Well, I'm back in Sydney after 5 days in Doha, Qatar, attending the FIA Institute's Medicine in Motorsport Summit, which is run parallel to the FIA's Annual General Assembly. The AGA is where the year is reviewed and the technical specifications and regulations for the next year's season are finalised. It finishes off with the prize-giving ceremony for the various championship categories, including Formula One, World Rally Championship and World Endurance Championship.

Similarly, at the biannual 2 day Summit, the previous 2 years are reviewed from a medical and safety perspective and various key topics and projects are presented, along with proposals for future direction. The big and occasionally controversial topics this year included the new Formula E category, the role of the circuit extrication teams, rally safety concerns and, yet again, concussion. There was also a very interesting retrospective, 4 year study presented by the British F1GP and Silverstone WEC CMO, Dr Peter Hutchinson, an overview of the role of physicians in motorsport presented by Dr. Hugh Scully, a brief and light-on-detail outline of the forthcoming Medicine in Motorsport 2nd edition text and the FIA Serious Injury database, as well as the usual updates on anti-doping. I won't go into detail on a lot of these and I've attached two pdf files summarising notes that I took during the conference (Day 1 / Day 2). However, a couple of these topics are worth teasing out a little bit.

Formula E

This seems to be a category for which the medical service is still being developed and evolved. There were a couple of key points made in this presentation by series medical delegate, Dr. Phil Rayner.

• The possible current that may be discharged from the batteries through a person's body, assuming dry skin, is 260 - 500mA, which is well above the threshold for VF, respiratory arrest and death. The current could be higher for someone who is hot and sweaty, as the resistance to flow would presumably be much lower.
• There is a risk of arcing
• The cars are powered by large lithium ion (Li-Ion) batteries. Once they start to burn, extinguishing them is extremely challenging. If I got the explanation correct, the battery sits in an isolated tank which can be flooded with water through one of two mechanisms; either on board 50L water tanks or by connecting 250L water tanks that are kept in each pit garage. When the isolation tank is filled, pressure plates in the base of the compartment blow out so that the heated water can run out allowing fresh cold water to continue to flow in. I'm not sure what the subsequent risk is to the rescuers who are now standing in this pool of water. The water itself is apparently pure and therefore should not conduct electricity, however the impurities picked up once on the ground wasn't really addressed. What this means if it is raining is also unclear. Dry ice can apparently be used as well. Finally, fumes from the burning battery may be an issue in enclosed spaces, such as the pit garage.
  
• There is no circuit kill switch on these cars, as in other categories. Instead, a William's engineer sits in the medical delegate's car and if there is a significant shunt, he goes with the team to the stricken car to do two things. First, he carries a voltmeter which detects whether it is safe for him to touch the car. Second, he is tasked with pulling the fuses, cutting the power supply from the Li-ion battery. This requires a special tool. The fuses are located close to 3 thick and obvious red cables - DO NOT TOUCH THESE RED CABLES if you wish to remain on this plane of existence. They are high tension cables and will fry your ass!
• Similar to the ERS indicator light on F1 cars, there is a safety light near the roll hoop above the driver's head. Green means the system is safe. A red light or no light means there is a problem, which may include the risk of electrical discharge.
• All Formula E mechanics and garage personnel have received one and a half days of BLS training, including AED use.
• The drivers, when self extricating, have been instructed to climb out onto the body of the car and then jump down on to the ground, landing on both feet at the same time to avoid completing a conducting circuit.
•  All of the pit garages have been set up with the same equipment (AED, 250L water tanks, linesman's insulated gloves) in the same locations, to provide standardisation.
  

The Case Against Extrication Teams

Wow. This presentation from Dr Sean Petherbridge certainly required the wearing of flame-retardant undergarments (Ladies, you'll be glad to know that someone has finally gotten around to designing a flame-retardant bra. See page 7 of the 3rd edition of the FIA Institute's Auto+Medical.). Controversial is probably the wrong term, as a straw poll taken at the end of the presentation suggested that the majority of delegates present were in favour of looking at a restructure of the circuit medical team/extrication team split and combining them into a single, cross-trained 4 person team in one vehicle, with several of these vehicles as needed per circuit.


