AUTO Medical 11 Issuu
AUTO Medical 11 Issuu
AUTO Medical 11 Issuu
ON SITE AT LE MANS
A look inside the medical operation at
the 24 Hours of Le Mans P26
LUCAS DI GRASSI
The Formula E racer tells of his recov-
ery from a suprise broken ankle P30
HOT
PURSUITS
How drivers and
doctors deal with
the hottest racing
conditions
AUTO+MEDICAL
LETTERS/
P4 The best letters and emails received from readers around the world
GLOBAL NEWS/
P6 Frdric Sausset launches disabled driver academy
P7 FIA closed-car device used at NHS Scotland event
P7 A look back at the Bahrain Motor Federation Medical Seminar
P7 Billy Monger getting up to speed after his accident
P8 Three British Touring Car drivers hospitalised after Croft pile-up
P8 Sean Edwards Test implemented accross motor sport series
P9 New FIA Medical Delegates announced for F1, WEC and WTCC
P9 Brazil to host FIA Americas regional medical seminar in October
P9 New Chief Medical Officers assigned for global motor sport events
FEATURES/
P10 HOT PURSUITS
This year's 24 Hours of Le Mans was one of the hottest ever. We
spoke to those involved about how to keep your cool whilst driving
P16 BIG INTERVIEW: DR VINCENZO TOTA
Audi Sport's team doctor Vincenzo Tota on his career, on safety, and
the challenges he faces working with a huge organisation
P20 IN THE LINE OF FIRE
First-hand look at realistic fire training simulations, and how they
are helping make motor sport a safer environment
P26 INSIDE LE MANS' MEDICAL OPERATION
An insight into the medical facilities in operation at one of the most
demanding motor racing events in the world
P30 THE ROAD BACK: LUCAS DI GRASSI
The Formula E and WEC driver discusses the seemingly innocuous
football injury that prevented him from racing in Le Mans
STUDY/
P A SYSTEMS-BASED APPROACH TO STAGE RALLY SAFETY
A look at how medical staff at the Isle of Mull Rally ensure adequate
safety provisions at the event on the remote Scottish island
Editor: Marc Cutler
Deputy Editor: Charlie Eustice
Designer: Cara Furman
We welcome your feedback: [email protected]
2
AUTO+MEDICAL
In this section, we print the best letters and emails received from readers around the
world. We welcome comments on articles as well as suggestions for future content. If
you wish to send in a letter or email, please direct it to: [email protected]
5
AUTO+MEDICAL GLOBAL NEWS
GLOBAL
NEWSFrdric Sausset in
action in his team's
Morgan-Nissan in 2016
6
AUTO+MEDICAL GLOBAL NEWS
7
AUTO+MEDICAL GLOBAL NEWS
8
AUTO+MEDICAL GLOBAL NEWS
9
AUTO+MEDICAL FEATURES
10
AUTO+MEDICAL FEATURES
FEATURES
HOT PURSUITS
How drivers and doctors dealt with this years Le
Mans 24 Hours, one of the hottest races on record
11
AUTO+MEDICAL FEATURES
Imagine youre a racing driver blasting along closed cockpits in which the temperature is
the Mulsanne Straight during the Le Mans high, even in normal conditions. Heatwave
24 Hours, hitting speeds of 300kph as you conditions are demanding physiologically and
overtake numerous cars in one go. Now psychologically for the body, and drivers feel
imagine it is 40C in the cockpit, you are more tired as a result. This is why they must
wearing three layers of overalls, a helmet all be in excellent physical condition to race in
and gloves, and you are tightly strapped-in endurance racing, and in the Le Mans 24 Hours
to your seat. in particular.
Sometimes racing is less enjoyable than it The risk of driving in the heat is not merely
seems. It also requires high levels of fitness and one of increased tiredness, it can be truly
preparation for all circumstances, particular dangerous in extreme cases.
sweltering temperatures in the cockpit. Effects related to high temperatures include
During this year's Le Mans, ambient fatigue, dehydration (which can lead to coma
temperature readings clocked above 30C for in certain cases), and body convulsions, which
the majority of the daylight driving hours, and could pose risks by overtaking the body
were much higher than that inside the cockpit. temperature regulation mechanisms, says
It is obvious that the drivers all suffer in Vivier. In medicine, malignant hyperthermia
these hot conditions, says Dr Dominique is characterised by body temperatures above
Vivier, Chief Medical Officer at Le Mans. 40C and above. This situation can lead to
They are wearing fire-proof overalls, helmets hospitalisation in intensive care or
and gloves, and they are driving within resuscitation units.
