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Bikes, motorsport and life

May 1, 2017

I like to think that I am not totally unfit. I attribute much of that to spending most of my younger years cycling everywhere and swimming a lot. I think it gave me a good base to work from.

I'm getting older and bits of me creak now. What is more noticeable is the longer recovery time. I've become more aware of my physical limitations and how they can impact on how I choose to spend my life. I figure that if I am going to be able to continue doing the things that I enjoy and particularly keep chugging away in motorsport medicine, I should at least try and maintain the fitness required to perform well. It also helps that I have few friends that I work with who have bought into the lycra look and post their performance-bragging on various social media and app formats.

Athletes constantly strive to go one better than the last time. Go a bit faster. Finish a place higher. And it's easy to watch a video blog of Nico Rosberg training or Mark Webber promoting his endurance event, The Mark Webber Challenge, and think “Yeah, those guys get paid to do all of that training. It's part of their job. I don't have that kind of time.” But that's missing the point.

I'm a mountain biker. I've been at it since my teens and I still love it. I started with a friend just as it was emerging as an entity in its own right. John rode a Rudy Project and my first few rides were on a Raleigh road bike (drop handle bars, slick skinny tyres, not terribly well suited to off-road trails) and we'd head up into the Dublin mountains and ride forest trails and single tracks, keeping an eye out for rangers as the trails were sanctified hiker territory in those days.

I moved up to a fully rigid GT Tequesta for the next few years until I finally made the splash to a front suspension Avanti Barracuda. I now ride a dual suspension, Stevens Carbon ES cross country bike, which I really enjoy.

However, I figured that as my recovery from particularly punishing rides gets longer, some stamina training might be useful and so I started looking back to road riding and I've ended up getting a fully rigid cyclocross bike - so almost full circle to where I started with my Raleigh. And while out riding yesterday, I made a few connections across various bits of life. Cycling is a bit like that.

Riding the dual suspension cross country bike is very forgiving. I still have to lean into corners, grind up ascents and bounce over rocks and fallen trees, but the bike soaks up a lot of the punishment and is probably capable of a lot more than I am. The cyclocross bike has been (and continues to be) a new learning curve. The different riding geometry, hand positions, lack of suspension and potential for toe-overlap with the larger diameter wheels (I still ride old school 26 inch wheels on my mountain bikes) has meant paying much more attention to the track I am heading down. I find I have to pick my lines more carefully and earlier. I have to be more conscious of my riding technique and keep my grip and joints looser. I feel a lot more vulnerable. But it is also quite satisfying.

It's a bit like learning a new skill or changing where you work or your career path. Having gotten to a stage of being able to float along the track without thinking too hard about it, almost lazily, you now need to sit up and work at it again. Which is a good thing.

At work, it would be relatively easy to fall into a pattern, scrape the minimum CPD points together each year, stay out of trouble and glide through to retirement. But that is self-serving and probably means I would not be giving the best care available to the patients in my care. Which is why I got involved in the FOAMed movement (To save a tangent, if you don't recognise this term, go here: FOAM - Life In The Fast Lane) as a way of keeping up with critical care evolution and tapping in to ways of learning new concepts and skills. It's also part of the driving ethos behind the Rollcage Medic site.

Motorsport medicine and rescue is no different. Again, it is easy to fall into a pattern of simply doing what was done before. Yet we should be firmly aware from our day jobs that this is limited thinking. The athletes don't stand still on tradition. Neither do the engineers. And at the elite end of the sport, the support they all get is evolving too. A friend of mine, Dr Luke Bennett, who works with the Hintsa Performance group, providing health and performance support to Formula 1 drivers and crews talks about the advances in how that care is developed and delivered.

Motorsport medicine and rescue is no different. Awareness and practice around concussion is evolving. Point of care ultrasound for diagnosis and therapeutic management has come on in leaps and bounds. Developments in race car power formats and safety structures continue and can often present a significant barrier to the medical response team arriving on scene. Dipping in to other industries to find useful practices to apply to our own is more commonplace. And these are just a few examples.

There are plenty of resources to fuel learning in our day jobs, a lot of which is transferable to motorsport, whether it is a clinical skill or a rescue practice. There are a lot less motorsport specific resources however. Local motorsport rescue groups and regulatory bodies (ASNs) have variable quality material with variable levels of accessibility. Peak bodies such as the FIA and the ICMS are realizing the value of making material available and improving their websites, printed publications and conferences. We still don't have a strong inclination to publish what we do and though there are some good projects out there, they will be of little value if no one is able to read or listen to the details in order to decide whether to adopt them into their practice. Following on from that, we also need to be better at applying the same critical appraisal that we do at work to what we do trackside. 

We need more collaboration. We need to cross train. We need to set up projects, training workshops and conferences even if they are relatively low key, to facilitate evolution and constructive networking.

So, if you have been free-wheeling along for a bit, maybe it's time to get off your dual suspension cross country bike and ride something else for a bit, even if it is still on the same trails. Get out of your comfort zone. You will feel a little vulnerable. It might even hurt a bit. But it may also lead to a new sense of satisfaction and reinvigorate why you do what you do. And while you don't need to necessarily aim for an elite level, it may help you to get a bit better at what you already do.

