Posted by Matthew Mac Partlin on Thursday, April 26, 2012

I caught up with the IRC Series recently and watched the Circuit of Ireland event on wrcforeva's YouTube channel. If you watch "IRC 2012 Circuit of Ireland - Day 2 Highlights" at about 17:54 on the timeline, Andreas Mikkelsen has a high speed side impact with a haybale barrier on the short Lisburn stage.


The commentator states that Mikkelsen lost 40 seconds on the stage and complained of "dizziness". It is suggested that he sustained a (mild form of) concussion. There were 2 more stages to go to complete the event and Mikkelsen had been within 3 seconds of 1st place before the collision and remained over a minute in front of 3rd placed Jan Kopecsky.

If you were the Cheif Medical Officer, would you have allowed him to complete the remaining 2 stages, knowing the pressure that would have been on Mikkelsen to score points?

The issue is one of fitness to return to competitive sport following a probable concussive injury and the implications that this has. CAMS released a brief statement on this topic in their March edition of Speed Read and it has been explored on this site too (Rollcage Medic newsletter, Luke Bennett's discussion paper). It's an area that is currently unclear as to solid recommendations, which the CAMS NMAC is seeking to address.

So should Mikkelsen have been allowed to compete in the final 2 stages? Post your comments below

Comments


 Davy
• a year ago

Only just found this site - as far as i know he stated afterwards he couldn't remember the last stages and was kept in hospital overnight with burst eardrum and 'concussion'
COI
Provided medical cover on this rally for the stage before this!


 ASMMR Mod Davy
• a year ago

Hi Davy,

Thanks for that. Presumably the stages that Mikkelson could not remember were the ones subsequent to the collision, therefore representing anterograde amnesia. Having just completed a review of concussion and return to sports, it appears that the duration of anterograde amnesia  is the component that most closely correlates with duration and severity of concussion.

Had this collision occurred on Day 1 of competition or during a recce stage, the presence of features of concussion should arguably have resulted in his exclusion from the remainder of the event. However, this would require a medical assessment which in turn requires that concussion be suspected by any of the event officials or Mikkelson's team so that he be referred for a medical assessment.

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 Leukocyte
• 2 years ago

This alternative view from a spectator camera demonstrates that the driver appeared to be moving and probably interacting with the marshalls at all times, and was underway within about 25 seconds, loss of consciousness at least seems very unlikely.



The dizziness (presumably reported post-event) is a concern, but as Boorik states, there was no realistic opportunity for the medical staff to be made aware of, let alone act upon, any concussive symptoms...UNLESS the driver made any officials aware of these symptoms between subsequent stages.

Had the opportunity for examination been available, it may well have been appropriate to exclude the driver on medical grounds from the final two stages.

 Rollcagemedic
• 2 years ago

Thanks for the YouTube link Leukocyte. Mikkelsen certainly seems to be moving about in the car, though as Rik says, concussion can be a subtle thing. It would have been difficult to stop him at the scene (He almost runs the medic over trying to extricate his car from the bales).

As you both state, if the medical team or CMO were not made aware of his complaint of dizziness during competition, they have no way of knowing, other than by sending someone down to the team garage on the basis the apparent mechanism on the report of the on-scene medic or video footage. But that might be a bit of a big call. Given that he did drive off unaided, there is no requirement for him to be assessed.

It's not clear from the commentary whether Mikkelsen's compplaint of dizziness was made during or after the event.

Hindsight is a wonderful thing.

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 Boorik
• 2 years ago

A difficult one! Was he in a position to be examined or did he just continue and was the CMO aware of what had happened. The conflicting demands of the team against the health of the individual who might have a somewhat nebulous and not easily determined injury (unlike for instance a broken arm). Under current CAMS guidelines if the car continues it does not automatically trigger a medical examination of the driver/codriver. RIK