This model is already in use at IndyCar and NASCAR circuits (both oval and road circuits) and in rally and works well.

This was probably the presentation that was discussed the most in corridors over coffee for the following day or so.


The Medical Management of Competitors at Silverstone Circuit UK: A Four Year Study

You'd be forgiven for reading the title of this 4 year retrospective review and thinking it might have been a useful 30 minutes for updating your Facebbook status and checking who has retweeted your amusing meme. However, it actually revealed a few pearls.

First of all, the study was done. And presented publicly. There is a deficit of proper, available motorsport medical research. So the fact that it even happened and was presented I think demonstrates that we are beginning to validate what we do outside of closed rooms.

Then, in addition to the expected analysis of competitor demographics and patterns of injury, there were a couple of points that came out that were quite valuable.

• Frequency and patterns of collisions were mapped against circuit location, which allowed identification of circuit black spots that have since been targeted for improved safety features or resource allocation
• Frequency and patterns of collision were mapped against the calendar year and staffing availability, which allowed an examination of workload and staff allocation for particular events
• The differences in outcomes of motorbike and car events could be analysed.

This stuff is pure gold for a given circuit and CMO and is analogous to audit processes that already occur in the hospitals and agencies that we work with in our day to day jobs. Additionally, not only does it highlight areas that may need improvement, it is hypothesis generating, leading to medical and safety areas that can be tackled prospectively.

We should all be doing this on a regular basis and sharing the information.


Concussion

Yep, concussion is still a problem on a number of levels. Dr Matt Croxford (@Ausrallydoc) summarised it neatly when he tweeted:


Essentially:

• It was generally recognised that there is more of a problem in working out when it is safe for a concussed competitor to return to competition than stepping them down after the initial injury.
• It was generally agreed that a concussed competitor should not be allowed to return to competition on the same day nor for as long as symptoms persist.
• The BESS test was offered as a sensitive indicator of ongoing injury. More on this in the future.
  
• The role of brain biomarkers, such as t-Tau, was played down due to paucity of evidence
• The role of brain imaging was played up, especially for persistent symptoms (despite lack of evidence linking intervention to outcomes)
• AWPTAS was not discussed specifically.

Rally safety

Mmmm. Overall, motorsport safety, particularly mortality is improving. However, rally is still a standout who's trend is moving in the opposite direction. This has been attributed to the reduced ability to control course hazards, distances to definitive care centres and spectator behaviour. Dr Jean Duby (FIA Delegate for WRC) made three specific points in this regard:

• Spectator risk - "usually don't understand or appreciate risk when trying to get good view"
• Photographer risk - "often underestimate risk when trying to get best shot"
• Rally marshal risk - "the tabbard is not a safety shield"

A couple of safety measures were proposed, such as

• Real-time GPS tagging of spectator tickets and official tags that highlights crowds gathering near a danger hotspot
• The role of camera drones - generally played down due to battery life and air traffic hazard
• The role of having a camera in the zero car that transmits live images back to rally control who can then respond a spectator liaison or security official.

Finally, and importantly, Jean Duby pushed his agenda of making first aid training mandatory for all competitors, which makes a lot of sense as the first on scene to a rally or off-road accident is likely to be the next competition vehicle. This is something that is already being developed by several ASNs, including Australia.



This year, the Summit also included a tour of the ASPETAR Sports Medicine and Orthopedic Hospital in Doha. It is an impressive facility with purpose built everything. Just shows what can be done when money isn't much of a problem.

And on the Thursday night, before flying out early on Friday morning, I had the pleasure of attending the Champions Challenge, where the likes of Daniel Ricciardo, Tom Kristensen and Petter Solberg vied for bragging rights and an oyster trophy by punting footballs into a goal using racing karts and answering quiz show questions thrown at them by Alan McNish. All good fun.


Finally, while I was in Doha, I grabbed the opportunity to sit down with Ian Roberts, Hugh Scully and Rob Seal and record a couple of podcasts. I'm currently doing some post-recording editing and they'll be ready soon. I've also lined up a few more to record in the near future. So keep an eye out on the Rollcage Medic Twitter, Google+ and FaceBook streams for their release.

As always, comments, questions and opinion are welcome below.

Take care

Matthew