Your Captain Speaking: Race On! EMS Coverage for Motorsports Events
Samantha, we’ve been trackside with race cars screaming by at more than 200 mph, waiting for the next crash. NASCAR, dirt bike motocross, drag racing, or those wild sprint car ovals—providing EMS standby at motorsports events is nothing like your standard 9-1-1 run. It’s high-stakes, high-speed, chaos where seconds count, and one wrong move can turn a bad day into tragedy.
We’ve done plenty of these races as paramedics; the adrenaline rivals flying a 747 into a storm. The key? Preparation, positioning, protocols, and a crew resource management (CRM) mindset.
Today, we're breaking down how to do it right so everyone—drivers, crews, spectators—goes home safe. It all begins long before the green flag drops.
Pre-event Planning
Treat it like pre-flight planning. Supervisors meet with the event organizer, track officials, and local EMS/fire/police at least 60 days out. Supervisors bring that knowledge back to those supporting the event.
What is the experience level of the teams? Paramedics and EMTs are awesome people, but if you pair two people who have never worked that venue, it’s going to bite you!
Review the track layout, expected crowd (5,000 to 100,000+), number of entries, and past incidents. What is the food, drink, and bathroom availability for EMS at the track?
Ask: What's the worst-case scenario? High-speed T-bone? Rollover into the wall? Fireball from fuel spill? Pit injuries? What are the high probability calls? Who is in charge at a crash vs. a medical event in the grandstands?
The Boredom Factor
Reality check. Often standby at a race is hours and hours of unrelenting boredom. It’s very easy to lose focus, miss radio calls, not be observant, or fall asleep on the job. I looked at it as an opportunity to review some procedures or the latest literature related to EMS that I wanted to get into.
We’ve had shifts where it was crazy from the moment we got there to nothing happened all day. Explore “what-if” situations while you wait, such as a crash at turn two that sends debris into the stands, causing injury.
Chief Medical Official (CMO)
Per National Motorsports Safety Association guidelines, this should be—at minimum—a paramedic licensed in the state, but preferably an MD/DO with EMS experience. The CMO oversees the medical center (infield care station), ambulance placement, and on-track response. No CMO? Ask whether the event can continue. For me, I’d like to go over to chat with them to establish some rapport.
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Staffing and Resources
Most sanctioned events require one ALS ambulance on site for the full event. (BLS might be acceptable if a fully equipped ALS medical center is staffed). For bigger tracks such as NASCAR ovals or dirt super speedways, add:
- Two to four trackside quick-response vehicles (UTVs or carts with trauma gear, AED, O2, C-collar/backboard).
- Fire/rescue trucks with extrication tools, foam extinguishers (racing fuel burns hot).
- Infield medical center with physician, nurses, paramedics—think mini-ER with X-ray if possible.
- Spectator coverage: Roving teams for heat exhaustion, falls, cardiac issues in the stands.
Know what the minimum requirements are. For example, if an ALS unit transports a patient, does the venue stop until they have a replacement?
I was dispatched out to a race to backfill an ambulance transporting a driver but when on-scene, they didn’t have any of the radios and other equipment needed. Have a plan.
Positioning
Visibility is everything as well as access to the racetrack. Place the primary ALS rig at the start/finish line or Turn 1 (highest crash zone on ovals). Trackside responders stage in "hot zones" behind barriers, ready to roll on yellow/red flags. For dirt tracks, watch for dust clouds hiding injuries.
Communication
Use radio discipline: Create a dedicated medical channel separate from race control.
There may be terms and abbreviations used that you don’t understand over the radio. Ask for clarification.
“Incident at the ‘skid plate’? Huh? What are they talking about?” If you can, have a separate radio channel or cellphone dedicated to this.
Brief everyone pre-race on flag signals (yellow=caution, red=stop all) and radio codes. On-track teams wear fire suits, helmets, Nomex gloves—treat the scene like a HAZMAT with flames. Approach from the "safe side" based on the winds. Beware of terms groups use that may have no meaning to other functional areas.
