AUTO+ Medical - Issue 9 by FIA AUTO

international journal of motor sport medicine Issue#9, December 2016

mission accomplished

A look back at the legacy of the FIA Institute as it completes its mission P22

INSIDE CIK-FIA WORLD FINAL

Examination of the medical facilities at 2016 CIK-FIA World Championships P40

James Hinchcliffe

The IndyCar racer recounts a nearfatal injury and his recovery P44

meeting of minds The 2016 FIA Medical Summit brought together leading motor sport doctors from across the world

AUTO+MEDICAL

LETTERS/ P4

The best letters and emails received from readers around the world

Global NEWS/

P6 P7 P8 P9 P9 P10

Motorsport Ireland to host medical motor sport training event Researcher hopes first female driver science study starts debate Emergency Services Rally School lines up 2017 training event High-speed camera wins tech award Obituary: Dr Aki Hintsa 1958-2016 Concussion round-up

FEATURES/ P12 FIA MEDICAL SUMMIT - mEETING OF MINDS The latest FIA Medical Summit took place in Vienna last month, AUTO+ Medical reviews the event's best presentations P22 FIA INSTITUTE â&#x20AC;&#x201C; LEAVING A LEGACY A look back at the achievements of the FIA Institute and an assessment of the legacy it has provided for global motor sport P32 ON SITE: PARAMEDICS Three paramedics working at motor sport events around the world explain their roles, experience and skillsets in their own words P40 INSIDE THE CIK-FIA WORLD FINAL A complete breakdown of the medical team that worked at the 2016 CIK-FIA World Championship event held in Bahrain last month P44 THE ROAD BACK: JAMES HINCHCLIFFE The IndyCar racer shares his thoughts and memories on the leg injury he sustained in practice for the 2015 Indianapolis 500

study/ P48 ANALYSIS: FEMALE DRIVERS IN A COCKPIT SETTING Dr Edward Potkanowicz examines the physiological responses of female drivers to the environment of a cockpit in a new case study

Editor: Marc Cutler Deputy Editor: Alex Kalinauckas Designer: Cara Furman

We welcome your feedback: medical@fiainstitute.com

AUto+mediCAL

Welcome to the new issue of AUTO+Medical, which features the latest news and reports from the world of motor sport medicine. I am delighted to be the latest member of the publication’s editorial board to present an edition. In our cover story we visit the 2016 FIA Medical Summit, which took place last month in Vienna. Many of motor sport medicine’s leading practitioners were in attendance and we report on the best presentations and discussions that took place during the event. Elsewhere in this issue we recall the many achievements of the FIA Institute over its 12-year history and assess the organisation’s legacy and the impact its work had on global motor sport. We then take a look at the medical team that worked at this year’s CIKFIA world karting championship, and hear from IndyCar star James Hinchcliff e regarding his recovery from the near fatal injuries he sustained during a crash in practice for the 2015 Indianapolis 500. Our scientifi c paper examines the physiological reactions of female drivers to the environment of a cockpit and it sparks a fascinating discussion on a new element of driver science, which has not been previously researched. I hope you enjoy the latest issue.

Dr Rob Seal President and Medical Director at the Canadian Motorsports Response Team

AUTO+MEDICAL LETTERS

In this section, we print the best letters and emails received from readers around the world. We welcome comments on articles as well as suggestions for future content. If you wish to send in a letter or email, please direct it to: medical@fiainstitute.com Dear Editor, I read with great interest Dr MacPartlin’s review of trauma resuscitative practice [in AUTO+ Medical #8]. Trauma management has developed rapidly recently, fueled by development in combat medical care and translated to civilian practice. Concepts and techniques discussed in Matthew’s article are debated with passion and excitement as trauma resuscitation becomes an advanced sub-specialty. We must think carefully about how this may pragmatically be applied to motor sport medicine. Matthew makes the astute observation that motor sport kinematics are different to military and civilian populations and must be acknowledged when translating research and guidelines. The speed a casualty may be attended gives the luxury of early intervention but consideration must be given to the resources and the skill set of care providers. Motor sport medics come from a variety of specialist backgrounds, and may not train in acute or emergency work regularly. I have worked trackside and on rally stages with pre-hospital care specialists, anaesthetists and emergency physicians who manage the unwell trauma patient daily. I have equally had the privilege to work alongside clinicians from nonacute specialties to whom advanced resuscitation is not a frequent event. These practitioners are valued members of the team but may feel uneasy performing procedures such as finger thoracostomies. They may not have the experience to undertake techniques such as delayed sequence induction or REBOA safely. Our aim is to deliver the best standard of care possible and it is our responsibility to ask how to provide this. The provision of advanced prehospital teams containing specialised motor sport resucitationists would be challenging for a well4