12
AUTO+MEDICAL FEATURES
CORE CONCERN
The human body is happiest at an optimal
internal temperature of 37.5C. The body is
able to regulate its temperature in a number
of ways shivering when cold helps to raise
the core temperature, and perspiring helps
to send the temperature the other way, with
the evaporating moisture cooling the body
from the outside. But what if evaporation is
hampered by numerous layers of clothing?
Professor Claude Meistelman, a lecturer at
the University of Nancy, and expert in heat
stress, says that developing a driver apparel
solution that is both fireproof and sufficiently
breathable is a fine balance. Prof. Meistelman says
breathable overalls are
At a cockpit temperature of, say, 32C, if the more important than
driver is wearing three layers of overalls with air conditioning
a lack of permeability, he will store heat very
rapidly. More breathable overalls are more one of the toughest parts of a race in hot
efficient in heat dissipation, and the rise in climates.
central core temperature is slower than with The worst time is when you stop, you dont
less well-vented overalls. want to be in there a long time, says Lopez.
One man who can attest to the sizzling Theres no air coming in, and all the heat is
weather in Le Mans this year is Jos Mara coming into the car because the engine is
Lpez, one of three drivers of the #9 Toyota stopped and youre not moving. The car is
LMP1 car. It was hot all weekend in Le Mans suffering, and youre suffering too.
this year, he said. In the cockpit, its all closed. Lpez echoes Professor Meistelmans point
Theres no air coming in, so when you are in the about heat storage and build-up being the key
car for two or three hours, it gets difficult. factors when it comes to driving in the heat. It
A full service stop in endurance racing takes gets uncomfortable in there, he says. When
roughly a minute and involves a change of all you first start, its okay, but the heat suddenly
four tyres, as well as a brimmed fuel tank, and comes quite quickly. Its most noticeable with
a swap of driver. Regular tyre/fuel stops take the breathing, because you breathe hot air and
slightly less than this, but they are nonetheless you sometimes have this sensation kind of like
youre suffocating.
we spend a lot of time in the car in conditions
IT FEELS KIND OF LIKE YOU like this. We have to be used to the conditions,
ARE SUFFOCATING but there are races sometimes like at Le Mans
and the Circuit of the Americas where it can
13
AUTO+MEDICAL FEATURES
be extremely hot in the car and difficult to
manage.
The Circuit of the Americas (COTA) and IF A DRIVER'S CENTRAL
more specifically the FIA World Endurance CORE TEMPERATURE IS ABOVE
Championship (WEC) race there in 2016 was 38 C, HE WILL BE MORE PRONE
one of the catalysts for a new heat-related rule TO MISTAKES, SUCH AS
in the championship which limits continuous
SPINNING OFF
driving time to 80 minutes if the ambient
temperatures will reach 32C. Race-winner
Timo Bernhard described the conditions as not guaranteed for anybody.
brutal, with temperatures reaching 35C Dr Vivier echoes this sentiment, saying it
during the race. is absolutely not possible to acclimatise to
A heat stress study by Professor Meistelman driving in the heat. One cant train to overcome
documents that at the Acropolis Rally in Athens these high temperatures conditions. The
in 2001, the ambient temperature was 33C, human body is made to ensure an optimal,
very similar to that seen in Le Mans this June. controlled temperature at 37.5C.
