EXTRICATION

GUIDE BOOK
Index

Acknowledgments 2
Welcome 4
Extrication Seminar 6
Extrication of the Injured from a Racing Car 10
Introduction into Rally 16
Construction of Rally Cars 22
Safety Equipment of a Racer 28
6 Ways of Extrication 33
1) Without tools 34
2) Cervical collar 40
3) KED 44
4) KED (roof) 52
KED application in details 56
5) With the Seat 64
6) Breaking the Seat 70

Photos of cars and possiblities of extrication:

Citroën C4 WRC 74
Ford Focus WRC 75
Ford Fiesta S2000 76
Peugeot 207 S2000 77
Škoda Fabia S2000 78
Mitsubishi Lancer Evo 79
Citroën C2 S1600 80

1
 Acknowledgments

Extrication guide book was prepared in cooperation with:

FIA Medical Commission

Especially the extrication ways were prepared by:

Jean Duby
Member of FIA Medical Commission
WRC Medical delegate

Cem Boneval
Member of FIA Medical Commission
WRC Rally of Turkey, F1 Istanbul GP CMO

Martin Konečný
Chief of Safety at Barum Czech Rally Zlín

Tomáš Novotný
Chief Medical Doctor of EMS for the Zlín Region

Jan Regner
Safety Comission of ACCR
Deputy CoC of Barum Czech Rally Zlín

The project was supported by:

and

Autoclub of the Czech Republic, Barum Czech Rally Zlín,

Medical Rescue service of Zlín Region, Z studio,
Rallye Autoklub v AČR, Rallysport Příluky, JNK video studio,
Rally Bazar, University of Tomas Bata, Rallye Zlín spol. s r.o.,
Anvel Racing Team, JAS, ...
2
 We would like to thank mainly those:

Radovan Novák / ACCR, member of FIA WMSC

Miloslav Regner / Clerk of the Course of Barum Czech Rally Zlín
Anton Vaňo / Director of Medical Rescue service of Zlín Region
Franti š ek Rosický / Chief of Czech Rally Commission
Lubomír Ne č as / Chief Doctor of Barum Czech Rally Zlín
Jaroslav Němec / Chief of ACCR Sport Rescue
Milan Procházka / Chief Doctor of ACCR
Miroslav Maňas / Chief Scrutineer of ACCR

And also thanks to people who worked during

the Extrication Seminar and during the all the preparation:

Vladimír Barvík, Miroslav Blažek , Jan Č ada, Ivan Dostál,

Pavel D ž avík, Martin Gracla, Vlasta Greplová, Jakub Hofbauer ,
Pavel Holánek, Petr Ju ří k , Květoslav Krampol, Martin Křen,
Jakub M üller , Daniel Kurcik , Adam Nedbálek ,
František Pilka, Martin Ptá č ek, Dana Regnerová,
Š árka Regnerová, Marta Regnerová, Jitka Rychlá , Egon Smékal,
Marek Sochor, Zdeněk Skřivánek, Antonín Sma ž inka,
Jiří Svoboda,Karel Š makal, Věra Š makalová, Jaromír Tomaštík,
Antonín Tlusťák, Roman Uhrovič and others

3
 Welcome
For a number of years now,
improving safety has been one
of the main concerns of the
Fédération Internationale de
l'Automobile.

Having, with some success,

concentrated its efforts on
circuit competitions, the FIA is
now investing in safety in rallies
and other competitions held on
roads and gravel. The research
and training are appropriate for
the World Championship, as
well as for the competitions
lower down the hierarchy:
European, national, regional…

The FIA Institute for Motor Sport Safety and the FIA Medical Commission can only give an
enthusiastic salute to the initiative of Jan REGNER to set up the first seminar for training
doctors and paramedics in extrications and first aid for accidents occurring during these
competitions, and also lend it our help and support.

Rallies and other competitions held on gravel or roads do not share a common unity of
place and time with circuit races. Devising a safety plan is, therefore, considerably more
complex. The personnel and the vehicles involved in safety are not concentrated within the
few hundred metres of a circuit but instead are distant and isolated. Considerable stretches
can be devoid of marshals and spectators or, conversely, there may be areas of
concentration with all the specific risks that this implies. Variations in climate and terrain
(altitude, surface, temperature, geography…) only serve to complicate the situation even
further.

The vehicles in a competition are very different and, in particular, are much more difficult to
keep safe, passively, than single-seaters. The safety equipment: rollbars, seats, belts,
helmets and FHR have undergone considerable development and are often unfamiliar to
the rescue workers. Similarly, the presence of a co-driver alongside the driver is another
factor to take into account.

Moreover, the disincarceration and extrication techniques have themselves been

considerably developed and are, in any case, different to those used on a daily basis by fire
services and rescue workers following road traffic accidents.
4
When an accident occurs in competition, the first people to arrive on the scene are usually a
doctor and a paramedic in their fast intervention vehicle. After a quick assessment of the
situation, the treatment begins: either immediate extrication in cases of extreme
emergency or stabilisation without extrication whilst awaiting the arrival of additional
resources. These actions must be carried out without delay and flawlessly, which implies a
perfect knowledge of actions that must be carried out almost automatically.

This is why the training of the rescue teams is particularly important and, in the future,
deserves to be given on a regular basis to all those involved in rescue operations at motor
sports competition events on routes or on gravel and at every level of these competitions.

It is these various disincarceration and extrication techniques, both extreme emergency

scenarios and those of a more routine nature, as well as the treatment of casualties, with
which you will be faced and which will be the subject of practical exercises throughout this
day that will, no doubt, be very tightly packed but rich in learning.

This initial experience has turned out to be a success and one of the main reasons for this
has been your participation.

Doctor Jean Duby

FIA WRC Permanent Medical Delegate

5
 Extrication Seminar CZ - 19.3.2010, www.Rally-Safety.com
Months of preparations led to the very first
Extrication Seminar, which was held in
Všemina near Zlín, Czech Republic in the
middle of Mach 2010. Its basic aim was to
present the results of developing the rally
accident extrication procedures, which
were set and improved in time in
coordination between specialists from the
Czech Republic and the FIA Medical
Commission.

For the event promotion, the leaflets were

produced and distributed to the European
rallies representatives during the FIA ERC
meeting held in January in Brescia, Italy.
Also the website containing detailed
information about the event content and its
program was established. During the event,

6
7
 Extrication Seminar CZ - 19.3.2010, www.Rally-Safety.com

people who couldn't arrive to the place had an opportunity to watch the seminar through
this website as the whole Extrication Seminar program was broadcasted live via the
internet stream.