funded international level series and near impossible for local circuits and club racing. In addition the results achieved by advanced teams, such as London or Sydney HEMS, may be partly attributed to the experience gained from a high patient volume. Thankfully the incidence of severe trauma in motor sport is low but this does pose a challenge for skill retention and team development. A suitable pre-hospital strategy for the severely injured driver may be to get the patient to the right location in the optimal time. Pre-hospital interventions that do not benefit outcome delay the time to definitive management and may be considered harmful. A motor sport ‘trauma system’ must ensure a stringent protocol allowing triage and a seamless transition from the incident to an established, resourced trauma team at a major trauma centre or local equivalent. A trackside medical centre does not have the resources, such as the availability of blood products, to provide damage control resuscitation. It cannot provide rapid CT diagnostics or definitive management in the form of surgery or interventional radiology. The benefit of a diversion to the medical centre must outweigh the risk of delaying the time to definitive management. Trauma system development has improved the management of trauma worldwide. The development of a pragmatic, tailored motor sport derived trauma system is essential to provide advanced resuscitative practice. Publications such as Auto+ Medical allow discussion of these issues on a global scale and a forum for the talented individuals who work in motorsport to collaborate. Dr Barry M Schyma FRCA Singapore GP Medical Team, British GP Medical Team Knockhill Race Circuit

AUTO+MEDICAL LETTERS

Dear Editor, Hello from Marrakech, the city that has welcomed the World Touring Car Championship under the patronage of his majesty King Mohammed VI, since 2009. Marrakech is a city that has met all the criteria and standards set by the FIA, especially the medical operations that are part of a chain set up to ensure the smooth running of the event. The FIA has strengthened its confidence in the city and it recently organised a Formula E race. I am writing to say how proud I am of the medical team here. It is made up of two parts: one is present on the racing circuit site and the second is based at the hospital centre. It is supported by paramedics, technical and ambulance personnel, not forgetting the extrication team who come from France, Germany and Italy - a team of

professionals who operate at the 24 Hours of Le Mans. The team is attentive at all times and understands the sense of considerable risk that represents every moment of a race and have tasted this adrenaline rush outside the usual working conditions. One of the strong elements that makes the success of this cohesive unit is the realisation of multiple simulations of management in case of an incident. The interest is to make and repeat the gestures and movements ‘according to the imagined situation’ in order to master the technical and logistical protocols and be ready for any situation. Every second counts to save a life. Dr Hanane Mourchid Circuit International Automobile Moulay El Hassan

The medical team from the Marrakech circuit welcomed Formula E for the first time in November 2016

AUTO+MEDICAL Global news

GLOBAL NEWS The third trauma and extrication training event will take place at Mondello Park

Motorsport Ireland to host training event Motorsport Ireland will host its third ‘Trauma and Extrication in Motorsport’ training weekend at the Mondello Park International Race Circuit on 28-29 January 2017. The two-day event, which follows previous editions that took place in 2014 and 2015, will engage the expertise of the University College Dublin Centre for Emergency Medical Sciences to create and deliver the course. The training on offer is intended for doctors working in rallying, circuit racing and hill-climb events, and it aims to give those attending the opportunity to participate in hands-on training with the latest innovations in prehospital trauma care, patient packaging and medications.

