Trackside Danger Zones

When trawling through the educational literature on being called out for a clinical response, a clear theme comes through – every call out starts with scene safety.

Queensland Ambulance Service Clinical Practice Guidelines (QAS CPG - and Ambulance New South Wales Greater Sydney HEMS (GS-HEMS CPG - offer guidelines on what constitutes a safe approach during the response to a civilian incident. It's worth reading them both separately, but here is an amalgamated version:

  • Core principle = Personal safety comes before patient safety, for the reasons mentioned above.

  • It's difficult and probably impractical to ensure complete safety, so we engage in risk management in order to operate with the minimum acceptable level of risk. This constitutes hazard identification (risk assessment) and risk mitigation measures.

    • Hazard identification – Nature / Seriousness / Likelihood (This is often tabulated into a risk matrix)

    • Risk mitigation measures – Can it be eliminated? If not, how can it be minimised? If not, how can any potential harm be minimised?

  • Safety is a responsibility of all FIV crew members. There is a personal responsibility to have the proper training (knowledge and skills), proper safety equipment and adequate fitness. There is also a responsibility towards vulnerable individuals or groups; e.g. spectators, novices and trainees.

  • Never assume that a scene is safe – There are many points at which things can go wrong (clinical, technical, logistic). Multiple people arrive very quickly at the incident scene, all with set objectives but which may not be fully aligned (control race, clinical care, clearing debris, moving the wrecked vehicle, restarting the race, taking selfies) and some of whom we may never have worked with before. Conducting some form of a Field Risk Assessment to assess hazards, resources and needs helps to get a handle on what is in front of you. There are many ways to do this. Here is one suggestion.

  • Zero point survey using S.T.E.P. U.P.:

    • Self - Am I in my best condition? Do I have what I need?

    • Team – Have we got the resources that we need? Can we communicate effectively? Have we got a plan?

    • Environment – What are the barriers and hazards? What can we do about them? What other resources are on scene?

    • Patient – How many? Who are they? What do they need?

    • Update your team (Shared mental model)

    • Priorities (Scene, clinical, extrication and transport)

  • Running through a STEP.UP. is useful at several phases including the planning stage, the start of day briefing, individual crew briefing or even periodically during the day, on arrival at the incident and each time there is a significant change in circumstances (clinical, techincal, logistic).

  • Have a planned crew approach:

    • Are we all going together or staggered?

    • Who is watching our backs?

    • Who has clinical lead and who has scene control?

    • Building trust amongst your crew goes a long way towards achieving these elements. Get in some wins for your team, learn eachother's language and a bit about their skills and be prepared to pitch in where you are needed.

  • Liase with other services that are already on scene before approaching the injured person. They may have useful safety or clinical information.

At a road traffic accident there are certain elements that paramedics and fire-rescue technicians will look to address early:

  • The traffic has been stopped or safely diverted

  • A working perimeter is established

  • Fuel and fire risk has been addressed

  • Engine ignition is off/disabled

  • Vehicles are stabilised

  • Undeployed safety devices (e.g. airbags) have been secured

  • Local hazards (e.g. high voltage wires, gas lines) have been identified and mitigated.

These principles are equally applicable to motor sport and should follow a similar pattern with tailoring to the context.

Track rescue is a coordinated dance

On arrival at the crash scene, all the incident response crew should be looking for hazards. At a circuit race, yellow (racing modified) or red (racing stopped) flags should be waving on the approach sector. To properly control the circulating cars under yellow flags, the safety car should be deployed (physical or virtual -, in which case safety car (“SC”) boards should be displayed and that information should come over the radio. For rallies and off-road events, there is no safety car and flags may not be displayed or visible. A rally stage will usually be suspended while the intervention vehicle is deployed, while the much larger footprint of a raid or cross country off-road event will usually mean that the intervention vehicle will be deployed into ongoing competition.

The intervention vehicle should park as close as is feasible to the scene, which may be difficult if there is a wide gravel trap or the race car has left the track and headed into trees.

The intervention vehicle should also be parked so as to provide a defensive shield for the crew working at the scene. This means parking between the crash site and the direction from which the next race car is likely to approach and presenting as broad a surface as it can. This is often called a fend-off position; the intent being that any subsequent vehicle spearing off the track at that point will hit the intervention vehicle rather than the crew at the incident site. Any additional response vehicles can park beyond the crash site or add to the defensive wall.

Fend-off, or Defensive parking

 One particular consideration to give is the likely direction that a recovery vehicle may need to work from. For example, if a race car goes into a tyre wall and will need to be pulled back out then the first intervention vehicle should be parked so as not to block that operation, particularly if the driver of the intervention vehicle will be getting out to assist. It becomes a judgement call to decide at the time where the best parking position is for any given incident.