A by-product of this heat at the Greek rally was Since the body has no need to remain at
an internal cockpit temperature of 46.5C in a constantly high temperature, prolonged
cars without air conditioning, and a core body exposure to heat will do little for a racing driver
temperature of 39.2C for drivers of said cars, other than to make them familiar with the
which can be a dangerous level at which to sensation of warmth in the cockpit.
operate. The body sweats to cool itself, and produces
Teams should understand that if the central the sensation of thirst when it starts to
core temperature of the driver is above 38C, dehydrate, explains Dr Vivier. However, the
there is a risk that performance could be body temperature cannot significantly rise in
influenced says the Professor. I cant say if normal conditions.
this is equivalent to the driver losing a certain In a hot race, then, sweating really is a drivers
amount of time or driving a precise amount best friend. Air conditioning and other cooling
slower per lap, but he will be more prone to techniques such as liquid-cooled underwear
mistakes, such as going off, or spinning the car. are ineffectual in the long run, making
permeable overalls and sweating the first line
PREPARATION AND PERSPIRATION of defence in body temperature regulation
Despite rigorous training regimes it is near when driving in the heat. This, of course, means
impossible for drivers to truly acclimatise to hot a lot of lost fluids.
conditions in a cockpit. Hydration is important, but its not just a
Some drivers expect an improvement in case of drinking a lot, says Lpez. You need to
adapting to the conditions if they spend a few be careful, because you might be told to drink
days in a hot environment before the race, three litres of water but if its only water, you
explains Professor Meistelman. However, this will wash all of the salts out of your body, and
is a hopeless endeavour, because adaptation to that will make things even worse.
hot environments requires several weeks and is You need to take supplements, salts, and
14
AUTO+MEDICAL FEATURES
things that help you to retain the water in your that there are two separate medical facilities;
body, which can be found in sports drinks. one for drivers, and one for the public. Packed
These will help you keep water in the body for grandstands all week coupled with the weather
a long time. If you only drink water, you will be could have presented a higher amount of visits
going to the toilet every 10 minutes. to the stands for medical staff, but Dr Vivier says
it was business as usual.
WELL-OILED MACHINE Heatwave weather conditions can cause
Thankfully, the 2017 edition of the 24 Hours of difficulties for the Medical Centre, but activity
Le Mans ran perfectly despite the extensive heat, was similar to previous years, both for the track
according to Dr Vivier. This had much to do with Centre and the spectators Centre.
preparation and messages of advice for teams, There were 54 causes for medical extraction
drivers, and spectators. of spectators, and seven such cases for drivers
Temperatures were at times above 35C, and on-track.
this was for several consecutive days with little Expertise and anticipation made the event
to no cooling of the air overnight. I had fears in run smoothly, and the public followed the
terms of the effects of these temperatures, not prevention and awareness messages regarding
only for the competitors and their teams, but for the heat effects. In this situation, the right thing
staff around the circuit, and the general public to do is to seek shade as much as possible and
who were present in large numbers. rehydrate steadily and significantly. When the
Close to 260,000 spectators were at the sensation of thirst occurs, it means that the
circuit over the week, more than doubling the dehydration mechanism is already engaged,
towns population of around 148,000. The so it is important to have this rehydration
volume of fans pouring into the venue means reflex constantly.
15
AUTO+MEDICAL FEATURES
DR VINCENZO TOTA
Official team doctor, Audi Sport AUTO+Medical: What is your background in
MSc (Sport Psychology), Specialist in Sport motor sport, medicine and training?
Medicine Traumatology, Degrees in Vincenzo Tota: I was a racing driver myself, I
Medicine & Surgery and Osteopathy raced for many years in off-road racing, and
then in offshore racing. This gives me a very
Dr Vincenzo Tota is the team doctor good perspective of what is going on with
racing drivers.
for Audi Sport and Medical Director of
I also have a good knowledge of
TechMed. He talks to AUTO+ Medical about engineering and ergonomics. When youre
how his past career as a racer has equipped doing the off-road races, you are obliged to
him for his role, and the challenges of do the mechanics yourself if you have a
preparing drivers for the demanding and problem in the middle of the Sahara desert,
technology-driven world of modern racing. you need to fix it yourself.