Rosemary Walsh, convenor of the Medical Officials Training Emergency Vehicles (MOTEV) Group at Motorsport Ireland, highlighted the real life extrication simulations that participants will complete during the course as an important opportunity for motor sport medical personnel to interact and share concepts and theories while dealing with the task at hand. She said: “An important aspect of the course will be the ability for all attendees to work with rescue and medical teams on real extrication scenarios. This allows both doctors and rescue crews to interact and train together where ideas and innovations can be shared.” Turn to page 32 to read about the training and skills of three paramedics who work at high-profile motor sport events across the world.

AUTO+MEDICAL GLOBAL NEWS

Researcher hopes first female driver science study starts debate The author of the first scientific study examining the physiological responses of female motor sport athletes to the environment of the cockpit has called for a new discussion on the topic of female driver science. The study, which you can read in this publication, was undertaken by Dr Edward Potkanowicz, who realised there had been no previous research into the effects of racing in a confined cockpit specifically on female drivers. Potkanowicz wrote: “An exhaustive review of the literature for investigations on the physiological response of the female driver to the environment of the cockpit yields nothing within the published literature. “But when examining the motor sport driver community, women are found in just about every kind of racing and at just about every level.” The study involved four female drivers who were observed during a 40-minute session on a 2.75-mile, 21-turn, clockwise course and their core body Susie Wolff drove for Williams in four F1 practice sessions

temperature and heart rate data were collected simultaneously. Their physiological strain values were derived from this data, but only the information from two of the drivers was used to produce the final results of the study due to an equipment failure. Potkanowicz also helped to coin the term ‘driver science’, which is defined as the objective and scientific examination of a driver’s physiological response to the cockpit from which databased recommendations can be made to improve driver safety, tolerance and performance. While explaining the results and limitations of the study, Potkanowicz described it as an important “first step” into a wider dialogue. “From a practical and applied perspective,” he wrote, “the value of the current case study is that it represents the beginning, and necessary first step, of a new discussion and a starting point for more inclusive work in the area of driver science.” Turn to page 48 to read the full scientific study.

FIA develops telemetry safety system for f1 race starts The FIA has developed an automated safety system for starting Formula One races that activates the aborted start procedure if a car stalls. The programme uses the telemetry data the governing body receives from all the teams to send a signal to race director Charlie Whiting if a car stalls. The field will then be sent around for another formation lap and the stricken car recovered. The new system was implemented after the 2016 Malaysian Grand Prix, where Toro Rosso driver Carlos Sainz stalled his car on the grid and then raised his hands to warn the race director about the situation. The previous procedure would then have activated a yellow warning light next to Sainz’s grid spot, but the Spaniard quickly put his hands back into the cockpit and restarted his car using the power from his MGU-K, which is a recent development from Formula One’s hybrid engines. The start in Malaysia then went ahead as normal but Sainz revealed afterwards he had only just got the engine restarted in time. He said: "I was aware of it because we tried it earlier in the season, but when the engine switches off the only thing you think is, ‘it's all over!' "Suddenly my engineer reminded me on the radio quickly, but the first time we tried to switch it on it didn't work. The second time, thank God again it happened just when the five lights were on, and at that point, 'voom', I was off when the lights went off."

AUTO+MEDICAL Global news

ESRS course participants practice fire fighting techniques

Emergency Services Rally School lines up 2017 training event in New Hampshire A training event for motor sport safety and medical personnel in North America is being planned by the Roadway Rescue emergency response training team, which has established a dedicated practical programme to cover the various aspects of incident response at a rally event called the Emergency Services Rally School. In conjunction with the Team O'Neil Rally School, Roadway Rescue provided a 20-hour ESRS education course in July 2015 that was split between theoretical and practical training using FIA and North American best practice guidelines for emergency services. The second event is scheduled to take place in Dalton New Hampshire on 8-10 September 2017. During the inaugural training event, class room modules offered to students, who are experienced motor sport emergency service workers, included medical, venue, fire and rescue considerations, as well as personal protective equipment education and teaching on various aspects of managing rally events. “We have on our hands a high speed, high performance educational program not only from emergency services but also the rally world,” explained David Dalrymple, the ESRS rescue training co-ordinator. Last year, following the theoretical sessions, the ESRS students were guided through the structure and safety systems of a modern Ford Fiesta rally car by five-time

