Posted by Matthew Mac Partlin on Friday, October 25, 2013

It’s hard to know that a problem exists if you don’t look for it.

Sometimes you’ll find it because the problem finds you, usually through an adverse outcome. But wouldn’t it be better to know of  a potential problem’s existence beforehand and, even better, put something in place to mitigate it. So it makes sense to look out for problems before they cause trouble; that’s just basic survival.

And it is not without precedent. It is why terms like “risk management” and “quality improvement” have made their way into clinical areas. Whether you work on the wards, in a clinic, the emergency department or prehospital, the concepts of risk identification, harm minimisation and continuous improvement will be something you at least aware of, if not actively involved in.

This awareness has led to the establishment of major national databases and registries as individuals and groups try to get a handle on the scale of certain issues. Examples would include the ANZICS Centre for Outcome and Research Evaluation (CORE) database or the UK’s Trauma Audit and Resource Network (TARN). For civilian trauma in Australia there is the NSW  Institute of Trauma and Injury Management or the Victorian State Trauma Registry.

So why is it so apparently absent in motorsport medicine and rescue in Australia?

This is not to say that medicine and rescue are provided to motorsport events in a haphazard or thoughtless fashion; far from it.  The doctors, paramedics and nurses who volunteer their time and expertise at races do so out of an enjoyment of being involved and a genuine desire to improve the sport. They are recognised at an international level for their acumen and professionalism.

Anecdotes are not evidence and while learning a hard lesson through experience may be valuable to an individual, it is less likely to lead to significant improvement in practice for all, unless it can be backed up by data. And that is where things appear to start to fray a little.

Anyone who has provided medical cover at a CAMS sanctioned event will have filled out an injury data sheet, but have you ever wondered what happens to all of that information? Where does it go? What is it used for? Does any good come out of it or is it simply an exercise in administrative process and medicolegal protection?

For more on concussion in motorsport listen to this podcast:

There has recently been cause to focus a bit on concussion in Australian motorsport and it has become fairly clear that there is a lot that we do not know, like how frequently it occurs if at all, or what consequences it leads to. We don’t seem to have the data, or, if we do, it isn’t being examined.

This reflects poorly on us, especially given our good standing amongst other motorsporting nations and considering that Australia is one of only five National Sporting Authorities (ASNs) sanctioned by the FIA to provide medical and rescue training to other ASNs. (The other four training provider ASNs are the UK, Spain, South Africa and the U.A.E.)

It has been done in other countries, such as the USA, where the International Council for Motorsport Science (ICMS) actively collects race injury data along with driver and vehicle accelerometer data from IndyCar and NASCAR events. The data is then available for examination by various relevant groups from physicians to race engineers. This collaborative analysis has led to innovations such as the SAFER barrier, driver cockpit design changes (Podcast with Dr Terry Trammell) and alterations to extrication and rescue practices. Any ICMS member can access or contribute to these resources, which has great scope for widespread improvement in motorsport incident outcomes in North America.

The FIA also collects crash and injury data which is processed by the various reaseach and engineering project teams. This information is less easily available to those not at the core, though it has begun to improve through the FIA Institute website.

So I would argue that there is an obligation to start collecting Australian motorsport injury data properly and to begin to use it to identify trends and patterns that could then be meaningfully intervened upon.  There is the start of movement in this area within CAMS and apparently there are a number of individuals from different backgrounds (clinical, engineering, regulation) who have voiced support for establishing such a database. As the profesionalisation of motorsport in Australia continues to develop, the stance on this issue must change from whether we need to commit to maintaining a registry, to acknowledging that we cannot justify not having one.

As usual, your thoughts and comments are welcome.

Resources and references