Dr Tota's experience
as a racer gives him a
unique insight into the
mind of a driver
16
AUTO+MEDICAL SCIENCE
A+M: In your current role with Audi Sport, always an FIA-sanctioned event, but when we
what kind of work do you do with teams go testing it might be that its only one car
and drivers? testing, so Im always pushing to have the
VT: Im the official team doctor, so Im best performance and the best care.
responsible for everything that Audi Sport
does. Whatever they do, Im involved, and I A+M: How has your experience as a driver
have a group of five doctors working with my helped your role as a medical professional?
company TechMed, so even if I have clashing VT: I know exactly from the physical and
events, there is always one of my team mental point of view what are the stresses,
covering the medical side of these events. We and where you need to be extremely strong,
take care of the team, we take care of the so this helps me in giving them the best
drivers, and we supervise the safety of the advice in terms of physical preparation,
tracks where we go. hydration, mental training, relaxation
techniques, anger management, how to
A+M: What are the biggest challenges convert negative energy into positive energy,
youve faced when providing medical care and so on. I know all about these things, just
trackside? because Ive done it myself.
VT: Dealing with champions and other very
good drivers is always challenging, because
they always want to test if you are an expert, I WAS A RACING
with a good updated knowledge. They keep DRIVER FOR MANY YEARS
questioning you on every single detail, and
- THIS GIVES ME A GOOD
this pushes myself and my colleagues to keep
updated on the latest technology or the latest PERSPECTIVE OF RACING
discoveries in motor sport and in sport DRIVERS TODAY
medicine. Im also very much involved in
safety, so I always push Audi to be careful, to
not go testing where it is not safe, and if it is A+M: What do you think are some of the
not enough, I will push the race crew to biggest changes in driver fitness and
improve their level of safety. development that have happened in motor
sport in recent years?
A+M: Can you give an example of a track VT: We have had two big milestones in fitness
youve really pushed to try and improve? and mental training: one is Ayrton Senna, and
VT: Wherever I go, I check with the medical the other one is Michael Schumacher. These
questionnaire, I check with the local doctors, two raised the bar incredibly high, and they
and if we go testing in a special location, I set the base for modern training. Before,
always like to have a very good standard, there were good talents with basically very
almost like an FIA event. When its a race, its little training. Now you can really build up and
17
AUTO+MEDICAL FEATURES
you do sprint racing or endurance racing.
In endurance racing you need to have
YOU NEED TO START
slightly increased body fat, because in a 24
hour race, for example, you really need to RACING EARLY IN YOUR
have some reserves. If you are sprint LIFE, SO THAT YOU ARE
racing, the leaner and thinner you are, the PROFESSIONAL AND
better it is for the performance. DISCIPLINED
18
AUTO+MEDICAL SCIENCE
19
AUTO+MEDICAL FEATURES
20
AUTO+MEDICAL FEATURES
IN THE
LINE
OF FIRE
How the latest fire training
simulations are helping to make
motor sport a safer environment
21
AUTO+MEDICAL FEATURES
using a full-scale model supplied by Haagen on a circuit, because there are people sitting
for fire safety training. inside the cars. As well as knowing how to put
The simulation started as an incident on out the fire, they need to know how to extract
track, indicated by a digital flag, that person from the car.
manufactured by DZ Engineering. Marshalls
were ready behind their post, manufactured SITUATIONAL AWARENESS
by Geobrugg and designed to protect track Fire training scenarios require balance. They
workers around the circuit. The fire gained must be sufficiently hands-on to properly
momentum and the driver was soon covered equip those training with relevant skills and
in flames. The fire team a combination experience, but not so realistic that they
between Stand 21, Haagen and a local fire present genuine danger. The scenario must
brigade were on hand to put the fire out. also be relevant to the environment where a
The driver was fully equipped with the fire is likely to occur in that persons line of
mandatory FIA-approved clothing, supplied work.
by Stand 21, and was protected against The type of training we provide really
second-degree burns for around 15 seconds. depends on who we are training whether
The flames were extinguished and the driver its marshals, volunteer firefighters, or maybe
(in this case a stunt man) emerged, sweaty team personnel, explains Frank Hulshoff,
but unscathed. Marketing Director at Haagen. Depending on
This kind of demonstration is typical of the that, we set up what we call an escalating
situation that fire teams must be prepared to approach to training they start training on
deal with at race tracks across the world. It is digital screens that mimic fires with smoke
essential that marshals receive fire safety and digital fires on screens, and the final part
training specific to motor sport, according to of any training is a real fire, where you have
Leon Timmermans, Managing Director of the heat and scare factor of the flames.