Originally, the event was targeted on medicals from particular European rallies, but this
problematic interested also many people from countries outside the Europe. Finally the
Extrication Seminar was entered by impressive number of 111 participants from 16
countries. 55 of them were doctors, second half of the group consisted of medicals and
rescue teams. There were also 7 doctors from WRC events, 1 doctor from Formula 1 and 2
members of the FIA Medical Commission, which guaranteed high and skilled level of
explaining several questions connected to the problematic of rally accidents and further
victims' extrication. In the theoretical part, the participants also shared their practical
experience charged during their real work.

8
All these reports, comments, ideas and experiences
were taken into consideration and discussed when
preparing this Extrication Guide Book.

In the second part of the event, participants could

see the presentation of proposed extrication ways
showed on the specially-built extrication trainer. As
a bonus the real intervention of medicals and
rescue team came through, so all the people could
see the extrication performance with real
demonstration features like cutting off the roof. Also
several rally cars were put to the Extrication
Seminar area, so the medicals and rescuers could
see on their eyes differences between cars of
different sizes, constructions, equipment, interior
disposals etc.

Although the Extrication Seminar was organised for

the first time, the consecutive feedback from the
participants was very positive and highly evaluated.
Also the organisers were satisfied with so high
numbers of participants as they got a lot of
interesting and needed experiences from each
other.

9
 Extrication of the Injured from a Racing Car
From the beginning medical services were provided by a number of different professionals
ranging from hospital doctors, drivers of medical transportation services, volunteers of the
Czech Red Cross and later by employees of the Emergency Medical Service.

Quality and safety organization of the competition has changed dramatically over the last
years on all levels; starting from the racing car structure, equipment with safety elements,
protective clothes and aids for racers, use of modern means of communication, car
monitoring by means of GPS or the technical level and quality of the medical services.

The latest policy prefers bringing a qualified doctor as close and as fast as possible to the
injured racer by using the medical system of rendez-vous, when the doctor arrives in a
small and fast ambulance car, or the doctor may be directly in the technical rescue car,
which arrives at the place of accident as first.

The doctor must have knowledge of technical possibilities and options and has to know
how to use extrication and immobilization aids in the ambulance.

He should also manage or coordinate the extrication procedure in cooperation with rescue
team. An irreplaceable role is played by team approach, personal involvement and
courage. Medical cars sent to rescue operations are now equipped with medical material,
immobilization aids and machines such as ECG with defibrillator, ventilator, suction flask,
airway securing aids etc. (see Appendix).

It is a common practice to use protective aids such as long sleeves, helmets or working
gloves during a rescue operation.
10
New ages place high demands on rescue teams and therefore we try to be prepared for the
competition as best as possible from the professional, technical and organizational point of
view. One of the key points in the professional preparation of medical rescuers and doctors
participating in the competition has been practicing extrication of the injured from a race
car. In the beginning it involved only practicing extrication from a passenger car using the
Rautek manoeuvre, later extrication from several types of borrowed race cars using
different procedures and aids. The logical outcome was the invention and development of
the extrication trainer, which offers the possibility of dismantling individual parts of the car
body structure for a thorough practice and examining several possibilities and alternatives
of extrication and rescuing of the victims.

Another reason for our efforts was the absence of approved, integrated and detailed
instructions and procedures of extrication for non-circuit events. It has been prepared only
for F1 and other circuit events so far by Mr. Jean Jacques Issermann, whose materials we
drew our inspiration from.

We are glad that an international working group was created, which will deal with this issue.

During our training we realized a number of factors, facts and obstacles, which affect the
speed or thriftiness of extrication and which need to be taken into account.

Extrication depends on a whole number of circumstances and so there cannot be a 100%

reliable and universal procedure. It always depends on the particular situation, experience
of rescue teams, “good luck”, ability to improvise and individual approach and, of course,
team work.

During our training we also verified, which options cannot be used, even with a non-
crashed car, and therefore there is no point in trying to use them during a rescue operation.

11
 Extrication of the Injured from a Racing Car

Basically, we verified six extrication procedures where the main criterion was the condition
of the patient, as described below in the text, and the resulting need for speed and
thriftiness of extrication.

The choice always represents a compromise between the required gentleness in relation
to the victims and the time limit from the point of view of preserving or renewing the vital
function.

Apart from an extreme emergent situation speed of extrication is of secondary importance.

The primary objective is to do this procedure perfectly gentle with high quality and much
care, trying not to be vulnerable to the victim. As the stabilisation of the injuried begins in the
car most of the time there is no need to rush.

The choice of medical rescue treatment then affects the patient's condition, injuries,
subjective complaints etc.

In the first place we need to establish the health condition of the victim - whether he
responds, whether he has pain, what kind of pain and its location, difficulties with breathing,
circulation, external injuries, bleeding etc.
12
Somatic habitus - or its weight and size may also represent a crucial problem during
handling and extrication of the injured from a crashed car.

The main tasks during a rescue operation should be, apart from immobilization, securing
and starting of treatment of the patient before extrication from the car, also the application
of an intravenous line, infusion volume therapy and administration of analgetics.

If situation permits, we apply two peripheral i.v. catheters G18 (if it is impossible to secure
i.v. line, intraosseal application with EZ IO or similar intraosseous applicator, if contained in
the ambulance equipment, by drilling into tibia or humerus is possible). Infusion liquids are
administered as prevention against a shock. In case of unstable circulation, cuff is used.
We administer crystalloids (electrolytes) and plasma expanders of the Haes type,
Gelafundin, as well as vasopressors.

The analgetics used include opioids - Fentanyl, Sufentanyl, Morphin or Ketamin.

13
 Extrication of the Injured from a Racing Car
From the time point of view extrication can be divided into:
EMERGENCY - immediate, when there is not time for anything - such as when the
car is on fire or the victim's circulation and breathing fail. Fortunately, this situation
occurs only seldom and can be described the saying „Take him out or let him die“.

URGENT - RAPID, ACUTE, in this case the victim is in a relatively stabilized

condition but the vital functions quickly deteriorate. Extrication should be as
effective and efficient as possible.

ELECTIVE - possible to postpone, when the injured is in a good condition and there
is time to elect between methods, which are more time consuming, but more gentle.

