4.1 The aim is to remove the patient from the vehicle as safely and as quickly as possible. The key determinant in this plan (apart from safety) is the condition of the patient. The PHR team must decide on how to compromise between the slower, methodical extrication with total spinal control and the quicker extrication of the less stable patient. Clearly, unstable patients will need rapid extrication (see below) but the ability to predict which patients are unsuitable for prolonged extrication due to the anticipated clinical course is more challenging. It may be better to compromise a degree of spinal protection earlier rather than have an emergency (‘crash’) extrication situation develop 30 minutes later.