Haagen, which supplies training both in It is important that this training takes place
motor sport and in public situations. in the area that a fire is most likely.
As we all know, there is a lot of risk of fire The pit lane is definitely a high risk area,
in motor sport. A lot of the marshals and says Hulshoff. It has everything from a risk
firemen who work on specific circuits around assessment point of view that you dont want:
the world have a sort of double role they people passing objects, cars, fuel, and its a
are either a volunteer or a professional in crowded place, so we want to be able to do
their day-to-day life for the fire brigade, and training there and raise the safety standard.
then help the circuits during certain If you look into the past, we all remember
weekends in training. the pit fire at the 2012 Spanish Grand Prix in
One of the areas where we help is in the Williams team garages. A lot of learning
creating a curriculum for these volunteers. has been made from that on how to
They have basic training of how to fight fires approach that situation. If you look at a
in a building or in a construction yard, but it is situation that will never change, the first
completely different to what they need to do people on the scene are team members, crew
22
AUTO+MEDICAL FEATURES
to training.
Our most renowned customer is the
WE BELIEVE THAT ELECTRIC Automobile Club de Monaco. They have a
VEHICLE FIRE TRAINING IS very strict training regime, and its not just a
NOT THAT GOOD... WE WANT case of learning how to put out a fire when it
TO WORK WITH THE INDUSTRY occurs, you also have to be very fit. One of
their requirements is that youre not
ON THIS completely out of breath when you get to the
23
AUTO+MEDICAL FEATURES
MEMBERS...THEY SHOULD
HAVE PROPER TRAINING
FUTURE-PROOFING
As motor sport moves from traditional
internal combustion engines to hybrid and
fully-electric powertrains, new challenges
are arising for fire safety teams. But it
doesnt make the risk of fire any less real.
The challenge of reacting to battery-
powered cars is completely different,
according to Timmermans. If you dont
understand how to control those fires, then
you are facing enormous risk, and thats
where we see a lot more development
possible. We want to work with the FIA to
understand this better, and do the best job
possible. Depending on the different levels
of the professionals and the volunteers, we
need to fight these issues together.
It is therefore essential to train for all
types of fires in motor sport and to
continually update this training as
technology develops.
As Timmermans says: We are convinced
there is still work to be done to improve
training for dealing with fires in electric and
24
AUTO+MEDICAL FEATURES
hybrid cars is not as advanced as it could be, If an electric road vehicle catches fire,
specifically completely battery-powered cars after extracting passengers and isolating
like Teslas or those we see in Formula E. In the battery, the fire department will often
these scenarios, what is very important is let the car burn out in a controlled way. But
cooling down the car and battery, to make a battery fire can last for hours so new
sure its not getting overheated. You might techniques must be developed.
not see when there is a fire around the We want to work on training people in
battery itself and what the impact of that is. how to work on such a car and the
So, what you normally do in a battery- techniques behind it, says Timmermans.
powered car is cool down the area where the But we also want to work with the industry
battery is located, and then control any fires, that builds those cars, and help fire
explosions or leakages. departments become more informed in
what they need to do in their procedure to
get control of such a fire.
Fire broke out in the Williams garage, No doubt fire safety has improved hugely
after the 2012 Spanish Grand Prix, in motor sport in recent years. In the 1960s
barely 90 minutes after the team
won its first race in eight years and 70s, fires were a common occurrence,
and the training in how to deal with them
was clearly not advanced enough.
Despite the enormous advancements in
fire safety, though, there is always room to
improve. Hulshoff feels that the world of
motor sport would benefit from some sort
of log book of fires throughout motor sport
history, to better prepare for similar fires in
the future.
When it comes to statistics for how many
fires there are in certain championships,
finding an exact number is relatively hard
to pin point, says Hulshoff. This is
something that wed really like to work on
with the FIA, and see if we can create a
database for it, and be given more
information. Realistically, large series like
Formula One, the World Endurance
Championship, and some of the American
series are quite well monitored, so its not
hard to see things that have happened in
the past and take learning out of that.
