title: Radiation exposure as a consequence of spinal immobilization and extrication.
abstract: BACKGROUND
  Extrication and spinal immobilization in the trauma patient with unknown injuries is a common practice of emergency medical services. High-speed crashes occurring in open-wheel racing seldom result in extrication or spinal immobilization.
  
  
  OBJECTIVE
  To evaluate the safety of self-extrication in IndyCar® (Indianapolis, IN) by comparing drivers self extricated with full spinal immobilization and subsequent radiation exposure.
  
  
  METHODS
  A retrospective review of prospectively collected de-identified IndyCar® crash and drivers' medical records was performed at treating Level I trauma centers. One hundred thirty-five crash incidents involving drivers evaluated by a medical team were included. Any driver with severe multiple trauma was excluded due to distracting injuries. Drivers underwent standard protocol for postcrash injury. Diagnostic and treatment outcomes including spinal and neurologic injury, need for surgery, and radiation exposure were collected for review.
  
  
  RESULTS
  Self-extrication occurred in 121 (90%) crashes, and overall cumulative radiation exposure ranged from 100 to 250 mSv, or 0.82-2.06 mSv per driver. Extrication with full spinal immobilization occurred in 14 (10%) drivers, with overall cumulative radiation exposure ranging from 140 to 350 mSv, or 10-25 mSv per driver. A total of 29 injuries were identified, nine of which (31%) were spinal. In these, six were emergency medical services extricated and three self extricated. None were unstable spinal fractures resulting in surgical care, surgical disease, or neurologic deficit.
  
  
  CONCLUSIONS
  In our IndyCar® racing experience, a protocol-led self-extrication system resulted in neither a mismanagement of an unstable spinal fracture nor neurological deficit, and reduced radiation exposure.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stevens
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Terry R
authors.initials: TR
authors.lastname: Trammell
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Geoff L
authors.initials: GL
authors.lastname: Billows
authors.affiliation: Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Ladd
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Olinger
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011859:Radiography; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D055815:Young Adult
keywords: computed tomography; emergency department; imaging; magnetic resonance imaging; trauma