Saving Lives in the Field: Why Remote Vehicle Incident Management & Extrication Training Is Essential for Teams in Extreme Environments

By Tom Jewell

27th June 2025

Organisations and individuals that work in remote and extreme environments face risks far beyond what most urban responders prepare for.

Whether you’re running a humanitarian mission in South Sudan, maintaining critical infrastructure in Arctic territories, operating security logistics in mountainous conflict zones or driving through the hills of Wales, road traffic incidents (RTI) remain one of the highest risk to teams and individuals.

Why not call them road traffic collisions? Because this narrows the risk down to collision based events and doesnt take into account other vehicle related situations that we can train to avoid or handle more appropriately.

In these environments, the absence of timely emergency services means your team is the first, and possibly only, responder or support. That’s why investing in remote vehicle incident management and extrication training isn’t just about compliance or health and safety box ticking. It’s about survival.

The Harsh Reality of Remote Road Traffic Collisions

RTIs are one of the most common causes of fatality and serious injury for personnel operating in remote environments. It has been for a long time, and continues to be the biggest risk for UK Military and one of the largest killers in the UK of young adults.

In these locations, the terrain is unpredictable, weather conditions can turn rapidly, and vehicles are often heavily loaded or poorly maintained due to supply limitations.

Common contributing factors include:

• Long drive times and fatigue

• Challenging terrain (e.g., unsealed roads, river crossings, mountainous switchbacks)

• Poor visibility or navigation errors

• Mechanical failures in older or overloaded vehicles

• Other road users 

• Differing road rules or cultural differences

• Vehicle threats

In a city, help is minutes away. In the field, it could be six hours or more before a helicopter or any form of medical evacuation arrives, if it can come at all.

That means your team needs to manage the entire incident lifecycle themselves:

• Secure the scene

• Stabilise the vehicle

• Triage and treat casualties

• Extricate safely using minimal tools

• Coordinate evacuation

• Transport to definitive care

Remote Vehicle Incident Management: A Mission-Critical Skill Set

At the heart of this capability is proper training, not just in first aid, but in remote-specific incident response and extrication. This includes:

1. Scene Safety and Dynamic Risk Assessment

• Windscreen report, taking in the size up on the incident and maintainng bandwidth

• Securing the scene from threats and environmental hazards (e.g. the general public, weather conditions, cliff edges, rivers, wild animals)

• Knowing what’s available such as vehicle chocks, ropes, even terrain features to stabilise the area

• Stabalising the vehicle using improvised techniques e.g. other vehicles, ratchet straps, vehicle relocation, deflating tires. 

• Establishing command and communication hierarchy, even if only among four teammates

2. Casualty Assessment and Clinical Prioritisation

• Understanding casualties mechanism of injury vs. the reality of delayed evacuation

• Medicaly trapped or mechanicaly trapped?

• Identifying red flags: crush injuries, compromised airways, internal bleeding

• Applying field trauma care (e.g. tourniquets, splints, airway management) while preparing for delayed extraction

• Creating extrication plans around the injuries sustained

• Stay put or transport to care?

3. Improvised, Low-Tech Extrication Techniques

• Understanding vehicle systems, their locations and hazards to rescuers

• Space creation using small tools such as socket sets, pry bars 

• Glass management using multi tools, knifes,, safety blankets, or window punches

• Patient removal strategies that mimic the latest evidence-based guidance 

• Use of team lifting and spine-protection methods when no spine boards are available

• Stabilising casualties using what’s available: sleeping pads, rigid bags, rope, vehicle parts

• Modifying other vehicles in order to transport casualties to definitive care 

• The focus is on simplicity, effectivness, minimising further harm and creating a casualty focused plan.

ENTER: The EXIT Project – Applying Clinical Evidence to Extrication

This is where Professor Tim Nutbeam’s EXIT Project (Extrication In Trauma) plays a transformative role.

The EXIT Project, a UK-based research initiative, is revolutionising how extrication is approached—not just by firefighters with high-end tools, but for responders in the field with limited resources and a pressing need for justified, evidence-based decisions.

