Smith, a former Cup driver currently competing in NASCAR's truck series, will compete in his first Cup event of 2017 in the NASCAR All-Star night Saturday at Charlotte Motor Speedway. He will pilot the Richard Petty Motorsports No. 43 car, which Almirola would have driven in the last-chance qualifying race for those who had not already earned a spot in the main event. Smith, who was eligible to compete in All-Star festivities because he was in the top 50 in the standings last year, will not be eligible to get in through the fan vote.
Almirola, who suffered a compression fracture to the T5 vertebra (middle back), was released from the hospital Sunday.
Almirola said Wednesday at the Martin Truex Jr. Foundation gala that he has a half-crushed vertebra in his middle back and will have more tests Thursday that will help determine his rehab and recovery time.
He walked gingerly down the runway with a child cancer patient, and had to convince doctors to give him permission to go through with those plans Wednesday.
"[My doctor] preferred me stay home and lay on the couch, but I can walk a little bit," Almirola said on the red carpet. "The doctors told me just be careful and don't let anybody give me a hug and all that kind of thing.
"For the most part, I'm OK. I've got a broken back and one of my vertebrae is crushed in half, but besides that, I'll live."
Almirola's crash occurred when Joey Logano spun into Danica Patrick and Almirola came sliding hard into Logano, picking his back wheels up high off the ground.
"I'm doing the best I can with a broken back," Almirola said. "It was important for me to be here. ... I had promised [the patient] Devin that I was going to be here to walk with him. I wasn't going to let him down.
"I'm in a little bit of pain but with the pain meds and maybe I'll have a drink to care of it. I think all in all, I'm pretty lucky. It's a lot easier to think about coming here and dealing with the pain knowing what all these kids are going through."
RPM set a Friday morning news conference with Almirola to discuss his recovery time. The next points race is May 28 at Charlotte Motor Speedway, followed by stops at Dover, Pocono, Michigan, Sonoma and Daytona.
Almirola is 23rd in the NASCAR Cup standings, 62 points outside the current cutoff for the 16-driver NASCAR playoffs with 17 races left in the regular season. If he doesn't compete in every regular-season race as required by NASCAR rules, he will need a waiver from NASCAR to remain eligible for the playoffs. Even with a waiver, he would need to win a race and finish in the top 30 of the regular-season standings to qualify for the playoffs.
Smith, who has one career win and four top-five finishes in 211 career Cup starts from 2007-2016, would be available to RPM, if needed, for additional races, but RPM did not announce a driver for beyond this weekend. Smith is well accustomed to a substitute role. He drove the Hendrick Motorsports No. 88 car when Dale Earnhardt Jr. was sidelined by a concussion for two Cup races in 2012. He replaced Tony Stewart in 2014 at Watkins Glen the day following the Kevin Ward Jr. tragedy. He replaced Kurt Busch for the first three races of 2015 when Busch was suspended by NASCAR, and he substituted for Kyle Larson in 2015 for the race at Martinsville after Larson fainted following practice a day earlier.
Almirola's injury is a common back injury, because it occurs in a pivot point in the back between the shoulder blades and is caused by sudden deceleration, when the torso leans forward and the back stays steady, said ESPN racing analyst and emergency room physician Dr. Jerry Punch. Normally, injuries to the lower back and neck are much more significant and much more unstable, Punch said.
Denny Hamlin missed four races in 2013 after suffering a compression fracture in his lower back (L1 vertebra), and Tony Stewart needed nearly three months to recover from an L1 burst fracture last year.
"These normally aren't as serious or significant as the L1s, certainly not like Tony Stewart's burst fracture, where the whole thing explodes and you're worried about spinal-cord penetration and injury and compromise," Punch said.
"These, you may have pain. ... Normally, these heal quicker and most of the time don't require surgery."
Punch, who is not treating Almirola, said there can be several extenuating factors that could impact the amount of time he would be out of the car.
"The reason the thoracic is so stable is because you have the rib cage attached to it and you have the sternum in the front, so it's like a big barrel," Punch said.
"You've still got support around the barrel and everything there. It's normally pretty stable. ... Most of these can require a back brace, and they'll just monitor the healing, how long it takes to heal depending upon how much compression there is and deviation there is."
Stephania Bell, a physical therapist and an ESPN injury analyst, said arm movements will impact that area and that because bones are sensitive to vibration, it could be extremely painful when controlling the steering wheel. Bell, who isn't treating Almirola and noted that there can be a high variability depending on the specific nature of Almirola's injury, said patients often aggravate the injury because they misjudge what they can do when the pain starts going away.
NASCAR's substance-abuse policy requires any use of painkillers to be approved before getting in a race car, typically limiting that amount to what it considers safe for someone to operate a race car.