Rollcage Medic Podcast

Feast your ears and eyes on podcast and vodcast goodness, as I pick the brains of the leading lights of the motor sport medicine and rescue community.

Some will be well known, others working in the background, but all are experts in their field with acres of experience that they are willing to share.

So tune in, turn on and absorb the goodness.

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Podcast 25 - Crew Resource Management in Motorsport Rescue and Safety - David Hakim

April 4, 2018


David Hakim is an anaesthetist (anesthesiologist) who lives, works and chases race cars in Canada. He gave one of the talks at last year's ICMS annual general congress in Indianapolis. The topic he chose was one that he has spent some time exploring in order to try to streamline how motorsport rescue and safety is practiced by the team that he works with. 

This exploration led him to learning more about how we think and behave in certain situations and, more importantly, what we can do about it to get the best outcomes.

Here's a breakdown of what we get into. It isn't everything that you need to know, so check out the references at the end for further reading.

1) What is Crew Resource Management?

There are several varieties of definition, but essentially it boils down to developing ways of doing things (processes, procedures, strategies) that minimise error potential and enhance the capacity for the individuals involved to best use their knowledge, skills and immediately available resources to achieve the best outcome possible for the situation.

It originated from the aeronautical industry as a way of trying to understand why crashes and mishaps occurred and then identifying strategies to prevent their recurrence. A lot of the language and characteristics of the CRM process have been ported over to various areas of medicine, with a number of groups and individuals working to figure out how best to apply these lessons to patient care.

Crew Resource Management (CRM) is also known by several different names including Crisis Resource Management and Cockpit Resource Management. However, direct extrapolation from aeronautics to another industry is not always valid and there often needs to be some tailoring of practice. So the term is often altered to fit and in motorsport medicine, it has been called Race Resource Management.

Regardless of the name, the key element of CRM is careful analysis of processes to identify the strengths and weaknesses leading to the developments of a strategy that promotes the best outcome followed by ongoing assessment to ensure that the target outcomes are being achieved and evolving as new information comes to light. It is an organic process.

2) Why should we care about CRM?

In general, when things are going smoothly, the stress levels are low and we feel like we are on top of our game. However, that time that we are really tested is when things are deviating from the intended trajectory. This is when a situation can feel like either a challenge or a threat, depending upon whether we feel that we have the requisite knowledge, skills and ability to deal with it. If any of these three components fail, the chance of error and therefore a bad outcome rises.



3) Knowledge and skills

These two components are what we spend most of our time and effort trying to improve. So if we are smart and have the right skills, why should anything go wrong? 

When we are calm, it is fairly easy to assess the situation, choose the correct course of action and act. In a crisis, the pressure is up and something akin to the fight or flight reflex may kick in. If we are not thinking straight, our approach to the issues confronting us may become unbalanced, leading us to apply our knowledge and skills inadequately or inappropriately or not at all.



Both System I and System II processes are useful and have their benefits and downsides. Understanding how they work and how we work with them can help us to refine how we behave when the pressure is on.

"Use your attention wisely"

4) Situational awareness

Simply put, this is our ability to remain aware of or environment and how it might evolve. 

A football player will be aware of roughly where their team mates and opponents are, how the ball is moving, the direction of play and where the goal is. Similarly, for a race track incident, there may be any number of items to remain aware of, such as the location of the incident, whether the yellow flags or safety car are deployed, is the car on fire, where are the rest of the race cars, what are the clinical priorities and whether it's more appropriate to go to the circuit medical centre or straight to the receiving trauma hospital. 

Under pressure, there is the potential to develop tunnel vision, either cognitively or literally. This can be due to:
  • Cognitive overload
  • Environmental overload
  • Communication overload
The result is becoming overwhelmed, which may lead us to being unable to effectively or appropriately apply our knowledge and skills.


5) Resolution

Cognitive and behavioural psychology

Understanding the concepts behind how we think and behave helps us to develop strategies to mitigate the error prone elements. There are multiple resource available to delve in here. Go check out the reference list below.

Cognitive off-loading
  • Pre-event planning and Standard Operating Procedures (SOPs) - How will we approach an incident? Role allocation. Exit strategy.
  • Checklists - These help to reduce the cognitive burden of certain activities, but they need care in their development. Go listen to this podcast: "Checklists" on Phemcast - https://phemcast.co.uk/2018/02/09/episode-27-checklists/
  • Rally points - Regular planned breaks in activity to perform a self and/or team catch up so that it is clear what the priorities are, what the intended targets are, how to get there and whether they are being reached.
  • Leadership and followership
Stress inoculation practice 
  • Sim training really helps here. 
  • Debriefing is critical and is where most of the learning is made explicit and concrete. 
  • There should be specific, achievable objectives. 
  • Start gently and build up as abilities and confidence grows.
  • Practice should be deliberate. 
  • Mixed team and mixed skill training not only improves knowledge and skills but also improves team cohesiveness.