Once parked, everyone in the intervention vehicle should look around to ensure that it is safe to get out.

 While walking over to the crashed race car, watch for hazards including:

  • other race cars,

  • environmental hazards; e.g. smoke, fire, fuel, unstable crash barrier, unstable ground, spectators

  • vehicle hazards; e.g. engine still running, drive wheel rotating, unstable vehicle, smoke, fire, ERS warning lights, broken car parts

Ideally, there should be a crew member assessing the immediate scene hazards (Incident) and another crew member watching for perimeter hazards (Environment) including any approaching competition or official vehicles that might pose a threat. How these roles are assigned depends upon how many FIV crew members there are (see Scramble to Turn 1 – Part 1: What is a First Intervention Vehicle? -

If there are other officials on scene, especially fire-rescue, identify whoever seems to be in charge and try to get some initial information. This is analogous to the “hands-off handover” in a trauma resus bay in the hospital. Try to keep the conversation to a minimum and ask for any identified hazards, whether they have yet been addressed and any other concerns, particularly about the competitor(s).

Mirroring a road traffic accident approach, the motor sport approach might look something like this:


Risk element

The traffic has been stopped (or safely diverted)

Risk mitigation actions

Session stopped or modified

  • Circuit: Red flags or Yellow flags + safety car

  • Rally: Stage suspended at stage start +/- Yellow or Red flags displayed at SOS points


Risk element

Local hazards (e.g. unstable barrier, unstable ground) have been identified and mitigated.

Risk mitigation actions

Hazard mitigation may be limited by the resources available, which highlights the importance of any pre-event planning and the benefit of collecting incident data over time for a given event.

Environmental hazards:

  • Race track status – active / modified / stopped

  • Weather

  • Fire

Incident scene hazards:

  • Ground – uneven, unstable, mud; ie. Slip, trip and fall hazards

  • Nearby obstructions – crash barrier, trees, large rocks, , bridge, constructions (eg. spectator stand, camera post)

  • Debris field – damaged car parts, fluid spills, damaged track items

  • Other people – spectators, other officials, other competitors, media.

Vehicle hazards:

  • Vehicle condition – sight, sound, smell

  • Fire, smoke

  • Impending submersion

  • Unstable vehicle position


Risk element

A working perimeter is established

Risk mitigation actions

First intervention vehicle to arrive on scene parks in a defensive, or fend-off, position.

Walk to the incident site in the shadow of that protection with one person specifically assigned to watch what may come from race direction.

Identify and, if possible, mitigate any slip, trip or fall hazards. There may be site specific hazards that needs containment.

As other responding vehicles arrive they can park to extend the defensive barrier.


Risk element

Fuel and fire risk has been addressed

Risk mitigation actions

Intervention vehicles should be kitted with fire extinguisher cylinders at a minimum. These are intended to create space to extract the competitor(s), not to completely defeat an established fire. Larger fires and fuel spills will need a fire unit to be deployed to the scene.

Race cars should have a plumbed in fire suppression system, though some categories are exempt from this requirement, so check this as part of pre-event preparation. The event briefing and medical response plan should include details on the expected in-car fire suppression systems.


Risk element

Engine ignition is off/disabled

Risk mitigation actions

Either ask the driver to turn off the engine or know how to access and activate the electrics isolation switch, which may be a button, a switch or a ring pull mechanism.


Risk element

Vehicles are stabilised

Risk mitigation actions

This is something that should be planned for prior to the event. Equipment and procedures for a range of scenarios should be planned for; e.g. vehicle on its side, vehicle on its roof, vehicle on top of a crash barrier.

For circuit events, the fire-rescue services will usually be involved as they have both the equipment and the training.

The limitations are greater for rallies and off-road events where the responding intervention vehicle may be a mixed clinical and rescue crew with weight and space limitations on what they can reasonably carry in the vehicle.  


Risk element

Undeployed safety devices (e.g. airbags, engine neutralisation switch) have been secured

Risk mitigation actions

This will be category dependant.

For lower tier events where road cars are participating, airbag deployment should already have been deactivated or tethered but this cannot be assumed.

Higher tier categories may have specific systems that require specific attention, such as the electric drive systems of Formula 1, Formula E or some LMP cars.

On the final approach to the crashed car, there is a reasonably narrow avenue depending upon the specifics of the vehicle and its immediate environment. Some race car cockpits limit the driver's ability to see outside a narrow forward arc and the combination of their helmet and any engine or environmental noise means they probably cannot hear you. Where possible, try to approach the cockpit occupants so that they can see you coming and so are less likely to suddenly get the car going and run you down, but be aware that the competitor's decision making capacity may be impaired.

With the crash scene made as safe as is practical it's now time to get your hands dirty, or covered in blood.

The Podcast