14
Election of the technical rescue operation needs to be solved with the
technical rescuers in the specific situation. It depends on a number of
factors, while the main role is played by:

- Impact mechanism - front, side, rotation, rolled car upside down…

- Surrounding terrain - getting out of the road, ditch, scarp, trees, solid structures,
water reservoirs…
- Speed of car and direction of impact - corresponding deformation and health implications
- Condition after accident - risk of overturn, falling, fire, sinking…

- Car type and construction

- Car categories- classes A, N, veteran cars
- Car size from small (e.g. Citroën C2) to big ones (e.g. Mitsubishi)
- 3-door, 5-door
- Seat type - standard, ear-chair type…
- Shape of helmet
- Usage of FHR (Frontal Head Restraint, earlier was called HANS)
- Design of roll-cage and reinforcements
- Steering wheel (less space in front of the driver than at the co-driver)

All elements of safety represent also an obstacle for the rescue team.

The speed of extrication of the patient depends on the following conditions:

- Deformation
- Access to the damaged vehicle
- Type of injury
- Patient condition -› urgent or elective way of extrication

These circumstances will affect one another.

Extrication should be considered as a medical action. Rescuers must solve the possibilities
and options of taking the victim out. Extrication is not the purpose and aim in itself.

The goals of extrication are:

- to remove the victim from the vehicle as rapidly as his or her condition allows;
- to allow continued care;
- to avoid creating or aggravating of injuries, mainly, but not limited, to the spine

15
 Introduction into Rally

16
Car racing is a sport where achieving the best time is the target. It represents a certain level
of risk; extreme situations and accidents can occur, they have become a part of the
motosport, and our effort is to minimize their consequences. We can achieve this by a set of
features adopted directly on the track, by using the safety equipment of the car and drivers'
protection.

Features on the track

Safety features on track represent a set of things that can directly reduce the risk of an
accident, reduce the gravity of an injury and ensure the best possible support in case of an
accident. Car races can be classified by several criteria, by types of car, international
prestige, audience rate, financial costs etc. From the point of view of measures on the track,
we may divide car races into races on special racing tracks (circuits, rally cross, and
autocross), short-distance races (uphill racing, sprint, slalom) and races on unadjusted
tracks (rally, cross country, marathons).

The best conditions for reducing accident consequences are at special racing tracks. In
particular road tracks are built with emphasis on safety with big escape zones, the camera
systems and track inspector stands enable perfect monitoring of the track from the control
office; an elaborated system of rescue teams is in place (specialized extrication team) and
medical centre directly at the premises etc. Considering the short distances the help arrives
in several tens of seconds from the activation of the rescue system.

17
 Introduction into Rally

In such races run usually specially constructed cars (formulas, prototypes, racing cars
called “silhouettes” etc.) and the possibility of extrication after an accident is counted on
already while designing these cars. The rescue team thus has a number of aids available,
such as special seats, some closed cars have openings in the roof that can be dismantled.
The preparation of the rescue teams then focuses on certain types of racing specials
designed for a specific race.

We have fewer possibilities during races on shorter distances, such as uphill racing. The
race track is only exceptionally longer than 10 km, the route marshal's stands are within
seeing distance, sufficient number of rescue teams are along the track, dangerous
sections and obstacles are covered by crash barriers or protected in some other way. The
track monitoring system provides exact information on what is happening on the track.
Even in this race category the help can arrive quickly, but the facilities of circuits with a
medical centre, heliport, etc. are already missing.

18
The common feature of such
races is great diversity of the
starting field - in one race
may run quite different
specials, which were
originally constructed for
quite different races
(formula, GT, rally). And also
cars of very different age
often start in one race.

Quite special chapter are races on unadjusted tracks, which are represented by rallies.
From the point of view or ensuring safety, only very dangerous obstacles are additionally
protected and the safety features are directed more at the position of the audience. It is also
more difficult to manage a rally race; usually several special stages run at the same time,
the track inspector's stands are not within seeing distance, direct connection exists only to
the so-called radio points and monitoring of cars in the traditional way is ineffective from the
point of view of the speed of a rescue operation. Considering the length of individual
special stages the availability of help is limited by time, because a rescue team has to travel
from a place distant up to 15 km from the place of the accident and along very poor roads.
The new Appendix H asks to put the intermediate point in a place that can be reached in
less than 10 minutes by the medical intervention car. With this regulation time differences
that may have been caused by the quality of the road and of the medical intervention
vehicle used are overcome.

19
 Introduction into Rally

In case of an accident also the

number of rescuers may be
limiting as it is much lower
than in the case of circuit
races. The rescue operation
may be made more difficult by
the car falling into a hardly
accessible place, forest, water
etc. The audience usually
arrives to the crashed car
much earlier and their lay first
aid is not always correct. They
may even obstruct the rescue
operation because their numbers are bigger then those of the organizers. While a rescue
operation on a circuit can be, to a certain extent, very precisely trained into the smallest
details, each rescue operation in rally is different. In some respects they are very similar to
common traffic accidents, so some procedures are based on this experience.

Safety features at speed trials (special stages)

The tracks of special stages are closed for traffic well in advance. Places, where the
spectators may stay, are marked and route marshals are posted along the track. The
number of marshals depends on the character of the special stage, number of access
roads as well as the density of population. In densely populated areas more than 10
inspectors per 1 km of a special stage may be posted, while in less populated areas only 2
per 1 km are requested.

Spacing of particular positions is determined in the safety plan, including the position of
rescue teams and the manner of their activation. According to older regulations one
ambulance Medical Intervention car and transportation ambulance or satellite ambulances
had to be stationed each 15 km of a special stage, but this has been revised in the new
regulations and medical support teams are positioned considering approach within 10 min
of driving time. Everything is covered in the FIA rules and regulations, including required
equipment, staffing and required qualification.

Several systems are used to monitor the movement of cars during rally. In the Czech
Republic the movement of cars is basically monitored in two ways - in radio points and via
GPS. The system of radio points is the basic one; cars that started to the stage are reported
via a walkie-talkie and organizers at individual stands check that the cars passed. The rules
prescribe the obligations and ways or reporting an accident for the crews (reporting in the
closest radio point).
20
Monitoring the cars via GPS is
more operational. Each racing car
is equipped with a unit. When
switched into active mode, the
alarm at the rally control reports if
the car stops at the track of the
special stage. It also enables
sending of an alarm signal to the
rally control through a push button
placed in the car interior. The
operating office of the rally then
may contact the nearest inspector
by a mobile phone, try to contact
directly the crew by a mobile
phone or send the ambulance right away. In case of a serious accident the activation of
rescue teams is then faster and if a computer with GPS monitoring is available at the start of
a special stage, the information about possible problem can be transmitted very quickly.