The podcast



The intro music clip is from Music For Pleasure - The Human Factor (7'' Version)
https://www.youtube.com/watch?v=qT_e_v4K1cA



The slides

(These are the slides from David's talk at the ICMS Congress)

Crisis m anagement final from DavidHakim83

References and resources
Finally, Dr Andy Buck has a whole website devoted to clinical CRM and human factors strategies called Resus Room Management - http://resusroom.mx/

 

Podcast 24 - ICMS ACG 2017 Day 2

January 12, 2018


And so to the final day of the ICMS annual congress. Following on from day 1, today covered:

  • A description of the Billy Monger / Patrick Pasma Formula 4 crash at Donnington Park along with the interventions and follow up thereafter.
  • An overview of and updates to the FIA's RaceTrue anti-doping program
  • The Dan Q Marisi Lecture
  • A panel presentation on developments in occulovestibular reflex testing and its application to concussion assessment in motor sport
  • A presentation on the physical and physiolo...

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Podcast 23 - ICMS ACG 2017 Day 1 Part 2

December 30, 2017


This is the second part of a three-part series of summaries that cover the two days of the ICMS Annual General Congress in earlier in December.

The topics covered included human factors, situational awareness and race resource management, research in driver physiology and safety in powerboat racing. Vincenzo Tota wasn't able to come and present his talk on concussion attributed to rigid race seat headrests in DTM cars (you can read about this in an earlier Rollcage Medic article - ) and was re...

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Podcast 22 - ICMS Annual Congress 2017 Day 1 Part 1

December 19, 2017


At the beginning of this month I made the long trip to early winter Indianapolis (yes, it snowed) for the International Council for Motorsport Science (ICMS) Annual General Congress. This is the second time that I have attended this particular conference, the first time having been this time last year. It was good to be able to attend for a second consecutive year and good to catch up with colleagues and friends. 



As it was in 2016, the ICMS AGC was embedded within the much larger Performance ...

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Podcast 21 - Concussion in Motor Sport - A literature review

November 4, 2017



Concussion is an ongoing issue in sport. It has gained a lot of attention over the past few years in turn driving attempts to improve diagnostic and therapeutic strategies. Have a look through the “References and resources” section below for previous posts and podcasts concerning concussion on this website.

Most of the work done on sports-related concussion has occurred in field and contact sports, such as rugby, gridiron and horse events. Predictably, there is an increasing awareness of t...

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Podcast 20 - David Dalrymple and Fire - Part II

September 20, 2017
Motorsport championships are heating up. As is the approaching Australian summer. So let's crack on with the second half of the podcast that I recorded with Fire Specialist and Motorsport Rescue Technician, David Dalrymple.


In Part 2 we cover:
  • Fire suppression and extinguishing agents.
  • Standards, recommendations and regulations.
  • The NFPA 610 regulations for fire response at motorsport events.
  • David's forthcoming article on two new mask respirators for fire management safety. David's First Res...

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Podcast 19 - David Dalrymple and Fire - Part 1

September 1, 2017

The speed, the heat, the fumes .... motorsport is great!

Unless the heat and fumes are the cause of a fire and the speed refers to the rate at which the flames are spreading. Then it's really bad.


There are a lot of reasons why a fire can get going during a motorsport event, whether at the scene of a crash or somewhere in the paddock or service park. We rely on the presence of knowledgeable and experienced fire marshals to have our backs (and fronts, sides, tops and underparts), but wouldn't i...
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Podcast 18 - The competitor's perspective with Karl Reindler

July 10, 2017


What's it like to crash at over 150kph? What's it like to be crashed into? What about being engulfed in a fireball while strapped into your seat by a combination of a 6-point harness, communications wiring, ventilation and drinks tubing and a window safety net? And what is it like to have a medical response team haul you out of your broken car and start working on you right there?

If you race for long enough and push hard enough there is a statistical likelihood that this will happen at some p...

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Podcast 17 - Naomi Deakin and Research in Motorsport Medicine

May 20, 2017

Naomi Deakin is a trauma fellow pursuing a PhD in England. No strange thing amongst doctors who are trying to carve out a place and career for themselves. Except that few choose motorsport medicine as an area to chase down that higher qualification. And yet why not? It's a fertile area full of possible aspects to explore.

Yet if you go looking for clinical advancement topics in motorsport your search will not take too long. There's just not that much too be found. This is odd for a profession ...
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Motorcycle rescue sim from SMACC Dublin 2016

April 2, 2017

Training as a team is really important. Technical skills are honed, communication becomes targeted and succinct and deficits are identified and can be troubleshot. Organising and running team training sessions takes a lot of work and commitment on everyone's part, but it pays dividends.

The Social Media And Critical Care (SMACC) conference does its best to evolve each year and seeks to explore some of the outer edge areas of acute care medicine. Last year's conference was held in Dublin and am...

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