North American rally champion Tim O’Neil before they completed a series of practical courses. These sessions, which took place concurrently with the students rotating between them, included practice with tools to cut through cars, extrication, fire fighting and scene stabilisation. The 2015 course ended with a final module that tested the students’ skills in a practical incident scenario. A Subaru WRX car was placed in a simulated crash setting and the students worked to rescue and evacuate a trapped and injured driver. Speaking after the 2015 course had been completed, Dalrymple felt that the ESRS had successfully delivered its objective of teaching safety and medical methods specific to a rally event. He said: “We felt we have met our primary goal of delivering a high performance educational program delivered in a real world setting and environment. “From arrival till leaving each day our students ate, drank, and learned in an environment that was rally, total immersed. Though each student worked their particular specialty we also gave them the tools to see and work other roles and responsibilities. “From the student evaluations to their performances we felt we were making the rally world safer, one person at a time.”

AUTO+MEDICAL GLOBAL NEWS

Dr Aki Hintsa 1958-2016

The high-speed camera captured Fernando Alonso's crash at the 2016 Australian GP

High-speed camera wins tech award The high-speed camera that was developed by the Global Institute for Motor Sport Safety in conjunction with Magneti Marelli has won the ‘Motorsport Technology of the year’ award at the Professional MotorSport World Expo. The camera, which was introduced into Formula One at the beginning of this season, rapidly films the driver at up to 400 frames per second. The data it captures provides information of what happened in the event of a crash and can help inform medical officials of any injuries a driver has sustained. Roberto Dalla, head of Magneti Marelli Motorsport, said of the award: “We are honoured to receive such an important award particularly because it fully seals Magneti Marelli Motorsport’s main goals in the field of competition: developing new technologies through racing that we will see applied in our road cars tomorrow, and make our know-how and talent available to the FIA in order to improve the safety of our racing cars and our street cars day after day. “We are particularly pleased not only for the creation and performance of the high-speed camera, but also for the excellent collaboration between the FIA teams and Magneti Marelli, which has allowed us to reach such a challenging milestone.”

xxxxx xxxxxxx xxxxxxx

Dr Aki Hintsa, who spent 11 years working for the McLaren Formula One team, has died following a battle with cancer. The Finn joined the British team in 1998 and he acted as a physician and chief medical officer during his stint with the Woking squad, which released an official statement to mourn his passing. “It was with deep sorrow that we heard the news that Dr Aki Hintsa had died,” read the statement. "Aki had been fighting cancer with extraordinary courage in recent months, his indomitable spirit an inspiration to all who crossed his path." Hintsa was also credited with helping to improve the performances of Mika Hakkinen, Kimi Raikkonen and Lewis Hamilton by developing their mental approaches as well as tending to their physical wellbeing. “He first joined McLaren back in the days of Mika Hakkinen and Kimi Raikkonen, with both of whom he developed a powerful rapport, working with them not only to improve their physical fitness but also to help them develop the mental and emotional strength to translate their mercurial talents into the disciplined performances,” explained McLaren. “Aki worked with similar success with the drivers who followed in Mika’s and Kimi’s McLaren wheeltracks, and grew particularly close to Lewis Hamilton. Undoubtedly, Aki played a crucial role within Lewis’ inner circle during his time at McLaren, and it was often to Aki that Lewis would turn first in times of stress.” Before his post with McLaren, Hintsa worked as a doctor in Africa where he observed the lives of Ethiopian distance runners and he deduced that their success “derives from holistic wellbeing”, according to the Hintsa Performance, the company he founded to help professionals in all walks of life achieve their peak performance.