25
AUTO+MEDICAL FEATURES
INSIDE THE
24 HOURS OF
LE MANS
MEDICAL CENTRE
AUTO+Medical takes a look at the medical
equipment, facilities and operations used
at the 24 Hours of Le Mans in 2017
When you have 180 drivers to look after, There are 50 doctors, 40 nurses and 48
and more than 1,000 times that number in extractors on call to take care of any racers
spectators, its worth doubling up on medical who may require assistance in the event of an
facilities. Thats exactly how they do things in accident, with a fleet of 25 ambulances, five
Le Mans, with dedicated medical facilities for medical cars, and four extraction teams ready
fans and drivers alike. to transport them.
26
AUTO+MEDICAL FEATURES
27
AUTO+MEDICAL FEATURES
INVENTORY
The entire circuits
medical supply is
housed here at the
spectators medical
centre, completely
separate from the
drivers medical centre.
A nurse manages
stock levels.
MEDICAL INTERVENTION
In total, the medical
teams at Le Mans ran
a smooth operation for
2017, despite scorching
temperatures. There were
601 interventions for
spectators, 54 of which
resulted in an evacuation.
On track, there were 51
interventions, and seven
of these required driver
evacuation.
28
AUTO+MEDICAL FEATURES
X-RAY
The radiography
room, housed in the
sport medical centre,
is the port of call for
suspected broken
bones and fractures
in Le Mans, and also
features a mobile
digital radiography
device, incredibly useful
for x-rays on the move.
SERIOUS INJURIES
This is the room where
serious injuries to
racers are taken care
of, should a serious
accident occur on-track.
29
AUTO+MEDICAL FEATURES
LUCAS DI GRASSI
The Formula E and World Endurance Championship racer takes a look
back at a seemingly innocuous football injury, a surprise broken leg and
a remakrable recovery to win the 2016/17 FIA Formula E Championship
During a charity football match at A+M: Was that at the Le Mans hospital?
Chelsea FCs Stamford Bridge, Lucas di LDG: Yes it was, and the feedback from the
Grassi sustained an injury to his ankle. doctors was actually not very good. The
Initially he thought it was not too serious orthopaedist had a look at my foot and
and he went on to take two podiums at thought that I was right-foot braking, and that
the double-header Berlin ePrix a few days it was dangerous for me to compete, but this
later. However, the pain didnt subside was not the case. I could not convince him
and after x-rays he was found to have a that in modern motor sport we brake with the
double fracture in his leg, ruling him out left foot and only use the right foot for the
of the Le Mans 24 Hours. He spoke to throttle. I had a long discussion with him, and
AUTO+Medical about the injury, and his he thought I was just saying it so I could race,
recovery from it. but that was not the case I was just telling
the truth, that we use the right foot for the
AUTO+Medical: Could you explain how throttle nowadays. There was no safety
the injury came about? concern, because in the worst case of a lot of
Lucas di Grassi: I was playing a charity pain, I would just not accelerate any more.
football match at Chelseas stadium in In any case, I consulted three or four
London on the Tuesday before the Berlin orthopaedists, including one from Brazil who
race. I got a tackle from another player, and I is a very close friend of mine, Dr Caniedo
had a lot of pain at the time, but I could hes a big motor sport fan. He races go-karts
move around so I didnt think it was serious and hes one of the top orthopaedists in the
and I just went straight to the Berlin ePrix. I world. He told me that I needed surgery as
went straight from Berlin to Le Mans, and I soon as possible because it was a diagonal
was in a lot of pain after the race weekend. I fracture, so we decided together with the
did an X-ray at the hospital, and found out Chief Medical Officer from Le Mans that the
that the fibula was fractured in two places! priority is Formula E, its not Le Mans itself, so
30
AUTO+MEDICAL FEATURES
Despite having a
fractured fibula - in
two places - di Grassi
went on to take pole
and two podiums at
the Berlin ePrix
31
AUTO+MEDICAL FEATURES
it was better to not do Le Mans, not be in pain, right exercise, trying to rest for the most
not compromise any of the other ligaments or amount of time I could, putting a lot of ice
anything on my foot. It was the wisest decision doing all the medical procedures
to not do Le Mans and fly straight to Brazil and recommended. Im feeling very good, feeling
do the surgery, so I did that. almost no pain, and Ive been off medication
We followed the FIAs advice, we followed for nearly two weeks. Everything works really
the Audi doctor, Dr Vincenzo Totas advice, and well.