Here are some resources to get going with, but feel free to contribute your own list or start your own resource and I will add it on below. Caveat emptor applies to all of the sites listed here:

  • FIA AUTO+Medical - A mixture of interest,opinion and research. (CoI – I'm on the editorial board)
  • FIA website - You will find regulations for FIA sanctioned events on licencing standards (Appendix L), medical services at FIA events (Appendix H) and anti-doping (Appendix A) down at the bottom of this page.
  • The Global Institute for Motorsport Safety - The FIA Institute was closed down at the end of 2016 and reconfigured as the Global Institute. As a new entity, there is only a small amount of material currently on the site.
  • ICMS website - Their annual ICMS congress in early December is open to anyone practicing medicine or rescue at motorsport events. Their website is currently undergoing some development to bring it up to date, though most of the content is behind a membership log in (US$100-300 depending upon your category).
  • CAMS website - Recently launched their Medical page to collate all the relevant topics to one area. In addition to the medical licence standards, medical services at motorsport events and various forms, it is also planned to publish topics of interest on a regular basis. (CoI - I am on the CAMS National Medical Advisory Committee)
  • MSA UK website - The annual yearbook ("Blue" book) contains the regulations for emergency and medical services. The have a policies and guidelines section. Their blog is empty.
  • The Motorsport Safety Foundation - There is a Research and Education page but I don't know much about the people behind this site
  • Rollcage Medic – Well, you are already here, so that's not hard
  • Emergency Services Rally School - A course based in New Hampshire (USA) for rally, rallycross and hillclimb intervention responders.
Motorsport research does turn up occasionally in mainstream peer-reviewed journals, but you've got to be looking for it or hear about it to catch it.

Declaration: I receive no financial or career incentives from any agency, organisation or product mentioned in this post.

ICMS AGM 2016 - Intro and Day 1

February 24, 2017

This conference was great. It was what a motorsport conference covering safety, medical and rescue issues should be. No topic was off limits, no presenter was protected from being challenged (and most audience challenges stuck to the rules of engagement), invited speakers were from a broad range of backgrounds (gender, profession, motorsport category and geography) and most appealing of all, there was a general air of desire to promote and progress improved understanding and practice.

(I don't...

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A tonic for the C-spine collar haterade

February 24, 2017

I've been drinking from that fountain. Semi rigid c-spine collars have been receiving a drubbing in recent times (Search the c-spine collar tag over to the right of this page). And with good reason, I thought; though I will admit to not being quite ready to throw them away completely as I have been a long time practicioner of avoiding the "always/never" ultimatum.

Then trauma master, Karim Brohi, Professor of Trauma Sciences at Barts and the London School of Medicine, and Consultant in Trauma...

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FIA Institute CMO Seminar - Day 2

January 6, 2017

The Christmas and New Year holidays are over and having spent some enjoyable time with the family poncing about, it's time to get back to work. Here is my summary of Day 2 of the FIA Institute Medicine in Motorsport CMO seminar held as part of the FIA AGA in Vienna at the beginning of December.

The first half of the day was composed of an opening speech by Jean Todt (which I missed) and four workshops. After lunch there were five free papers presented followed by the closing speech. After a so...

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FIA Institute CMO Seminar 2016 - Day 1

December 14, 2016

Two weeks ago I was sitting in an apartment in the middle of the Vienna Naschmarkt, having flown in at 6am that morning from Australia to attend the biennial FIA Institute Medicine in Motorsport Chief Medical Officer's seminar. Traditionally, while there are a handful of exceptions, this is a fairly passive affair consisting of a series of talks and a couple of fairly didactic workshops (SMACC it is not).

Two years ago a small bonfire was lit when Dr Sean Petherbridge (CMO for the Abu Dhabi F...

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The crushing weight of evidence

September 21, 2016
It's interesting how things sometimes seem to come together at the same time for different reasons. I've been thinking about extrication recently in the setting of a competitor trapped by compression. That got me thinking about a talk given by Sydney HEMS doctor, Cliff Reid, titled "The wrong stuff" during which he went through some pre-hospital dogma bug-bears (bug-dogs?), including the management of crush injury/syndrome. At the same time of my pondering a tweet went out for a doctor in Ita...

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Flight after a pneumothorax

August 10, 2016

There have been a number of incidents at motorsport events that have resulted in a blunt chest injury mechanism with the competitor presenting to the event medical centre for assessment and while no major injuries were found they have subsequently been diagnosed with a pneumothorax. Usually it has been a small one, associated with one or more fractured ribs, diagnosed on a CT. Some of the more high profile incidents include:

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How to do simulation training well

August 9, 2016
The previous blog post covered a recent session that I ran for some Australian Rally Championship competitors which covered First On Scene Response training. The aim of the session was to give the competitors some basic skills so that should they be the first to arrive at a rally accident where someone has been seriously injured they have a framework to get help and provide some potentially life or limb saving assistance, buying time for the medical team. The session was deliberately practica...

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An untapped rescue resource for rally and off-road events

June 2, 2016
Last week I finished up a clinical week in the ICU and went home. Just like this time last year, I packed my bags after putting my kids to bed and early on Friday morning, before they woke up, I got into my car and drove three hours to Canberra for the National Capital Rally. This time, however, I had a few extra bags and boxes.

There is a requirement for motorsports, like many other events, to have medical cover in case of illness or injury. At circuit races a medical crew can be at a crash...

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Protecting yer noggin'

April 1, 2016

There is a lot made of safety at motorsport events. Competitors sign a waiver acknowledging that motorsport is dangerous and the same statement is printed on every ticket sold. Crashes such as Fernando Alonso's in Melbourne a few weeks ago, Robert Kubica's hand injuring rally crash in 2011 or Simone De Silvestra's 2010 IndyCar inferno amongst many others serve to reinforce that message.

It is not surprising then that safety is emphasized for those officials working at a motorsport event, whet...

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