Rally control office

At rallies nowadays, a system of operating the event from the rally control office (in the past
each special stage had a separated control office). The control office accommodates
representatives of the communications, medical and technical rescue teams and other
staff as needed.

The control office uses various communication channels to monitor the track telephone
connection with the starts and finishes of the stages, GPS monitoring system, radio
network using radio points at
the SS, on-line shots from
cameras placed at the start
or other places of the track
etc.

The control office is in charge

of organizing rescue
operations and issuing other
instructions. Members of
rescue teams must be
informed about a person who
will inform them at the spot.

21
 Construction of Rally Cars
Rally cars are divided into several groups and classes. In most cases the division concerns
permitted engine modifications, chassis groups, brakes and transmissions. Only basic
level of the safety equipment is the same for all groups and classes; for cars of lower
categories not all the safety elements are obligatory (safety fuel tank, external disconnector
on the bonnet etc.).

Categorization of racing cars into groups and classes is described in the FIA rules. We will
deal only with the construction or racing cars as regards the safety elements. We have to
bear them in mind during a rescue operation after an accident of a racing car. It basically
applies that the more advanced the group allowing more modifications is and the newer
(more state-of-the-art) racing car is, the more difficult will be the access to the victim and its
treatment. This can be best demonstrated with modern specials of the WRC category. A
number of components were improved and reinforced so as the crew members are
protected as much as possible from an injury in case of an accident. Ironically, during a
rescue operation and namely during extrication of a victim from such car these safety
elements rather hinder the operation.

The safety equipment of a rally car consists of several elements, which mutually
complement one another. All these components gradually develop and improve in order to
provide the best protection. Some safety elements previously introduced only in the
highest championships are also gradually introduced in national and cup competitions.

22
The safety equipment of the rally cars Additional safety features are
includes: represented by the equipment of the
crew members:

- Glass foils, Makrolon windows - Helmet

- Foam filled door - Balaclava
- Fire extinguishing system - FHR (Frontal Head Restraint,
- Safety fuel tank earlier was called HANS)
- Safety roll-cage - Gloves
- Racing seats - Overall
- Belts - Underwear
- Boots

Glass foils, Makrolon windows

They represent simple protection of the crew from penetration of objects into the car from
the outside and from injury caused by glass fragments, such as during the car rotation. The
use of protective foils is prescribed by Appendix J of FIA ISC.

From the rescuer's point of view the foil has to be taken into account namely in cases when
we are trying to break the glass and get quickly to the victim. The principle of the foil is
similar to the windshields of ordinary cars, the glass of which is already manufactured with
such foil.

A newer safety element is the Makrolon window, which has the same function, but is more
resistant and can be disassembled without tools. Makrolon windows are obligatory in
World Championships for newly manufactured cars of the S2000-R and WRC category in
2010 and for all cars of these categories starting from 2011.

23
 Construction of Rally Cars
Fire extinguishing system
Each car must be equipped with a homologated fire
extinguishing system listed on the FIA technical list.
Appendix J and then installation instructions by the
manufacturer apply for the use and placement of the
fire extinguishing system. The fire extinguishing
system consists of a pressure tank, distribution
system into the car interior and engine area provided
with nozzles and control. The last part of the system
is a portable 2 kg fire extinguisher.

The control elements must be placed so as both the crew members may operate them, the
control mechanism must be also placed outside the car in front of the front pillar on the
bonnet. This must be marked by a red letter E in a white circle with red border with minimum
diameter of 10 cm.

The fire extinguishing system must be functional in all car positions.

From the rescuer's point of view it is good to learn how to operate the system in case that he
arrives to an accident with a fire without the technical rescue team car (e.g. in case of two
reported accidents on the same special stage and the need to divide the assistance) or in
case of a rescue operation when the cars move between particular special stages etc.

Usually elements of the fire extinguishing system do not represent any obstacle during
extrication because the pressure tank is placed at the back and the distribution system and
control mechanisms are only small parts.

Main disconnector
The main disconnector is equipment for disconnecting the electrical circuit with the
purpose of switching off the engine and minimizing the risk of fire. If it is installed in the car, it
is operated from the outside similarly as the fire extinguishing system and is market with a
red lightning sign in a blue triangle with the base-line of at least 12 cm.

24
From the rescuer's point of view the disconnector
represents no limitation, but it is good to know how it
works and how to use it in case that he performs a
rescue operation in an accident without the assistance
of the technical rescue team.

Safety fuel tank

A safety fuel tank is not obligatory for all rally cars. It
prevents fuel leakage even in case of substantial
deformation. If installed, it cannot be older than 5 years.

A safety fuel tank is installed in the rear part of the car, so it may obstruct the use of the
extrication procedure through the back. Dismantling of the tank during the extrication is
impossible.

Safety protective frame (roll-cage)

The safety protective frame, also called as the roll-cage, is the most visible change in the
construction of a racing car. It serves a protection of the crew members by reducing the risk
of car deformation during an accident.

The structure itself, which is made of tube space frame, is divided into several parts, the
meaning of which is not important for the medical rescuer.

The safety protective frame is a big enemy for the rescuer during a rescue operation. Not
only it restricts the space for extrication, but also obstructs the work inside the car and
moreover, if damaged, the sharp edges of fractures are very dangerous as they often

25
 Construction of Rally Cars
threaten both the victim and the rescue team. It is advisable to cover the fractures.

Even though the structure is solid, for the technical rescue team it is not difficult to cut and
remove it with the help of modern hydraulic tools.

Racing seat
The seat is crucial for the protection of the driver and co-driver. The basis of the seat used to
be a pipe support structure, however, today the seats are made from one upholstered
laminated piece. Due to safety reasons the shape of the seat gradually changed and we
can repeat the rule that the safer the seat is, the more difficult it is to extricate the injured
driver. The latest seats have high solid sides, improved side protection of the body and
head (the so-called ears). Even though the acquisition costs are high, it is sometimes
necessary to destroy the seat during a rescue operation (cutting off the ears or breaking it).

