Posted by Matthew Mac Partlin on Wednesday, August 29, 2012

OK, so it's been a while since I put up the very first Hot Lap case, but hey, I do this stuff in my spare time so as much as I'd like to, I can't guarantee I'll get one out every week. Anyway, on to the next scenario and thanks to Andy Neill for sending me the link to the video.

You are the Chief Medical Officer for the 2012 Pike's Peak International Hillclimb and you are kicking back at race control enjoying some of the action (I've never been to the Pike's Peak Hillclimb race control so I've no idea whether this is even possible, but allow me a bit of creative latitude), when you see this on one of the monitors:



A second live feed shows a bit more:



Oh dear!

Question 1

What are the dangers in managing this incident?

Question 2

What injuries would you suspect?

Question 3

How would you manage this incident?

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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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Answer 1

Scene

• Spectators on the circuit approach

• Other competitive vehicles on the circuit

• The target vehicle is off circuit some number of metres down a loose, rocky slope. Getting to it safely while carrying rescue and medical equipment is likely to be hazardous

• It looks like a hot day out there, which may be important if you or your team have to spend more than a few minutes working on site

Vehicle

• Risk of fire

• Risk of vehicle slipping further downhill and injuring rescue team in the process

Casualties

• Getting the injured competitors back to the medical centre is likely to be difficult, especially if non-ambulant. there is risk of further injury to them and to rescuers

Answer 2

Well, all of them probably! To state the obvious, this is a BIG off. As the second video clip shows, the various safety devices (rollcage, race harness, race seat, helmet, deformable structures, etc) did their job and the driver walks away apparently unhurt. But I'd be going to this expecting every type of blunt injury from head to toe. There may also be penetrating injuries if parts of the vehicle fracture near the competitor or invade the cockpit.

At one point in both videos, the co-driver's helmet appears to move outside the confines of the rollcage, which is always a worry.

Bring everything to the scene for a kit-dump and be ready for anything!


Answer 3

Dispatch

• Scramble a medical response vehicle (first intervention medical and rescue equipment and personel) and bring a second up on stand-by

• Put an alpha (ambulance) vehicle on stand-by and if neither the driver nor co-driver were seen to move on the live monitor or from reports coming back from local officials, consider scrambling the alpha and the second medical response vehicle

• Make sure that fire and rescue have been scrambled to the scene also as these guys will protect your team. Check either with the emergency communicator, the chief rescue official or directly with the race director, who should all be in the same room as you.

• Start getting scene information fed back to you as soon as possible

Scene control

• It's likely that the race will be put on hold for the duration of the rescue, but there may be other competitive vehicles on the stage

• Make sure any medical and rescue vehicles park defensively and if available, display warning signs back along the competitive route. If no warning signs are available, use any non-rescue official or spectators available to flag down other vehicles so that they don't cause further incidents.

• Establish a safe work area by using non-rescue officials or spectators to keep curious onlookers back

• Make sure that the vehicle's electrics have been de-activated (Kill switch is usually between the front windscreen and bonnet and/or in the cockpit on the centre console, where it is not always obvious)

• Check for any signs of a fire and that the fire guys are on hand and ready. If they are not available, you'll need to have your own extinguisher with you (Yep, more stuff to carry)

• If it's likely that you'll be there for a while, try and put up a tarpaulin shade - officials and spectators are good for this and the tarp should be part of your kit

Vehicle safety

• The fire and rescue team will usually stabilise the vehicle, but if they are not available, you might have to do this yourself. No point getting stuck into a trapped competitor only to have the car slide further downhill, or rollover on top of you. We'll look at chocking methods another time.

• As above, make sure that the vehicle's electrics have been de-activated (Kill switch is usually between the front windscreen and bonnet and/or in the cockpit on the centre console). It also helps to know where the fire suppression system activating button is, just in case. In some vehicles, the electrics kill-switch and fire suppression button are one and the same.

• Watch for broken plastic, glass and carbon fibre

• Watch for hot vehicle elements

Competitors

• Rapidly perform a primary survey to identify the management priorities.

• Make a rapid assessment of whether an emergency extrication is needed (immediate clinical or environmental threat to life such as a cardiac arrest or the vehicle is on fire). Otherwise, a planned extrication should happen once practical.

• Clinical management should occur along EMST/ATLS pathways with attention to airway protection, supported oxygenation, cervical spine control and haemorrage control (MARCH pathways put control of massive haemorrage up front). Do only what is required to facilitate a safe transfer to either the medical centre or to the receiving hospital.

• Removal of the helmet and head and neck restraint device will usually be required and may have to be done while the casualty is still in the vehicle if there is entrapment by confinement or compression, or if the person's injuries limit their ease of extrication.

• At the same time, an extrication plan should be formulated between the medical and rescue teams.

• There should be constant communication between the team at the scene and race control so that necessary resources can be rapidly deployed and a streamlined extrication and transfer can occur. This bit is often underestimated!

Disposition

• Depending upon the set up of the event, the default is often a transfer to the medical centre for stabilisation and further assessment and then subsequent transfer to a receiving hospital if needed. Some events have a suitable trauma hospital nearby and so may have a plan in place that all significant traumas go directly from the scene to th hospital, either by road or by air.

Luckily for the driver and co-driver of this incident, they were both unharmed and no doubt will be back racing after a stiff drink and a good back rub.

Please feel free to leave any comments or bits of experience you've had.

Have fun!