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The value of preparation and pushing for safety

December 2, 2020

There is no doubt that Romain Grosjean’s crash at this weekend’s Bahrain F1 GP was anything other than terrifying. That he was able to effectively walk away with no more than burns to his hands and ankles is amazing when you watch the footage of what happened.


His survival is down to two things - the evolution of safety equipment, in particular the Halo device, and the presence of a dedicated medical and rescue response (and the use of the word dedicated is deliberate and two-fold).

As Sir Jackie Stewart said in his message on Instagram “it would have been a very different story only a few years ago.”

Romain’s survival starts with changes in approach to safety that go back to Sir Jackie Stewart’s advocacy for drivers to wear full face helmets and race harnesses, for track design to be more deliberate with regards to safety and for a medical professional to be present at races. 


Through the years, tragic incidents have prompted an ongoing evolution of safety developments that have encompassed the cars, the competitors, the tracks and the people who support the events. It is work that often goes unrecognised until challenged by either criticism or near tragedy. The FIA along with other motorsport groups deserves credit for their work on many of the most impactful of these.

  • The introduction of the race harness
  • The addition of a fifth and sixth point of attachment to the race harness (crotch straps) to mitigate submarining injuries in front-on collisions
  • The evolution of helmet design which is still ongoing
  • The evolution of fire retardant race wear, also ongoing 
  • The introduction of the FHR (HANS, Hybrid, etc) to limit excess flexion-extension forces on the neck and resultant fatal injuries

  • The ongoing evolution of the race car’s safety cell
  • Bringing the seating position rearward so that the driver’s feet are behind the front wheel axle
  • The development of deformable crash structures to aid deceleration and the dispersal of forces around the driver
  • Quick release steering wheel for driver access
  • Yes, the Halo device. It may be aesthetically displeasing but after several notable crash incidents, it would appear to have validated itself several times over. It may have escaped attention due to the ferocity of Grosjean’s crash but on the opening lap after the red flag period of the Bahrain GP Lance Stroll’s car was flipped upside down and again the Halo probably prevented serious injury.

  • Race track design. While there may be justifiable criticism of dull race tracks, the pursuit of excitement should not result in being lax about hazard prevention.
  • The SAFER barrier. There are still some design flaws to work through but the inherent danger of unprotected Armco barrier, particularly in a head on collision by an open cockpit race car, was highlighted and underlined several times by Grosjean’s crash. Had the Halo not been part of the package the media headlines would likely be very much more somber.

  • The presence of a dedicated medical and rescue team to respond to on track incidents. This includes the medical chase car crewed by people like Dr Ian Roberts and Alan van der Merwe.

Not infrequently there is a push to reduce the attendance and input of medical and rescue professionals at motorsport events. It sometimes takes an incident like this to recognise their worth. And evident in the response of Ian and Alan is that there is more than just knowledge and skill, there is a deep dedication to the role. Listen to the their post race interview. They don’t simply respond to incidents, they proactively plan for them. 

At the start of race day they run through a checklist that includes the race details, expected problems, the weather forecast, the state of the chase vehicle, the presence and readiness of their equipment, how they will communicate with each other, race control and the local doctor sitting in the rear passenger seat. Then they run through potential chase lap scenarios and how they will respond. I know this because I have been the local doctor in the rear passenger seat. This is quality performance and facilitates effective decision making in high stakes environments.

No single thing saved Romain Grosjean. Every part of the chain of systems that aligned to result in him climbing out of his burning wreck and later waving to the camera with no more than burns dressings on his hands and feet deserves recognition and praise. That is why it is important to watch these videos, as hard as they can be to watch. We can learn from this and carry on evolving safety in motorsport.


Pre-hospital TXA for trauma - The STAAMP Trial

October 13, 2020

Tranexamic acid (TXA) is an antifibrinolytic medication that displaces plasminogen from the fibrin complex which should result in a more persistent clot. Given that the majority of trauma deaths are due to haemorrhage, this would seem to be a reasonable therapeutic target.

TXA has established use in the management of epistaxis and postpartum haemorrhage (1) . The CRASH-2 (2) and MATTERS (6) trials demonstrated mortality benefit in trauma patients at risk of bleeding by adding TXA to the ...

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Motorsport and the virus

April 17, 2020
Outcomes in motorsport are often determined by little things. A fifty cent bonnet pin. The nut that keeps a wheel in place. An nth of a second in pit lane or through a corner complex. These small things determine championships.

A very small thing has brought our sport almost to a complete halt. The SARS-Cov-2 Coronavirus. So small it can only be indirectly seen using an electron microscope.

In addition to the usual months of planning, strategies for managing the coronavirus at the opening F1 ra...

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Ankle injuries - A good review on the Emergency Medicine Case site

July 4, 2018

The ankle joint was one of the last things I studied in anatomy waaaay back in university; probably in First or Second Med. It seemed to be a victim of priority and as a result was never studied that well. Yet we see 'sprained' ankles all the time in the ED and there is a goodly proportion of them that end up in the circuit medical centre. 

Often it's an official who has rolled their ankle while accessing or leaving their track position. Sometimes someone has gone over in the paddock. It might...

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Back yourself - A cautionary tale

July 4, 2018

OK, I promised that I would lay off concussion for a while but on the same day that I published the first part of the concussion podcast with Prof David Hughes, I received an email from a friend in the U.S.

Gregg Summerville is a New Jersey emergency physician who also works with Corvette Racing, travelling with them to places like LeMans and Watkins Glen. As a result, he gets to know the drivers and administrative staff quite well. He sent me a piece that he wrote based on a clinical scenari...

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Renal tract trauma

August 10, 2017

You've picked up a competitor from the track following a collision that occurred on the exit of a high speed turn. He's now at the medical centre and has begun to complain of flank pain. He's certainly pretty tender over his right lower ribs posteriorly and on further examinations there's a little bit of blood where wee usually comes out.

Eeek! He might have blunt renal tract trauma.

Luckily, you've just been to this website and read through the material below. Having taken care of the core res...

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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 kee...

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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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