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 scene within seconds. Rallies and off-road events are a bit different due to the much larger geographic footprint of the event. Even with real-time GPS tracking of individual vehicles providing early warning of an incident, it can take much longer for a medical crew to get to the accident scene. That time delay can be critical.

On a rally or off-road event, the vehicle that is most likely to get to the crash scene the quickest is not a rapid response rescue or medical vehicle; it is the next competitor.

A rally runs on a series of closed sections of road (tarmac, gravel, snow), called special stages, in one direction from a start point to a stop point. The crew that takes the least time to complete all of the stages wins. Competitors start each special stage in series with a two to three minute gap between vehicles. For a targa rally, the gap may be only 30 seconds.

Off-road races are similar, but are often run over much greater distances and may not necessarily stick to one particular track. Think of events such as the Finke Desert Race or the Dakar.

There are regulations that mandate the actions of the first three competitive crews that arrive at a crash scene. If the crew of the crashed car have put out their “OK” sign, the subsequent cars can keep going. If they have put out the “SOS” sign or there is no visible sign next to the damaged vehicle, the first three cars to arrive must stop.

The crew of the first car on scene are required to park in a fend off position, place the two red warning triangles back up the road to warn subsequent cars of the incident, make an assessment of anyone who is injured and attempt to get in contact with race control (rally base) to get assistance. The crew of the second car are required to stop, get details on what has happened and then drive to the next SOS point on the special stage where there is a stage official with radio communication to race control. The crew of the third car are also required to stop and get details on what has happened and then drive to the finish of the special stage where again there is a stage official with radio communication to race control. All subsequent cars are either stopped on stage back from the scene without blocking access by emergency vehicles or are driven at non-race speed to the end of the special stage.

And that's where the instructions end.

Now imagine that you are a rally competitor with no medical training and you are the first car to arrive at the scene of what appears to be a serious accident. You have stopped, placed your triangles, your co-driver is on his mobile phone trying to get in touch with your team to get a message to rally base and a competitor who you know is unconscious in the car in front of you. It might take ten minutes for the medical response vehicle to get to you. It could be a long and frightening ten minutes. It could be ten minutes where doing some simple things might buy time and change to the outcome for the better.

So last weekend at the ARC National Capital Rally of Canberra there was an extra session put on before the rally crews hit the gravel at speed. We piloted a First On Scene Responder Training for Motorsport Competitors. Five rally crew pairs (driver and co-driver) got the chance to spend about an hour practicing a set of skills that might help them to save a life.

Here's what we did.

The session was kept deliberately short in order not to eat into time that they needed for other aspects of race preparation. It was hosted at a competition event so that they did not have to make any special journey to get to it. In fact, it was held in a field right after a media session, so they literally did not have to go anywhere in particular and they were already suited up in race suits with their helmets and FHRs (Frontal Head Restraint devices) with a competition-ready rally car. It also made sense to conduct the session in an environment that mirrored the one they could actually be faced with (In-situ simulation has been all the rage for the past 3 years in critical care training. For more information and resources on this see the references at the end of this post.)

There was a brief introduction for the participating competitors to put what they were about to do into context, but there were no long lectures and no PowerPoint presentations. Within the first five minutes or so they boys and girls were getting their hands on eachother and practicing skills that had a short learning curve, had practical value and did not require them to carry any extra equipment beyond what they already have in their cars. They practiced:

  • Opening the airway of an unconscious person

  • Straightening and supporting a potentially injured cervical spine

  • Controlling major bleeding, including a partial or complete amputation

  • Rapid extrication

  • CPR

  • Basic burns management

  • Pressure immobilisation for snake bite envenomation (This is Australia, where even going for a pee in the bushes can be a life threatening event)

Everyone got a chance to practice and they did it suited up in full race gear. Two of the co-drivers (Thanks Erin and Kirra) got into the rally car and had their airways opened, necks supported and got hauled out of the seat using a modified Rautek manoeuvre. There was a resuscitation mannequin with an open wound and a traumatic amputation that spurted 'blood' until a makeshift tourniquet was applied. The point of all of this was to provide some practical experience so that should they be faced with the real thing, they had each already got the feel for what to do and therefore would be less likely to be overwhelmed or panic.

That said, it was impressed upon all of the participants that this training doesn't make them bullet proof. This is confronting stuff if you really have to do it and there is still a fair chance that a seriously injured person may not survive despite trying to help. So we spent a minute or two discussing the potential psychological impacts of being involved in such a situation and some of the beneficial coping strategies (For more on this kind of stuff, listen to the presentations and interviews with Ashley Liebig – Links below).

An ARC media crew were present at the training and recorded the whole session. I will link to it once it has been released, so keep an eye out for the notice on Twitter (@rollcagemedic), and FaceBook (Rollcage Medic).

So, will any of this be of any use? Hopefully no one will have to find out, but encouragingly there were a few signs that the training went well. Everyone seemed pretty engaged and there were good questions being asked throughout the training. No one complained about having to be there or drifted off to update their Instagram profile. I'm waiting to gather up the responses to the training survey that was sent out to all of the participants and hopefully the responses will help to tailor future versions of this course, but some of the early responses have indicated that the training was thought to be useful and that there was a sense of confidence about using the skills if faced with the real situation.

One of the developments for future versions of this training will be to use a flipped classroom model by releasing a series of short videos on the skills being taught that should be watched a week or so before coming to the training session. This allows the participants to get an idea of what they are going to do and get the theory covered and should let us get stuck straight into the practical stuff on the day.

Additionally, it is likely that some of the content would need to be tailored for off-road events where, for instance, the modified Rautek extrication manouevre may not work as well for some of the vehicles with high ground clearance.

The impetus to provide this kind of training has been building over the past two years or so and it begs the question why we haven't being doing it long before now. WRC competitors have been getting a lecture from the FIA Permanent Medical Delegate for Rally (Dr Jean Duby) at the start of every season for some time now (FIA AUTO+Medical Issue 7). However, the top end of the sport is arguably fairly well catered for in terms of the provision of rapid medical intervention. The local clubs and lower order competitions just don't have that kind of budget or support and so these are the competitors who might benefit the most from this kind of training. There is already a proposal to link this training to licensing requirements.

This was a pilot session in Canberra. The next time it runs will probably be at the Rally Australia WRC event in Coff's Harbour later this year. Hopefully we will get to run it at an off-road event soon as well.

As always, your opinions and comments are welcome.

Update 30/08/2016

ARC.com Media sent the link to the final edit version of the footage that they shot that day today. Here it is:


The video lives on the ARC YOUTube Channel here: https://youtu.be/hKwjlT1P0BI


References and Resources

Dealing with the aftermath of a high stress incident
In situ simulation training
Flipped classroom model of teaching
Modified Rautek manoeuvre