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 scenario that he was faced with and is happy for it to be published on the Rollcage Medic site.

It's a great piece because it highlights exactly many of the anxieties that we face as clinicians when dealing with a contentious diagnosis. Contentious because of the controversy over its variable manifestations and lack of outcome clarity and contentious because of the potential implications for a competitor and their team in a hotly contested championship.

So the outcome of Gregg's team interactions should give us all the confidence to back our own clinical opinions when managing similar situations.


Concussion: A single USA Sports Car Experience.
Dr Gregg Summerville.

Fifteen years ago I became the Chief Medical Officer for the American le Mans Series. A lot of lessons learned in those fifteen years about motorsports concussions can be summarized in this one event. In retrospect, I knew very little when I started. Today, I am amazed at how little we are taught about concussion as Emergency Medicine Physicians. My experience has been gained largely on the job: trackside, in the paddock and in the infield care centers, and in doing follow-up phone calls with concussed or potentially concussed drivers. But one experience taught me a lot about how to deal with concussions.

My first driver concussion experience was a big one. It was three days before the big season finale ten hour endurance race called Petit le Mans. The Audi works prototype had crashed hard in a practice session. It was a test day, so no series safety team people were on the track. The driver, Emanuelle Pirro, had self extricated and was reported to be fine with no complaints. Nothing to be concerned about, right? Forty eight hours later, one of his teammates reported that Pirro was not himself. He was displaying some odd behavior; irritable, unable to sleep and withdrawn. I sent for him. His neuro exam was normal. He had no major complaints. He said he just needed some rest. We had a conversation and decided to re-evaluate in the morning.

I called Dr Steve Olvey after some mental debate about what I should do. Steve continues to be our motorsports concussion guru. “Oh, he is concussed!” was what Steve said.

I knew the decision that I had to make.

I was so nervous about it. What if he was better in the morning? Was I sure he had a concussion? How was I going to tell the team manager? What would everyone think? I remember going to a night-before-the-race party and shuffling around with this tremendous weight on my shoulders. I was expected to do the right thing: by the series, by the other drivers, and by myself. I could not allow this person to race. But I had never pulled a driver before. I was nervous. This was a multi-million dollar enterprise. The team had come to the U.S. at great expense, to race their famous cars. This driver had won Le Mans. I was in tall cotton now!

Morning came, I spoke to Pirro and he was still having marked fatigue and inability to sleep. So I meet with the series director who helped me make what should have been a slam dunk decision. He then took me to the team director. I was like a child needing to be led by the hand to the principal’s office. I delivered my decision to this stern looking German, Dr Ullrich. What was he going to say to me?

His response was that he understood. Another of his Audi drivers, Tom Kristensen, had a concussion the previous year and he was familiar with the problem. He told me it was the right decision. He just asked why I had not come to the decision the night before when it was obvious that Pirro had a concussion? He now had to find another driver. What should I say?

He was right. I delayed making the decision because I lacked the conviction to follow what was an obvious diagnosis of concussion. Fortunately, a driver who had done testing in the Audi was on another team racing that weekend. He was pulled from that car to drive the Audi. And Pirro, this quiet respectful man and the only driver who would stand when the series chaplain prayed at the drivers meetings, watched from the pit lane and went home to recover.

What are the points to take home and learn from my mistakes?

1. Know how a concussion manifests itself. I like to say that 80% of concussions are easy to determine. No-brainers. Talk to the drivers and it will become obvious. We can deal with the other 20% later.

2. Have the conviction to stand by your decision. Don’t let the driver or team talk you into waiting, or re-examining later. A concussion sits out the rest of the weekend.

3. Have a mechanism to test for those 20% that are questionable. Whether it is King-Devic, ImPACT, or even one of the SCATs, have something to back you up in case the diagnosis is not clear. A normal neuro exam does not clear a concussion.

4. Use the resources that you have available to help your decision. Talk with team and especially family members. Partners and spouses are great at telling the truth about their partner’s status after a crash!

5. Have a plan for follow up. We are finding that some concussions do not manifest for days after a crash. Plan follow-up phone calls for drivers that have had a hard crash. And for those who have had a concussion, define strict return to racing protocols so everyone can be sure of full recovery before resuming racing.

Concussion resources

Rollcage Medic on concussion