The seat in a rally car is mounted with special holders directly to the car body, position of the
seat can be changed by using various mounting holes. Therefore the racing seats can not
be moved so easily like in road cars. If the seat should be removed from the rally car, it
would be possible only if the seat holders can be accessed from both sides.

26
Apart from the classical
anchoring, new racing seats
homologated for the World
Championship have in the floor
also holders from the side. Due
to safety reasons the weight
increased from approximately 4
kg of the classical seat to 12 kg
of the new seat.

Safety belts
Together with the seat, the safety belts provide main protection to the driver. The classical
three-point belts are not used; the oldest racing seats are designed for four-point belts, but
they are no longer homologated for cars in the FIA championships. Much better body
support is provided by 5-point and 6-point belts, when two pairs run through the seat above
the driver's shoulders, one from the left and front side and one (or two in case of 6-seat) run
through the bottom part of the seat.

The belts are connected in one general lock with a lever mechanism; all stripes can be
released just in one operation (also belts with three-button unfastening system are
recommended for rally, but they are not as widely used as belts with the lever mechanism).
In some cases the belts need to be taken out of the seat, which is not a problem. Attention
must be paid only to the belt with the lock.

If the belts are impossible to be released for any reason, they have to be cut if necessary.
The unfastening mechanism is, however, very easily accessible and reliable.

27
 Safety equipment of a racer
The constructional parts of a racing car are considered to be the safety equipment of the
car. These safety elements are supplemented with safety equipment of the racer. It
includes the overall, helmet, in some cases FHR (Frontal Head Restraint, earlier was called
HANS), gloves, shoes, underwear and balaclava.

Overall
Today's overalls are manufactured from
state-of-the-art materials on Nomex base,
which can protect the racer from direct fire
injury for several tens of seconds. The latest
overalls have up to four layers and apart from
fire protection they must protect the racer
also from mechanical injury. At the same time
they have to meet high demands on comfort,
which are requirements contrary to each
other.

An important accessory to an overall is inflammable underwear, which is obligatory for all

FIA championships. It includes a turtleneck and pants.

From the point of view of a medical rescuer an overall is an obstacle to basic examination
and treatment. The acquisition cost of new clothing is not negligible, but the racer's health
has a priority in a rescue operation. Therefore do not worry and cut the overall if necessary.
Unlike the other safety elements, the look and use of overalls has not changed for decades
and only the materials used are new.

Gloves and shoes

Gloves and shoes represent an
important safety element. They
supplement the overall and cover
the remaining parts of the body
(except the head), which are not
covered by the overall. There is an
exception for co-drivers, who are
not obliged to use gloves.
Gloves are easy to take off and don't represent no major obstacle during a rescue
operation. Shoes are designed as very light with thin sole (it is important to have good
feeling for the driving) and there is no need to take them off during a rescue operation. Any
treatment of legs (fixation of fractures etc.) can be performed without taking the shoes off in
the field.
28
Helmet
A racing helmet provides essential protection to the racer's head. Helmets are basically
divided into closed and opened helmets. Closed helmets are used more frequently for
circuit car races (for races of open cars, such as formula cars they are obligatory). In rally
open helmets are used in large majority of cases.

Their advantage is, from the medical rescuer's point of view, easier and thus thriftier taking
off. An important accessory of a helmet is a balaclava, which is a part of the inflammable
underwear and only the eye opening remains unprotected.

In rally it is important to bear in mind the intercom, which is the communication equipment
used between the driver and co-driver. This equipment consists of a box with an amplifier
and control elements. A microphone and headphones are then placed in the helmet. Do not
forget to disconnect this equipment before taking off the helmet (6.3 mm jack located
mostly on the belt is used). Disconnection is performed by gentle pulling.

Helmets are fastened by straps under the chin. In some situation it can be very difficult to
unfasten them. In such case do not worry and cut the strap.

FHR (Frontal Head Restraint)

FHR (earlier was called HANS) is still quite a new equipment. It serves to protect the
cervical spine. It consists of two parts; a specially adapted helmet with fixtures and a part
placed on the shoulders. The FHR principle is simple and in case of an accident the
correctly adjusted equipment allows only certain movement of the head towards the body.

FHR started to be used in Formula 1 at first and later it became to be used via other circuit
disciplines also in the WRC and other FIA Championshipsrally world championship. The
introduction of FHR raised almost always a number of discussions about the usefulness
and effectiveness of this equipment, but racers got used to it relatively quickly and no
longer consider it as an obstacle.

FHR was originally supplied in two versions; one with the shoulder part firmly attached to
the helmet, the other one with detaching mechanism. Today all FHR systems are supplied
with the detaching mechanism. In case of an accident the straps with non-detachable FHR
had to be always cut.

The manner of FHR unfastening is relatively simple, though it requires previous training out
of the car. If the buckles are not accessible, the straps need to be cut rather than trying to
move the victim.

29
 Safety equipment of a racer
Helmet Head Restraint
Unfastening
procedure
Tether

Tether-anchorage

First of all it is necessary to move the loop with strap in the direction of the groove on the
lock.

By applying pressure at the

point of connection the straps
and eyes of the mechanism
are loosened and can be
released by sliding in the
direction of the bigger hole.
30
Now the eye with the strap can be removed from the pin.

31
 Cervical
Safety equipment
collar of a racer

The next step includes taking off the helmet, which can be performed by drawing apart of
the facial parts and tilting to the front.

After the helmet is taken off, the second part of FHR is removed by rotating around the neck
and then sliding it down.

In order to get access to the victim's face the balaclava needs to be removed. If necessary it
can be cut.

32
6 ways of
Extrication

33
 Without tools
EMERGENCY extrication is of outmost importance when the victim is in a life threatening
dangerous situation. It involves a fast manual extrication with bare hands, and mostly
without any time provided for manual inline immobilization. Hence possible trauma to the
spine may be aggravated and the rescuer has to deal with this responsibility. But it is "a take
him out or let him die" situation, which is fortunately very rare. A quick modified Rautek
manoeuvre may be perfectly applied.

This way is designed for fast extrication when vital functions are not present and CPR is
indicated. It can also be used in cases when the victim is in a life threatening position due to
fire or other unpredictable circumstances. In this case, time is the main priority.

Usually a marshal, spectator or the crew from the following rally car are the first on scene. In
this situation the slight lifting of the head by gentle upwards finger pressure from the chin is
a life saving manouver to keep the airways open.