my doctor in Brazil. We did the surgery the day
after I arrived, they put in a titanium plate, and A+M: What would your advice be to drivers
I did four weeks of recovery, physiotherapy, a who have similar injuries?
lot of work in the swimming pool, and now Im LDG: First, you cannot stop your life because
almost 100 per cent, less than a month after. of racing. Riding bicycles is dangerous, and I
broke my collar bone once training. It
A+M: So how did you recover so quickly? happens, so dont stop your life because
LDG: Like I said, I 100 per cent trust this doctor youre afraid of getting an injury. But as soon
from Brazil, Dr Caniedo he did a fantastic as you have one, go and see your doctor
surgery, I managed to focus myself on the straight away. If its an injury that is not critical,
recovery, eating the right things, doing the you can do a race and you feel safe to do it,
Di Grassi in action in
Monaco, where he fin-
ished in second place
32
AUTO+MEDICAL FEATURES
performance out there on the race track.
THE ORTHOPAEDIST
A+M: You mentioned that a doctor did not
WOULD NOT BELIEVE ME THAT
understand your situation with the pedals
WE DO LEFT-FOOT BRAKING...
What advice would you give to motor
sport doctors who are dealing with drivers? HE THOUGHT IT WAS
LDG: I think for the doctors, they are right to DANGEROUS TO COMPETE
be very conservative and evaluate the whole
33
AUTO+MEDICAL SCIENCE
AUTO+MEDICAL SCIENCE
SCIENCE
A SYSTEMS-BASED
APPROACH TO STAGE
RALLY SAFETY AND
MEDICAL RESPONSE
Held annually on a remote Scottish
island, the Isle of Mull Rally is one of the
most unique motor sport events in the
world. But with such limited facilities,
how do the event organisers ensure that
those in need of medical care get it? This
article takes a look at the systems in place
to ensure a safe event for all.
Author: Dr. Ben Shippey, Consultant Anaesthetist, NHS
Tayside
INTRODUCTION
Since 1969, there has been a motor sport
event held in early October on the Isle of
Mull, in Argyll and Bute, Scotland. The Isle of
Mull is a large island in the Inner Hebrides,
separated from the mainland by the Sound of
Mull, which is served by several ferries. The
island is approximately 340 square miles
(880km2), being 28 miles (45 km) from
furthest north to furthest south, and 30 miles
(49 km) from furthest east to furthest west.
The population varies seasonally, but is
approximately 2,800 people.
The event has been through several
iterations, but perhaps the biggest change in
the competitive nature of the event was the
passing of an Act of Parliament in 1989, which
permitted the temporary suspension of the
35
AUTO+MEDICAL SCIENCE
36
AUTO+MEDICAL SCIENCE
purpose built facility in Craignure, vastly
increasing the physical space available and EVERY YEAR,
allowing the development of telemedicine
APPROXIMATELY TEN CARS
facilities connected to tertiary care facilities
LEAVE THE ROAD AT SPEED,
throughout the country. The hospital is
staffed by nurses, including two extended AND HALF OF THOSE ROLL
role emergency nurse practitioners, OVER
supported by a radiographer, and local GPs.
There is no facility on the island for critical
care, so patients requiring services that landing strip on the island) can preclude
cannot be offered locally are transferred to civilian helicopter landings on Mull.
the mainland. This is done either by the The rally poses significant challenges,
Scottish Ambulance Service (SAS), on the ferry therefore, to the provision of a seamless
to Oban, or if more serious, by the Emergency trauma service. A systematic analysis of these
Medical Retrieval Service (EMRS), a specialist barriers was undertaken by rally organisers,
service developed to deploy a consultant-led summarised in Figure 2 below.
