It's been a while since I posted one of these, so I figured it is time to get them going again. This Hot Lap case is inspired by a You Tube video that was posted on Twitter recently. Off we go ...

You are in position on circuit and are lucky enough to have a live feed of the action when you see this happen


Let's assume that this is a fully resourced event. There are three angles to play with:

• The medic in the chase medical car on the opening lap
• The chief medical officer (CMO) in race control
• The trackside medic or the medic in that sector's medical intervention vehicle (MIV)

Here are some things to think about

• What will be your initial actions?
• What are the key priorities?
• What injuries might be encountered and how will you deal with them?
• What might you do after the event?

------

Read on once you've worked out your strategy for each angle

-----

I'm not going to claim that I have the one and only correct answer for this, but I'm going to make some suggestions and highlight some resources along the way. Feel free to leave comments, opinions and corrections in the DisQus section below.

This is clearly a big accident and it could be a little overwhelming at first. Elements that leap off the screen include the lack of any apparent deceleration before impact, the breaching of the tyre barrier and wall, the car getting significantly airborne and debris raining into the spectator area. One additional issue is the fact that the race car has ended up outside the tyre barrier on what appears to be an accessory access road. There is a lot to deal with here, no matter which role you are taking.

Let's deal with some initial actions.

As the medic in the opening lap chase car:

• This is a no-brainer that you are going to have to attend this competitor. The tricky part is how to do this safely and quickly. Bear in mind the debris that launched into the spectator area; the driver may not be the only casualty! Also, while we saw one car apparently spear off the track on its own, there may be other cars involved.
  
• If this is a non-competitive event or a club or regional event, it should be red flagged by race control. A practice or qualifying session would also most likely be red flagged, even at an international event.
• However, if this were a high profile event, given that this is the opening lap of the main race, at very least a safety car would be triggered with yellow flags displayed on the approach to this corner. The aim is to control the speed of the remaining vehicles so that no more come off at this point while officials are attending the scene. There's no guarantee though, so keep your eyes peeled.

As the event CMO, the same concerns apply with a few additions.

• Making sure that the safety car has been triggered.
• Bring that sector's MIV up on standby in anticipation of it being scrambled to the scene very soon. The crash looked severe so keep nudging the clerk of course.
• Put the sector's ambulance on standby.
• Think about having the preceding sector's MIV on standby too, as back up might be needed for this one.
• Check that the fire and rescue controller has their team ready, as they are also likely to be needed.
• Make sure that the medical centre is aware that they need to be ready to receive an injured competitor.
• Start working out how the MIV is going to get to the scene, especially as the race car is on the "wrong" side of the tyre wall. More on this in a moment.
• Again, from the video feed, the driver may not be the only casualty, so this could rapidly escalate to a mass casualty scenario requiring response by more than one medical crew and several ambulances. It may even become an internal disaster, with control being handed over to the local disaster response agency.
  

If you are the MIV medic you would be:

• In your vehicle with your seat belt on, anticipating being scrambled to the incident.
• Watching the flow of traffic, particularly looking for gaps, any sign of the safety car and that safety car boards and yellow (or even red) flags are being displayed.
• Listening to the radio for the call to scramble to the scene and any information on its exact location and condition.
• Thinking about what clinical response may be required, including the possibility of there being more than one casualty. This should be discussed amongst the members of the MIV crew so that there is a clear plan of attack on arrival.
  

Let's look at the management priorities next. They'll be fairly similar regardless of which role you are playing, though with a slightly differing slant.

• Make the circuit safe for the medical and rescue teams to operate.
• Access the incident scene. Tricky, given where the race car ended up.
• A rapid scene assessment (hazards, casualties and likely injury spectrum).
• Rapid and concise information relay to race control with request for additional resources as required.
• Begin to provide clinical management and be ready to direct subsequent rescuers who arrive to any other injured people.
• Clear the injured individuals from the scene, either to the medical centre or direct to the receiving trauma hospital.
• Reset the medical and rescue teams to their positions once everything has been dealt with.
  

There are a few detail worth expanding upon from this list.

Making the circuit safe will require yellow flags on approach, most likely a safety car to be deployed and clear calls over the radio instructing on-track responders when they can enter the circuit. But keep your eyes peeled on a live circuit; race cars can be on you in a split second, especially when you are working at a corner.