34
Real extrication may be performed by one or two medical rescuers. During this manoeuvre
the support of the possibly injured spine is very limited, and the victim sitting in a specially
molded racing seat with the helmet and FHR (Frontal Head Restraint, earlier was called
HANS) still on handling is definitely not easy.

If extrication is performed by one rescuer, medical, paramedical or driver, he checks that

the legs are not hurt or stuck (if hurt, don't worry: life is more important, if stuck, try to
unstuck as quick as possible without any precaution for the same reason), in any way
disconnects the intercom cables, releases the victim's safety belts, places his left arm
(when rescuing a victim sitting on the left in the car) under the victim's left arm and grabs
under the chin and provides the correct head position. While stabilizing the head with the
left hand the rescuer slightly leans the victim forward to place his right arm around the back
under the victim's right arm and grasp the victim's left forearm.

35
 Without tools

The rescuer slightly lifts the victim from the seat and pulls him/her onto his thigh. The body
must be handled carefully to avoid hitting the roll cage (in particular the part above the
victim's head).

36
If the extrication is performed by two people, second person (member of Rescue team,
marshal or even the spectator) is holding the legs and together with the first one slide the
victim out of the car and place him on the floor.

37
 Without tools

If there is no need for urgent CPR (emergency extrication due to fire, water etc.), the helmet,
FHR and balaclava can be taken off (or cut it) in a semi-seated position outside of the car.
While doing so it is important to keep the correct position of the head, neck and body.
Cervical collar can be applied and the victim can be laid on the floor (scoop, spine board).

38
If urgent CPR is indicated (cardiac arrest, unconsciousness), as long as it is not a full face
helmet it is possible to initiate CPR with helmet on. The victim is laid down providing some
support to the back (a blanket for example), CPR is initiated and removal of helmet/FHR
and application of collar is postponed until vital functions are established.

If the victim is on the right sided seat, the procedure is the same except that during
intervention the function of the arms has to be switched.

39
 Cervical collar
URGENT extrication is performed in situations where the victim is stable at first sight but
shows rapid deterioration, hence the time has to be used as effective as possible. In such
instances removal of the helmet and FHR (Frontal Head Restraint, earlier was called
HANS), rapid application of a cervical collar and manual inline mobilization may be applied
while taking the victim out on a spinal board.

Application of the cervical collar will ensure the correct position of the cervical spine. This
procedure is designated for cases when it is not necessary to extricate the victim from the
car as quickly as possible at all cost (emergency extrication), but there is not enough time
available to use any of the extensive procedures (elective extrications).

In all other cases except the emergency extrication, the application of the cervical collar is
mandatory as a first step.

During the application of the cervical collar it is necessary to use space around the victim in
the most efficient way: If possible, one member (R1) of the extrication team approaches the
victim from the second seat, the other (R2) uses the access through the door.

Before releasing the seat belts, it is necessary to stabilize the head in the correct position.
This is done by rescuer (R2) who holds the head by grasping it from the front with both
hands. The fingers and palms are symmetrically slid under the helmet, grasping the head
from the backside on the occipital area and thumbs are on the cheeks (maxillar bones),
while pulling the head slightly upwards. This grip provides the best possible stabilization for
the cervical spine. It is best to stay in the visual field of the victim so that he doesn´t need to
turn his head to voice while verbal or non-verbal communication is easily possible.

40
After unfastening or cutting the FHR (if necessary) straps and unbuckling the helmet, the
rescuer (R1) in the car takes off the helmet (if there is enough space in the car) and
subsequently removes the FHR by rotating it to the front and pulling it downwards.

It is also necessary to take off the victim's balaclava (it is possible to cut it), unzip the
overall and make space for the cervical collar. In order to ensure its proper function, it is
important that as less of fabric as possible is between the skin and the cervical collar.
Before the cervical collar of the proper size is applied, the rescuer (R2) still holds the
victim's head. It is also recommended to hold the head after applying of the collar during
manouvering or extricating the injured person.

I.v. access, infusion of electrolytes or plasma expanders and analgesia should be

provided in the car before moving the victim if necessary.

41
 Cervical collar

After the cervical spine stabilization the classical Rautek maneuver can be performed,
while the rescuer (R2) extricates through the door and the rescuer in the car (R1) helps
mainly with the victim's legs as the small space between the bottom part of the seat and
the wheel rim represents the biggest obstacle. The fixation of legs by the Velcro straps
is possible.

42
In the ideal situation the victim is slid out of the car onto a spinal board (or scoop) in order to
minimize movements of the spine. During the extrication the members of a rescue team
(R3, R4) are holding the spinal board and helping to rescuer (R1) with the legs to move the
victim to the transport system. It is important that the spine board is placed under the
victim's back in the direction, in which he is taken out of the car.

If a spinal support utility is not available, the rescuers have to carry the victim delicately
to a suitable place.

43
 KED
It is the basic extrication procedure classified into the elective category, i.e. when the victim
shows adequate and stable vital signs and we have time to prepare for car evacuation. The
KED (Kendrick Extrication Device or SED by Spencer etc.) is used for spinal
immobilization. The principle is basically the same as with extrication of a formula car
driver, even though in the formula car a part of the seat may be used to support or stabilize
the spine - the whole procedure is then easier. It is a procedure recommended by Dr. Jean
Jacques Issermann, the man who introduced the extrication teams, extrication ways and
training in motorsport which can be modified depending on the extent of damage to the car
and the possibility of securing access. There is also the possibility to use it in the “Original
Way”.

The initiation of the procedure is the same as in the case of a cervical collar application.
Following its application, access behind the victim's back is secured and the KED is
applied.
Before the applying the KED, it is necessary to take out all upper safety belts from holes in
the seat.
Subsequently, the KED has to be slid down behind the victim as possible, up to the level of
the buttock and at a level where you can put the sides under the armpits. This is not an easy
task!

This is performed by grasping the victim's overall at the chest and pulling him gently
forward. Then try sliding the KED behind the victim's back. It is very difficult to slide in the
KED correctly and this action needs a lot of training beforehand. Before sliding in the KED it
is advisable first to pass the red and bottom right black straps to the rescuer in the car,
which he should place outside the seat.

44
When sliding in the KED, its correct position needs to be checked; it must be positioned
midline along the back axis and at the correct height. This activity requires application of
force in order to push it properly down behind the victim's back. In modern seats with lateral
head support extensions you may be forced to cut them off. In the case of the new seats for
WRC this is a must.