critical care service to the remote Spectators are not all conversant with
communities of Scotland. The EMRS uses a rallying, and will stand in locations where
helicopter based in Glasgow, or military they are exposed to significant risk. Marshals
aircraft if SAS aircraft are engaged on other are few in number, and are variably trained in
missions. The nearest major trauma centre is first aid, as are competitors. Cars may have
130 miles (4 1/2 hours) by road, or 80 miles accidents unseen, and only be discovered
(30 minutes flight time) by air, in the centre of when they are overdue at a subsequent point
Glasgow. Weather conditions and darkness along the rally route. Neither the skills, nor
(there is no instrument approach into the the equipment needed to provide advanced
OPPORTUNITIES
Stage design Marshal Training Local Air assets available
Social media Competitor engagement SAS engagement
training EMRS assistance
Rally is popular
BARRIERS
37
AUTO+MEDICAL SCIENCE
WHERE THEY ARE EXPOSED
TO SIGNIFICANT RISK
38
AUTO+MEDICAL SCIENCE
SPECIALIST TRAINING AND EQUIPMENT use their specialist skills in the local hospital,
A First on Scene training evening was held making them able to care for a casualty from
on the evening before the rally, and was scene until retrieval by the EMRS, reducing
attended by 78 marshals, spectators and the need for sequential handover. The
competitors. This training was provided by equipment and disposable supplies needed
experienced rescue marshals and rally to create a temporary level three critical care
paramedics, and consisted of didactic and bed in the Mull and Iona Community Hospital
practical instruction on scene safety, were obtained from a variety of sources.
approach to the scene, fire, patient Monitoring was loaned by Drager Medical UK,
assessment, airway and cervical spine basics, and a portable blood analyser by Abbott
cardiopulmonary resuscitation, haemorrhage Point of Care. A portable ventilator (Oxylog
and clear communication. 3000+) was loaned by the Scottish Centre for
Negotiations were undertaken with NHS Simulation and Clinical Human Factors.
Highland. This resulted in temporary Disposables and drugs were supplied by NHS
honorary contracts being awarded to three of Highland according to protocols provided by
the rally doctors (two anaesthetists and an the EMRS, supplemented by a few disposable
emergency physician), and an intensive care items purchased by the Mull Rally.
nurse, creating the opportunity for them to Surprisingly little additional equipment was
John MacCrone
(pictured) won the
Mull Rally in 2016
39
AUTO+MEDICAL SCIENCE
management, information transfer triage and
on-scene decision-making capability.
Additional developments have taken place
NEITHER THE SKILLS, NOR
in subsequent years. The First on Scene THE EQUIPMENT TO PROVIDE
training has been expanded, and is now ADVANCED RESUSCITATION
compulsory for competitive crews: the logic ARE PERMANENTLY PRESENT
being that the first person to arrive at the ON THE ISLAND
scene of an injury is either the non-injured
competitor in the car involved in the incident,
or the next competing car on the road, if both
competitors are injured. Further negotiations
with local emergency services have allowed
the rally to have access to the UK emergency
40
AUTO+MEDICAL SCIENCE
Portable gas
analyser, loaned
by Abbot Point
of Care, and
subsequently
purchased by
NHS Highland
41
AUTO+MEDICAL SCIENCE
42
AUTO+MEDICAL SCIENCE
43
AUTO+MEDICAL SCIENCE
CALL FOR
SUBMISSIONS
Every issue of AUTO+Medical contains a scientific research paper
that looks at the various medical issues that surround motor sport.
All submissions are welcome For each submission please AUTO+ MEDICAL
so if you have a study that include a summary of the EDITORIAL BOARD
you feel would be suitable research and all necessary
for publication in future contact information. Dr Paul Trafford
issues of AUTO+ Medical, (Chairman)
please send it to: The editorial board will
[email protected] evaluate each submission Dr Robert Seal
before it is accepted for use (Medical Director,
in the magazine. Canadian Motorsports
Response Team)
Dr Matthew
Mac Partlin
(Assistant Chief Medical
Officer, Australian GP)
Dr Pedro Esteban
(FIA Medical Delegate,
World Rallycross
Championship)
Dr Jean Duby
(FIA Medical Delegate,
World Rally
Championship)
Dr Kelvin Chew
(Chief Medical Officer,
Singapore GP)
Dr Jean-Charles Piette
(FIA Special Medical
Delegate)
44