Advice from race control on how best to approach the scene will be vital. The race car is on the outside of the tyre wall, with a gravel trap between the track an the wall. Driving across the gravel trap is usually not a good option. There appears to be a grass strip between the gravel trap and the tyre wall which might provide access to the scene. Alternatively, there may be an option to approach the scene via the access road outside the tyre wall where the race car ended up. However, this is unlikely to be a viable route for the MIV, which will be trackside.

In this instance the MIV did approach via the grass strip, but this means that they arrive on the wrong side of the wall. One option will be to get to the stricken car via the breach in the wall; however, this may be hazardous due to debris and the risk of fire. Climbing over a section of intact tyre wall may be a better choice, though there is still a risk of injury and there is the problem of moving equipment from the MIV to the scene.


Once on scene, there needs to be a quick scene assessment for hazards, casualties and likely injury spectrum, prompting a brief call to race control with initial information. Apart from the usual potential hazards of fire, smoke, a live engine with moving car parts, there are also the possibilities of an unstable car, an unstable tyre wall and nearby spectators getting involved and becoming casualties.

When scanning the scene for casualties, it is easy to centre in on the driver, but take some time to look around for others. There have been a few times when there has been delayed recognition of a second vehicle further up the track or a track marshall requiring attention. There may well be injured spectators in this incident.

On to the possible injuries. Well, as far as the driver goes, anything is possible, from head to toe. Blunt injures are likely, but given the mechanism, penetrating injuries are a possibility too. These may be compounded by driver entrapment by either confinement or by compression. Disincarceration and extrication may have to be built in to the clinical management. An acute medicalevent affecting the driver should also be considered, especially as there was no clear pre-impact deceleration; could the driver have been unconscious prior to leaving the track?

There may also be spectator injuries, which could range from simple lacerations and contusions, through to fractures and head and torso injuries. There is even the possibility of burns injuries.

The aim will be to identify and treat life-threatening injuries and then rapidly stabilise any injured persons for transport to either the medical centre or the receiving hospital. Current practice is to minimise interventions to those that will ensure that the casualties arrive alive to the medical centre or hospital rather than providing extensive care while trackside.

Last of all, it's worth giving some thought to post event actions. This was a big incident. There should be some level of investigation, most of which will rely on information from the sector marshalls and any attending medical and rescue crew. The condition of the track (track surface, standing water, oil, etc) and the crash barrier (Run off wide enough for average speed? Was a two-layer tire wall enough? Did something facilitate the car launching over the wall?) will be examined. The race car will also be scrutineered - Did the brakes work? Was there a fault that caused the accident? Did all of the safety equipment perform correctly?

The medical team's response should also be looked at. While there is little doubt that everyone will have done what they thought was best, there is nearly always something that can be learned which may be useful in future. Did the communications run smoothly? Was everyone comfortable with their roles? Was the necessary equipment available and did it work? Are there any recommendations for future similar events? A lot of this will be part of the chief medical officer's post event report. There  will probably also be a check into medical problems being the possible cause of this driver's crash, particularly given the apparent lack of pre-impact deceleration.

So, there we go. It was a long one, but I hope it was worth it to go through. Many of us cover motorsport events on a regular basis, for others it's a bit more intermittent. Either way, working through a mental simulator using a short video like this can be a useful exercise. There are a few resources out there. There's the FIA Institute's Medicine in Motorsport textbook, which has had mixed reception but is a reasonable first effort for something that was needed. And there's rumours of a second edition being written.

Secondly, the FIA have made moves to introduce basic and advanced medical responder courses. These are being written and designed right now, so expect to hear more about this soon.

One of the things that has come out of the FIA's first edition of AUTO + Medical newsletter is how much work is going at various local levels with regard to training and improving the provision of medical and rescue intervention at motorsport events. Germany, Mexico, Bahrain and the UK are all working away, as well as here in Australia. Hopefully there will be more of this with greater chances for collaboration between the various ASNs. There may even be greater co-operation between other agencies that cover the various forms of motorsport, from karting to speedway to off-road.

Anyway, that's enough from me for now. As always, comments on any of the material above are welcome below.