AUto+mediCAL gLobAL news

CoNCUSSioN

several drivers racing in series around recent months due to concussion. AU

saRah coRnett-chinG ARCA racing driver Sarah Cornett-Ching crashed heavily in a race held by the NASCAR feeder series at the Kentucky Speedway on 23 September and was later diagnosed with concussion after hitting both the outside and inside walls of the track at high-speed. The 25-year-old was forced to miss the ARCA season fi nale as a result of her condition and was referred to the Carolina Neurosurgery and Spine Associates during her recovery. Speaking two weeks after the crash, Cornett-Ching described her symptoms: “I really get bad headaches [and feel] dizzy,” she said. “The sun hurts my eyes. My balance is off . I don’t walk with a nice stride. I kind of shuﬄ e a little bit because my balance sucks. I can’t even imagine being competitive in a race car having those things going on right now.”

dale eaRnhaRdt JR NASCAR star Dale Earnhardt Jr was forced to sit out the second half of the 2016 stock car championship after missing six races in the middle of the year with concussion symptoms. The 42-year-old’s condition was traced back to a crash in the Michigan NASCAR Sprint Cup race in June and he stopped racing after the Kentucky round in July. Four-times Sprint Cup champion Jeff Gordon – who had retired from full-time racing at the end of the 2015 season – and Alex Bowman replaced Earnhardt for the remaining NASCAR events of 2016, but he has announced that he will return to the series in 2017. He said: “My intentions are to race and that’s the plan we have going forward. We’re booking things [for next season] per normal and per usual. We’re doing all our photo shoots and everything with the anticipation of our sponsors marketing me as the driver of the No. 88 car. I think that’s perfectly on track and a reasonable goal to be in the car and competing in Daytona.”

AUTO+MEDICAL GLOBAL NEWS

n round-up

the world were forced to miss races in AUTO+ Medical examines their cases.

Matt Neal British Touring Car Championship driver Matt Neal missed the final race of the 2016 season after being diagnosed with concussion following an accident during the penultimate round. Neal, who has won the BTCC title three times, crashed into the barriers during the second of three races at the Brands Hatch circuit on 2 October after clashing with Triple Eight Racing’s Ash Sutton. The 49-year-old was eliminated from the title battle as a result of missing the final race, and his Team Dynamics teammate Gordon Shedden went on to claim the 2016 crown. On Twitter, Neal wrote: “Mild concussion so world bit fuzzy [sic] appears throttle potentiometer failed but at least Flash [Shedden] finished job in style!”

Will Power Former IndyCar champion Will Power was cleared to compete in the series’ 2016 final round after crashing heavily at the previous race at Watkins Glen and subsequently going through a concussion testing protocol. The Australian driver has experienced concussion symptoms on several occasions since he crashed at the Sonoma track in 2009 and he missed the 2016 IndyCar season opener with the condition, although it was later discovered that he had in fact been suffering from the residual effects of an inner-ear infection. Power was examined at the University of Miami Concussion Center two days after his accident at Watkins Glenn and was cleared to compete again after passing the concussion protocols. “He flew down to the University of Miami Concussion Center early this morning and we conducted two sophisticated tests to determine if he’d suffered a concussion over the weekend, and he passed both of them with no issue whatsoever,” said Dr Stephen Olvey, who oversaw the tests.

AUTO+MEDICAL FEATURES

FEATURES Meeting of Minds

The 2016 FIA Medical Summit brought together leading motor sport doctors from across the world. AUTO+ Medical examines the various topics that were discussed in Vienna.

AUTO+MEDICAL FEATURES

The grand Hofburg Palace in Vienna was a suitable location for the biggest ever FIA Medical Summit. The event brought together 179 leading motor sport medical personnel from over 40 countries around the world for a two-day conference to discuss the latest developments and theories in the field. Professor Gérard Saillant, President of the FIA Medical Commission and the FIA Institute, opened the summit and encouraged debate and interaction amongst the delegates. “This meeting is very important for discussing new standards and developments in the FIA regulations and what has happened over the last year,” he said. “But in addition to discuss a lot of medical issues.” The first day of the conference stimulated debate with two round-table discussions on concussion and the use of cervical collars. Professor Steve Olvey and Professor Peter Hutchinson presented research papers on concussion and this was followed by a discussion between F1 Medical Delegate Professor Jean-Charles Piette, Brazilian Grand Prix Chief Medical Officer Dr Dino Altmann and Global Institute Research Engineer Andy Mellor. A second round-table later on day one examined the use of cervical collars for trauma patients and produced a fascinating debate about the latest studies into this area. Chaired by German Grand Prix CMO Dr Michael Scholtz, the discussion featured contributions from World Rally Championship CMO Dr Jean Duby, World Endurance Championship CMO Dr Alain Chantegret, and British Touring Car Medical Director Dr Paul Trafford. There were papers presented throughout the summit, which covered topics including video laryngoscopes and the responsibilities of CMOs at motor sport events. FIA Safety 14