45
 KED

There are two possibilities of applying the KED:

1) Way by J.J.I. 2) Original Way

(Dr. Jean Jacques Issermann)

5.
2.

1. 4.

3. 6.

4. 1.

5. 2.

6. 3.

46
1) Way by J.J.I.
(Dr. Jean Jacques Issermann)

In the first step the head is fixed

using two straps; first the bottom
strap over the chin and cervical
collar (this strap has an opening in
the central part) and then the
upper strap over the victim's
forehead crossing the chin strap.

After positioning it correctly proceed to fastening the straps at the front. It will start fastening
with the upper green strap, then middle orange followed by the bottom red one.
Correct connection and tightening of the black bottom straps under the legs is very difficult in
a racing seat and we may say that the more advanced the seat is, the more difficult this
activity is. In order to position them correctly the victim's legs need to be slightly lifted while
fastening the straps.

The straps tightening order is the same as the straps fastening order. It is important that the
victim is not moved during the tightening of the straps. Before proceeding the extrication,
there may be checked each strap for the correct tightness (beware of unnecessary jacket
movements).
47
 KED
This way is remembered by the mnemonic:
2) “Original Way” “My Baby Looks Hot Tonight“
(Middle, Bottom, Legs, Head, Top)
After positioning it correctly proceed
to fastening the straps at the front. You will start fastening with the middle orange strap
followed by the bottom red one.

Correct connection and tightening of the black bottom straps is very difficult in a racing seat
and we may say that the more advanced the seat is, the more difficult this activity is. In order
to position them correctly the victim's legs need to be slightly lifted while fastening the
straps.

The straps tightening order is the same as the straps fastening order. It is important that the
victim is not moved during the tightening of the straps.

In the next step the head is fixed

using two straps; first the bottom
strap over the chin and cervical
collar (this strap has an opening in
the central part) and then the upper
strap over the victim's forehead
crossing the chin strap.

Finally connect and tighten the

green strap.

48
It is advisable to fix legs and arms to protect them from further injuries and facilitate easy
manoeuvring with the victim outside the car.

49
 KED

Velcro straps of different lengths will serve well for this purpose. It is advisable to have them
ready for this occasion.

Extrication from the car is relatively easy but the risk of head injury caused by the safety roll
cage installed in the car needs to be taken into account. Extrication is started by two
rescuers positioned by the door outside the car by grasping the side loops, while the third
person (rescuer, marshal, spectator…) tries to manoeuvre the victim's legs.

50
Once outside the car, assistance of another person, who will grasp the legs, is necessary.
In the ideal situation the victim is slid out of the car onto a spine board in order to further
minimize movements of the spine and ease transport.

51
 KED (roof)
As described in the introduction, KED offers many opportunities of use, which were created
by modifying two standard procedures, i.e. the classical KED application through the door
and application through the roof. Application through the roof is similar to its use in circuit
racing cars, but with the limitation that rally cars are not modified and constructed to
perform this extrication. Also the necessary space needs to be prepared first with the
assistance of the technical rescue team. Thus it will be more time demanding, but will
enable more exact application of KED and better protection of the victim's spine. It may also
be the only possible way of access in case of the door being blocked from the outside by a
rock, tree or similar obstacle.

The core procedure is the same as with the classical application through the door. Because
FHR (Frontal Head Restraint, earlier was called HANS) and manual stabilization provides
basic protection to the cervical spine, it is recommended first to proceed making required
working space and then to start with releasing the victim and cervical collar application. It is
important to protect the victim from possible injuries during the process of cutting the roof
open by suitable aids. Because the driver sitting in the seat with a helmet is not aware of the
situation around him, it is important to keep him informed about what is happening around.

52
KED (roof)

The space created may be used for

removing the helmet and FHR as
well as the application of the
cervical collar.

Application of the KED vest is much

easier and precise in this case;
manipulation of the victim is less
vulnerable.
53
 KED (roof)
If there is problem with space in the area of legs under the steering wheel and enough time
for further cooperation with the technical rescue team, they may be asked to pull the wheel
up and forward (cutting of the steering rod could be dangerous). Extrication is then easier
and substantially less vulnerable, because leg injury may be expected.

After all KED straps are fastened and tightened, the victim may be extricated through the
roof, if the opening is sufficiently large, or through the door if access is available.
54
KED (roof)

55
 KED application in details
KED application is performed by three
medical rescuers; firstly the cervical collar
applied and after that, two rescuers apply
the KED jacket. The third one fixes and
stabilizes the correct head position.

It is important to apply the jacket to

victim's body in correct height in order to
provide support to the whole spine during
handling and movement with the victim.

The KED has to be put as down as

possible at the level of the buttock and at a
level, where the rescuer is able to put the
KED sides under the armpits. It is not so
easy. You have to pull the injured gently
forward while maintaining the stability of
the head and neck with outmost care.

56
There are two possible ways how to install the KED (SED). The first way introduced by Dr.
Jean Jacques Issermann or the second way called as “Original Way”.
- The way by Dr. Jean Jacques Issermann proposes first to fasten the head and then to
continue with the green, orange and red straps followed by black bottom straps.
- The “Original Way” is to fasten firstly the orange and red straps followed by black bottom
ones and after that to continue with fixing the head. Fastening the green strap follows as the
final step.
In open cars they do all these actions simultaneously by the five rescuers.

The straps tightening order is the same as the straps fastening order. It is important not to
move the victim during the tightening of the straps. Before proceeding the extrication,
rescuers may check each strap for the correct tightness (beware of unnecessary jacket
movements!).

1) Way by J.J.I. 2) Original Way

(Dr. Jean Jacques Issermann)
5.
2.

1. 4.

3. 6.

4. 1.

5. 2.

6. 3.
57
 KED application in details
1) Way by J.J.I. (Dr. Jean Jacques Issermann)

Once the jacket is behind the back, rescuers can start fixing the head with two additional
straps included in the KED set. Start with the bottom strap over the chin (it has a hole for
easier placement on the chin and cervical collar) and then put the upper strap. The straps
are fastened into a cross; the bottom in the upper part and vice versa.

58
After positioning head straps
correctly, rescuers may proceed
to fastening the straps at the
front. They will start fastening
with the upper green strap, then
middle orange followed by the
bottom red one.

