Posted by Matthew Mac Partlin on Tuesday, March 13, 2012

An international open-wheel circuit event is 15 laps into a 56 lap race when a sector marshall calls in a racing incident:

"Car 11 heavily into the tyre wall driver's left at Turn 7."

The circuit's camera system brings the following image up on screen ...



Question 1: As the event Chief Medical Officer, what immediate actions would you direct?

Question 2: As the attending medical team leader on the scene, what injuries would you suspect and what are your management priorities?
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The suggested answers are further down the page. You can go ahead and look, or, have a think about them first...

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The management of a scenario like this is going to depend a little on the resources available to you, but as it is an international event we'll assume that there is a decent level of coverage with an appropriately staffed medical centre, several strategically located medical intervention vehicles (MIVs, callsign = Victa) and track medical pairings (on foot, callsign = Track medical)), along with fire rescue (callsign = Foxtrot) and towing (callsign = Tango) vehicles.

As the event Chief Medical Officer (CMO), the first thing you'll need is information. Your top concerns will be scene safety for your team and the resources that will need to be mobilised to optimally manage the potentially injured driver.

You'll get a lot of information from the circuit cameras, which can give you ideas on location, the number of vehicles involved, the position of the vehicle involved (overturned?), the apparent degree of damage to the vehicle and crash protection barriers, possibly the condition of the driver (moving / not moving) and surrounding hazards.

The next source of information will be the other calls coming in to race control from other trackside officials, such as sector marshalls and fire & rescue to their relevant communicators. So keep an ear on these.

Finally, you'll need information back from your own team - the track medical team or MIV team. Particularly you'll want an early code designation from the on-site team, as this will affect resource mobilisation and the state of the race (yellow flags, safety car, red flag).

So, knowing all of this, let's tackle the first question ...

Question 1: As the event Chief Medical Officer, what immediate actions would you direct?

Key features:

• Reported heavy impact + apparent broken front left axle => potential for significant blunt and deceleration trauma

• Vehicle is located on the outside of a sharp bend + heavy impact (suggesting a reasonable amount of speed) => Dangerous location for both the driver and attending officials, as well as the potential for other vehicles to go off at this turn and become involved in the scene

• Apparent cloud of smoke over the vehicle's engine => potential for fire -> Driver injury + scene hazard

• The driver is still in the car => Is he stunned? Is he trapped? Is an injury preventing escape? Is he unconscious?

So first line actions to direct would include:

• Ensure / Request at least a safety car is deployed to control the rest of the field. (A red flag is unlikely unless there was track obstruction due to the incident or subsequent medical and rescue resources)

• Put the nearest race direction MIV on stand-by and prepared to scramble in cooperation with the Race Director as soon as is practical. (There'll be more than just your team's activities going on and there's little to gain from the MIV shooting out into the path of an oncoming race car.)

• If there is a track medical team nearby, scramble them to the scene, though they should remain behind the crash barrier until cleared to approach the car. In this scenario, given the car's postion, they should be able to get a good view of scene hazards and the condition of the driver from behind the barrier.

• Ensure fire and rescue have also been scrambled, particularly given the possibility of fire.

• Put the nearest race direction ambulance (callsign = Alpha) up on standby.

• There may be a category specific medical car scrambled, such as the FIA Medical car in Formula 1 races or the V8 delegate care in Australian V8 Supercar events. They often self-activate in cooperation with the Race Director, but you'll need to be aware of what they are doing. They are a useful resource.

• Put the remaining MIVs on stand-by (They may be needed as back up or to provide cover for the missing MIV for a race restart once the scene has been cleared)

• Put the medical centre on stand-by

As further information starts to feed back from the scene, start thinking about disposition and resetting. Depending on the injuries sustained and the distance to the nominated trauma hospital, the driver will at least need to be assessed at the circuit medical centre, but if seriously injured, primary transfer from the scene directly to the trauma hospital may be more appropriate. As the race gets ready to restart, any MIVs or ambulances missing in the process of providing care to the driver will need to be covered. Many events cannot be restarted until all rescue vehicles are back in position and this might need some circulation of vehicles to shorten the time taken to reset.

Question 2: As the attending medical team leader on the scene, what injuries would you suspect and what are your management priorities?

Some of this is a repeat of the CMO thought processes outlined above.

Suspected injuries:

• Any blunt head, chest, abdominal or pelvic injury

• Possible vertebral column injury, with particular focus on the cervical spine

• Rapid deceleration injuries - e.g. thoracic aortic dissection, mesenteric vessel injury, splenic pedicle injury, duodenal injury, cerebral contre-coup injury

• Limb injury - long bone fractures (potentially compound), joint fracture-dislocations, amputations (less likely here as the driver cockpit appears to be intact)

• Burn injuries

• Depending on the circumstances of the incident location, be alert for injured officials and spectators.

Management priorities

• Ensure scene safety - Has the MIV driver parked the vehicle to protect the scene? Are there fire officials on scene and what action has been taken? Ideally a quick nod from a fire official is a good thing to seek before launching into a potentially dangerous environment.

• Rapid driver assessment for condition and code - Is a rapid extrication needed due to scene hazard (e.g. a spreading fire) or a life-threatening injury (unconscious driver, impaired airway)? What equipment are you going to need (resus pack, O2, c-spine collar, trauma pack)? Are back up resources required (largely determined by the code designation and the need for a planned extrication, but circumstances may dictate more are needed, e.g. associated spectator injury)?

• The aim is to stabilise the driver enough to enable a safe transfer of the injured driver to either the medical centre or designated trauma hospital while not spending excessive time on-scene. This largely means airway and c-spine protection, control of major external haemorrage and, if needed, intravenous (or intraosseus) access for volume replacement followed by appropriate disposition. Making that call is often the difference between clinicians whose usual practice is primarily hospital based (with lots of on-site resources) and pre-hospital specialists such as paramedics and retrievalists.

So, hopefully this scenario has been useful to think about. I'll put out more of them as I build up more cases. I'll try to include off-raod scenarios as well as circuit events and play with available resources a bit. If I've missed anything that you think is important or have some practice tips to offer, please send them in to me at The.ASMMR@gmail.com or post them in the Comments section below. Also, if you have a particular scenario to puzzle over, send it in and I'll post it up so others can offer their opinions.

Take care