Director Laurent Mekies finished the opening day with an update on the developments for frontal cockpit protection on single seater cars. FIA President Jean Todt opened the second day of the conference and reaffirmed the significance of the fields of medicine and safety to the motor sport community. “I attach the utmost importance to the question of safety in motor sport,” he said. “Among all the answers we seek to provide on a daily basis, the medical aspect is central. Doctors are at the head of the systems that we develop in order to respond ever more effectively.” The second day of the summit featured four interactive workshop sessions on areas such as airway management on track, extrication techniques and the use of a motor sport survival kit. Papers were presented on topics including consistency issues for extrication training, and simulator training of medical car and extrication teams. AUTO+Medical takes a closer look at three of the major topics – the latest studies around concussion, the Halo frontal protection device, and the development of new simulation technology for extrication teams. School of hard knocks Concussion in sport has long been a serious issue, and this is particularly the case in motor sport. Several tests have been developed to help doctors diagnose concussion, which is also called mild traumatic brain injury (TBI), and assist them when it comes to making a decision about when a patient can return to action after sustaining damage. Professor Olvey, the Motor Sport Director at the Sports Medicine Concussion Center of the University of Miami, used his presentation to the summit to explain how these processes are

AUTO+MEDICAL FEATURES

Prof Hugh Scully gave a presentation on the role of the CMO

The I-Portal PAS can diagnose concussion in minutes

“

The I-Portal PAS is the coming thing, it is going to replace the other tests or go in tandem with them

”

evolving to the point where their human aspect can be virtually eliminated. Olvey explained that the current testing modalities for mild TBI fall short of providing accurate information on the existence of the disorder and provide little or no prognostic information. A new technology, the I-Portal PAS (Portable Assessment System-integrated head-mounted display and eye-tracking), uses special goggles to track eye movement. This is a smaller, portable version of previous technology that involved a chair and moving objects for patients to focus on. The goggles can be used anywhere and the new test takes just five minutes to complete. It can also provide objective quantification and can diagnose and clear concussion immediately. “It’s the coming thing,” said Olvey. “It is going to replace the other tests or maybe go in tandem with them. You could actually do it on site [over] five minutes and you’d have your diagnosis.” “It is clear up to 95 per cent [accuracy],” said Olvey. “These tests can diagnose concussion on the spot. The goggles are made to be much more attractive [than the chair test], they’re smaller and they’re reasonably priced so they can be used by racing organisations, teams and so forth.” During the round-table discussion on concussion, Professor Hutchinson explained the classification for severity of head injuries during his presentation outlining TBI for chief medical officers and the definition of the physiology of concussion. After explaining the clinical definition of TBI, which he stressed can be sustained without any loss of consciousness, retrograde amnesia or post-traumatic amnesia, Hutchinson explained the importance of recognising the rotational 15

AUTO+MEDICAL FEATURES

injuries that can cause concussion without a direct head impact. “I think what is becoming apparent in terms of the mechanism of such injuries is that rotational forces are paramount and they lead to a transient distortion of the brain tissue,” he said. “That’s an important element of the injury mechanism, which partly explains why concussion may be seen with rotational injuries to the head even when there is no direct impact.” During a presentation on his experience of concussion in Formula One, Professor Piette explained that despite what is sometimes indicated in the media, a return to action for drivers following TBI is not just a formality. “It’s not a two-minute play [time] and we need to have a complete chart with the past history [of the patient], the past symptoms and current ones – if any – a clinical detailed examination including balance, and an ImPACT test,” he said. “Afterwards there will be a decision but before then it is important, in my opinion, to have a chat with the driver and no witnesses just to ensure that he really wants to come back to the track and is not forced to do so by his team.” Piette also described the process of the 45-minute computerised ImPACT test, which has been used in Formula One for the last 13 years. But he questioned the validity of baseline tests – which are compared with the patient’s post-concussion test results during the ImPACT assessment – that drivers may have completed a long time previously. “Does the test have to be repeated every two or three years even in the absence of any concussion?” he asked. He also questioned the scientific validity of the test itself and of the medical literature dedicated to this topic. In the next part of the discussion, Dr Altmann outlined the novel biomarker research 16