Hazards Unique to Motorsports
Race car crashes can result in high-velocity trauma: deceleration injuries, blunt force, and spinal damage. Are you solid on the safety equipment installed in the race car? They are many and complex. The first time you see how a driver is restrained is impressive and begs the question: “How am I going to extricate?” The steering wheels are often removable; learn how to do this in case pit crew members aren’t available to assist.
For dirt bike/motocross events, jumps, whoops, and berms mean more orthopedic or head injuries. Quad bikes? Even worse—crush injuries.
Spectators at motorsports events can experience dehydration, alcohol-fueled fights, and cardiac events in the heat. Have cooling stations and IV fluids ready.
NASCAR/GMR (Global Medical Response) protocols emphasize:
- Rapid extrication: Halo technique for cars—cut A-pillar, remove roof if needed. For dirt bikes, helmet removal only if airway compromised (use jaw thrust).
- Fire risk: Always approach with extinguisher ready. Racing fuel (methanol, ethanol blends) are invisible flames—Scene safe?
- Spinal precautions: C-collar and backboard per protocol, unless they self-extricate and refuse (document!). More on refusals in a moment.
- Infield triage: ABCs first, then full trauma survey. Transport to trauma center, not local ER—pre-notify hospitals.
- Hearing protection: You may have to supply your own.
Checklists and CRM—Your Lifesavers
Remember PSI ME GLOC ABCD from a previous EMSWorld article? (Your Captain Speaking: An Acronym for Every Call)
Adapt it here:
- PPE: Fire-resistant gear, eye protection (debris flies).
- Scene safe: Track clear? Hot fluids leaking? Wind direction.
- Initial triage: Multiple patients? Prioritize.
- Mechanism: 180 mph impact? Assume internal bleeding.
- Equipment: Trauma shears, tourniquets, pelvic binders, burn sheets.
- General impression: Driver trapped, conscious?
- LOC: AVPU quick.
- ABCs: Airway (intubate if needed), Breathing (be prepared for thoracic trauma with rapid intervention), Circulation (IVs, fluids).
- Decide: Load and go or stabilize?
Equipment Essentials
Pack smart:
- Advanced trauma bag: Hemostatic gauze, chest seals, TXA.
- Extrication: Jaws of Life (or track-provided), hydraulic cutters.
- Meds: RSI kit, pain control (fentanyl), blood products if advanced.
- For dirt: Splints for open fractures.
No heroics—stage until track is safe.
Legal and insurance
Each venue is different. You may be asked to sign a “standard” form that spells out your responsibilities, waivers, and risks. Documentation may be different from your normal run reports or in addition to them. Dispatch normally would provide you with time of the call, on-scene, enroute, etc. but they’re often not involved at all while you are on-duty. HIPAA still applies but share with race doc for continuity.
Drivers are always angry after a crash. Some want immediate revenge to another driver. In our area, drivers sign an agreement that says, basically, if they refuse medical treatment, AMA, they will never be allowed to race that track again. I have had to gently remind them of this clause if I really thought they needed further treatment. Know the venue’s policy before you’re in the middle of a heated refusal discussion.
The Bigger Picture
Motorsports medicine is growing—FIM for bikes and FIA for cars are organizations working to ensure consistent, first-rate medical care and prevention strategies.1 Check them out. Train with local tracks yearly. For community dirt ovals or drag strips, partner with fire districts.
Bottom line: These events are predictable chaos. Plan like a life depends on it—because it does.
Our next article will be on supporting music concerts and other sporting events. Rock On!
1. FIA is the Federation Internationale de l'Automobile, www.fia.com. FIM is the Fédération Internationale de Motocyclisme, www.fim-moto.com
About the Authors
Dick Blanchet, BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, MO, and Illinois for more than 22 years. As a captain with Atlas Air for 22 years on the Boeing 747, he has more than 21,000 flight hours. A USAF pilot for 22 years, he flew the C-9 Nightingale Aeromedical aircraft. A USAF Academy graduate with a Bachelor of Science degree, his Masters in Business Administration is from Golden Gate University.
Samantha Greene is a paramedic and field training officer for the Illinois Department of Public Health Region IV Southwestern Illinois EMS system, a paramedic and FTO for Columbia (Ill.) EMS, and works full time at the St. Louis South City Hospital Emergency Department as a paramedic. She was recently recognized as a GMR Star of Life.