What Makes the EXIT Project Groundbreaking?

• Clinical Data Over Dogma: EXIT challenges outdated extrication norms and instead uses empirical data on patient physiology, injury mechanisms, and outcomes.

• Speed vs. Safety: Research from EXIT has shown that prolonged entrapment, often due to over-cautious “spinal protection” procedures, can lead to hypoxia, crush injuries, or unnecessary death. In contrast, rapid extrication, when clinically justified, often leads to better outcomes.

• Minimal Handling: EXIT emphasises methods that reduce unnecessary patient movement—crucial when spinal or thoracic injuries are suspected.

• Adaptable Protocols: Their findings are now being translated into field-applicable models that non-specialist responders can use—perfect for remote deployment contexts.

In essence, EXIT provides the medical and scientific foundation to support what field-based teams already know: in many situations, waiting for a ‘perfect’ extrication is worse than doing a rapid, imperfect one if done correctly.

Training Recommendations for Field-Based Organisations

1. Embed Remote Incident Training into Core Preparedness

Every team member—not just the driver or medic—should understand:

• Scene control

• Basic extrication

• Use of recovery and rescue tools

• Patient triage and protection

• Tactical communication under stress

2. Simulate Realistic Vehicle Incidents

Don’t teach in a car park. Simulate rollovers, side impacts, and entrapment in rough terrain. Use your own vehicles or write-off models. Practise under time pressure with basic gear.

3. Teach Extrication as a Medical Skill

Field medics and first responders need to see extrication as part of clinical care. It’s not enough to treat the injury—you must also enable safe rescue without worsening it.

4. Apply EXIT Principles to Field Protocols

Train your teams to:

• Know when rapid extrication is justified

• Prioritise airway, breathing, and circulation over rigid spinal immobilisation

• Make justified decisions in line with best evidence—not just perceived protocol

Tools You Probably Already Have — and How to Use Them for Rescue

You don’t need the “jaws of life” to save a teammate. Here’s a list of common field tools that can double as extrication aids:

Tool	Use
Shovel or spade	Pry doors, clear access paths, stabilisation or dig pits to bury your shit
Tow strap / rope / ratchet strap	Force doors, reposition vehicles, stabilisation or securing your luggage to the roof
Pry bar / crowbar	Door defeat, glass removal, identifying vehicle SRS systems or opening your tin of food
Bolt cutters	Cut seatbelts, door restraints or padlocks
Trauma shears	Remove clothing, seatbelts or turning your t shirt into a vest when its hot
Blanket / tarp	Cover glass, stabilise patient movement or having a nap on the back seats
Car jack	Raise collapsed frames or heavy doors, lift vehicle off crushed casualties or change your tyre
Sleeping mats / rucksacks	Improvised spinal support or sleeping

Training teams to see dual-purpose uses in their field kit adds confidence and capability in critical moments.

Conclusion: Preparedness is the Real Rescue Tool

The best rescue in a remote vehicle collision isn’t a helicopter or a fire truck. It’s a trained teammate who knows how to take control, triage effectively, and act decisively with whatever tools are available.

By integrating remote incident management training and drawing on clinically validated resources like the EXIT Project, organisations can turn potential tragedies into survivable events.

Whether you’re operating in the jungle, tundra, savannah, or desert, your greatest asset is your team’s ability to respond safely and intelligently.

Want to go further?

To bring remote vehicle incident and extrication training to your organisation, consider:

• Booking onto our bespoke R-VIM (Remote Vehicle incident Management) course or contact us to create a bespoke training package for you and your team

• Using simulated vehicle crash drills as part of pre-deployment exercises

• Engaging with the latest findings from the EXIT Project to update your SOPs

Because in the field, you are the rescue team.

Whats next?

In my next post I will be breaking down each of these aspects and focusing on each one in more detail. I will begin with exploring the 'Windscreen Report'.

Be The Help.