The next step includes running

black straps under the thighs
from the outside and fastening
them into the correct buckle,
crossing to the opposite side.

Now the connected

straps can be
tightened in the same
order as they were
fastened. Take care
that the victim is not
moved during the
tightening procedure.
If necessary, slide a
pad, which is included
in the KED set, behind
the victim's head.

59
 KED application in details
2) “Original Way”

Once the jacket is behind the

back, start connecting the
front straps; first the middle
orange and then the bottom
red strap.

The next step includes

running of black straps under
the thighs from the outside
and fastening into the correct
buckle, crossing to the
opposite side.

60
Now the connected straps can be tightened in the same order as they were fastened. Take
care that the victim is not moved during the tightening procedure. If necessary, slide a pad,
which is included in the KED set, behind the victim's head.

After tightening fix the head by means of two straps, which are included in the set. Start with
the bottom strap over the chin (it has a hole for easier placement on the chin and cervical
collar) and then put the upper strap. The straps are fastened into a cross; the bottom in the
upper part and vice versa.

61
 KED application in details
Finally connect and tighten the green strap.

62
Now the rescuers can start with the
victim's extrication.

Loops at each side of the back of the

jacked can be used for handling the
victim. It is recommended to support
the legs while lifting or moving the
victim.

63
 With the Seat
This procedure is designed for specific cases when there is extensive bodywork
deformation due to massive impact. While the technique appears to be very eccentric at
first thought, it is based on the theories of extrication with seat used at formula cars and the
seats with inbuilt KEL driver extrication system. The main advantage of this procedure is
that the victim's body is in fact moved only after it gets out of the car where there is enough
space for correct manoeuvring. It could be a good extrication way if there is suspicion of
pelvis or/and femoral fractures and if cutting of the seat is easy and the car is destroyed.

The basic procedure is the same as with the previous procedures, i.e. releasing the belts,
taking off the helmet, FHR (Frontal Head Restraint, earlier was called HANS), balaclava,
and cervical spine stabilization with the collar.

The use of this procedure is also limited due to the car construction and extent of the
damage. The technical rescue team needs to have an unobstructed access to seat holders
on both sides. But it's impossible at many cars, e.g. Fiat Grande Punto S2000 or Škoda
Fabia S2000 due to the high centre tunnel.
64
After the victim is ready for extrication, it is necessary that the technical rescue team
prepares a sufficiently large opening in the door area. Make sure that the victim is protected
while the rescue team cuts off particular parts of the car body. The victim is not aware of the
situation around, it is important to keep him informed on what is going on.

65
 With the Seat

Subsequently, it is necessary to take out all safety belts from holes in the seat and fix the
victim to the seat. Prepared Velcro straps of different lengths will serve well for this purpose.
The longest one will be fixed over the chest and behind the seat. The strap must be
fastened at the front for easy unfastening after extrication. The shorter strap is used to fix
the head; holes in the upper part of the headrest, used for safety belts, may be used. Again,
take care that the straps are fastened at the front. Additionally it is advised to strap the legs
and arms in pairs for easier manipulation during the extrication.

66
After the seat is cut off, it is important to take it off carefully. At this point it is essential that the
medical rescuer who holds the victim's legs keeps the legs in the same position towards the
seat during the entire manoeuvre. After extrication the seat with the victim may be laid with
the back on the floor. Even at this moment it is important to hold the legs in the same
position. We may unfasten the straps around head and chest.
67
 With the Seat

As it is impossible to place the cut-off seat directly on the vacuum mattress (danger of
damage by sharp edges), it is recommended to use temporarily the scoop stretcher or
spine board. In this case we place the seat with the victim on the board, get ready for slight
lifting of the victim and slide the seat out in the direction of the victim's legs. The rescuers
stand astride over the injured and grasp his body, (not the overall!), while lifting him slightly
up.

68
The victim may be also transferred by placing the seat in the same axis with the stretcher
and transferring the victim from the seat. This procedure brings bigger risk of involuntary
movement of the victim.

69
 Breaking the seat
The procedure of extrication of the victim from a crashed car through the back of the car
with breaking the seat represents a substantial additional damage to the bodywork and car
equipment. It is recommended mainly in the case of extensive damage to the car with
deformation of the sides and when the side door is impossible to remove within a
reasonable time. A typical example of the use of this procedure is a car wedged between
trees, lampposts, buildings etc. The use of this procedure is not limited to suspected spinal
injury; it is a way of approach to all kind of injuries. The difficulty when using this procedure
is the installation of a safety tank, which occupies a big space at the back of the car.
Therefore usage of this procedure may be impossible at newer cars like WRC or S2000
due to restricted displacement of the seat to the back.

Even though the way of approach is absolutely different, the beginning is the same; i.e.
manual stabilization, taking off the helmet, FHR (Frontal Head Restraint, earlier was called
HANS), balaclava and applying the cervical collar. However, if the situation requires using
this procedure with the above types of accidents and deformation, medicals need to count
with very little space for these actions. It will depend on the conditions in individual cases
and whether there is at least some access from the side or the front.
70
After the victim is secured, the technical rescue team will come and remove the safety roll
cage and other necessary bodywork elements behind the seat as far as to the back door. It
is important to keep the victim informed about what is happening with the car and also how
he will be extricated. It's also needed to keep him covered or protected while cutting the
framework and bodywork or breaking the glass. The usage of these individual protective
means is, of course, obligatory for the technical rescuers.

71
 Breaking the seat
When the space behind the seat is prepared, one member of the extrication team has to
lean the victim slightly forward in order that the rescue team may cut both side parts of the
seat and incise the bend between the seating and backrest parts. When cutting, the use of
some device-board to protect the victim's backside is required.

Then the seat can be broken by jerking back. This creates a space for sliding the scoop
stretcher (spine board) inside and for careful towing of the victim first back onto the
stretcher in the back door area and then out of the car through the 3rd of 5th door. Before
the towing the victim into the scoop (or spine board, which is more safe to prevent cutting or
injury of the victims back) it is recommended to install the KED first.

72
Note: The last picture was taken on a trainer. For the sake of clarity, more elements, than it
is necessary for the action, were removed from the car.

73
 Citroën C4 WRC

74
Ford Focus WRC

75
 Ford Fiesta S2000

76
Peugeot 207 S2000

77
 Škoda Fabia S2000

78 77
Mitsubishi Lancer Evo

79
 Citroën C2 S1600

80