Professor Olvey delivers his presentation on concussion

technology used in blood test diagnoses for concussion. These tests analyse neurons and other cells as a way of providing objective means to identify TBI. Altmann cited a study from Dr Linda Papa at the Orlando Medical Centre who looked at the elevation levels of GFAP and UCHL1 cells in 589 patients suffering from concussion. “The conclusion was that GFAP performed consistently in detecting mild to moderate TBI, CT lesions and neurosurgical interventions across seven days, and UCHL1 performed best in the early post-injury period,” he said. “Biomarkers are a powerful tool for us to diagnose concussion and it’s really very close to

AUTO+MEDICAL FEATURES

“

rotational forces are paramount and they lead to a transient distortion of the brain tissue

”

Dr Dino Altmann discusses biomarker research

Dr Jacques Tropenat asks a question during the discussions

clinical practice in the coming years.” In the final presentation during the concussion round-table, Mellor presented the engineering perspective of analysing past accidents that have led to drivers suffering concussion and other serious injuries. After introducing the cases of Roland Ratzenberger at Imola in 1994, Soames Langton at Nogaro in 1996, Michael Schumacher at Silverstone in 1999 and Sergio Perez at Monaco in 2011, Mellor presented the findings and analysis of the forces that were placed on the drivers during those accidents. He concluded that concussion can be sustained during a wide range of crashes, from 17

AUTO+MEDICAL FEATURES

mild hits to devastating impacts. “Concussion does seem to have a wide range of linear G-levels,” he said, “from the huge values to the values around 15-18 G-level, [which] still seem capable of causing concussion in certain accident types.” Following these presentations there was an interactive discussion between the delegates and the doctors on stage. What became clear was that there are more concussions in motor sport than were previously thought and new technology and methods of analysis are shedding new light on the subject. But motor sport is well equipped to deal with this. As Professor Hutchinson said: “We are in a very strong position in motor sport medicine as we have the potential to produce very high quality research into the cause and treatment of concussion.” Halo in action FIA Safety Director Laurent Mekies gave a presentation on the development of the Halo frontal protection device for open-wheel race cars, which is due to be introduced into Formula One in 2018, although a final decision by the governing body still has to be made for that to happen. He presented the research that the Global Institute for Motor Sport Safety has already conducted on the device and explained that the concept is now being taken further forward. The presentation used a number of accidents from the last ten years as case studies and in virtually every instance the researchers found that the halo would have improved the situation for the drivers involved. Mekies also outlined the significant major risk areas in motor sport crashes that were highlighted during the research: car-to-car contact, car-to-environment contact, and the 18

The Red Bull Ring extrication team gave a demonstration using the halo

danger of external objects. The operational risks of driver extrication and visibility were also considered. However, driver tests have discounted the concerns about obstructions to their vision. “Most of the feedback from on-track testing has confirmed visibility is substantially unaffected, and there is no significant visual obstruction due to the central strut,” said Mekies. “Some drivers expressed initial feelings of discomfort, but feel that they would become accustomed to the field of view with more running.” The FIA feels that all of the visibility concerns will be alleviated through drivers undertaking additional running, in addition to changes in colour and surface finish, and by using a slightly narrower central pylon.

AUTO+MEDICAL FEATURES

Mekies also explained that the halo, which is able to withstand 15 times the static load of the full mass of a Formula One car, would prevent another car (or structural parts of another car) from contacting a driver. Furthermore, it would stop helmet contact with a wall or barriers in most cases considered from previous incidents, and it increases the net level of protection for drivers against small debris. “In the event that the car is overturned, turning the car back onto its wheels is already the preferred procedure,” he added. “Rapid marshal intervention will ensure additional risks, such as fire, are nullified before and while the car is being turned back onto its wheels, allowing the driver to get out as normal.”

Following Mekies’ presentation, delegates at the conference were given the opportunity to participate in a practical workshop using the FIA Institute chassis fitted with the halo structure. Professor Piette introduced the workshop and he explained that there should be no problem for extrication teams to remove a driver from the car following an accident. “The main difference is there is something that makes it more difficult to access the driver and for the initial phases, the arms of some extrication team members go under the halo,” he said. “The accessibility is a little bit reduced, although not so much. “Lifting is a little bit different as the space over the driver has been slightly reduced in

F1 drivers Jolyon Palmer and Marcus Ericsson try out the halo device

AUTO+MEDICAL FEATURES

front, so you cannot lift the seat vertically in a single motion. At the end you also have to rotate it and put the trunk forward a little bit with some inclination.” Yet with practice extrication teams would be able to remove a driver as easily as they did before. To demonstrate this, an extrication team from the Red Bull Ring circuit provided a live demonstration of both a normal extrication and an emergency extrication. In each case the driver was successfully immobilised and lifted up and out of the car. The workshop allowed delegates to see the halo structure from their own perspectives and afterwards they gathered together for a discussion on the system’s practicality. When responding to a question as to why the halo had not been made of carbon fibre, Piette explained that the decision had been made to use titanium, to avoid the risk of that material breaking apart and injuring the driver. Although a decision on the use of halo will not be made until mid-2017, such workshops will ensure that safety and medical teams will be ready if it gets the go ahead. Finding the edge German Air Force pilot Fabian Berger gave a presentation about a new technology that he hopes will improve the preparation of extrication and medical car teams. “What we wanted to do was bring a little more safety to motor sport and try to use tools from aviation and convert them to racing,” he explained. “I fly a fast jet [and] I spend 30 hours training every year in the simulator. Everybody always asks me, ‘does that stuff work?’ [and] a simple, ‘yes’ is probably not enough.” Berger described how he set out to find statistics to back up the theory, which he developed with his fellow GAF and DMSB 20

“

We wanted to achieve efficient conduct on-track and off-track by training non-technical skills

”

Academy instructor Dr Sven Marquardt, and he discovered that accident rates can be reduced by an increased awareness of Race Resource Management and human factor training. “We wanted to achieve the safe and efficient conduct of duties on-track and off-track, [and

AUTO+MEDICAL FEATURES

we do that by] training non-technical skills such as communication, decision making, leadership and so on with the overall aim of safer environments to work in and the higher efficiency of the [safety and medical teams],” he said. Berger and his team devised a method of “simulate, teach, repeat” to improve the performances of extrication and medical car crews. This involved setting out a simulated scenario with a chassis or a real race car, and holding training extrication scenes that are observed by cameras and microphones. The extrication process is filmed and

afterwards the participants gather to watch the footage, learn what went right or wrong and how better communication and organisation could improve their routine. The process repeats until the required level is reached. After gathering enough materials to approach software firms, Berger arranged a test with the Vienna-based SIMstation company that took place at the Hockenheim circuit in October 2016 and was attended by the track’s extrication team as well as staff from the Nurburgring’s equivalent squad. An Audi TT Cup car was arranged with cameras set up to capture an extrication exercise. Afterwards, the software allowed Berger and his instructors to analyse the team’s performance more in-depth than they had previously been able to. “The nice thing about it is that you can actually annotate everything that happened, jump back and forth, and zoom up the monitors on the different screens, stop, rewind [and] fast-forward,” he said. “It’s a pretty cool tool to use.” In the future, there are plans to refine the process and software so that it can be standardised and used to train officials from all over the world. Berger is also looking into adding eye-tracking systems to see where people are looking when they perform tasks, as well as adding in critical incident reporting methods and real-time transmitting systems. But the feedback gathered from the German officials already trained in RRM and human factor subjects has led to Berger believing that the process could bring significant improvements to motor sport safety. He said: “They like it because it’s something new and most of the time it’s [about] things they didn’t think about [already]. It will actually help them make less mistakes than before.” 21

AUTO+MEDICAL FEATURES

Mission Accomplished

The FIA Institute will complete its mission at the end of 2016, leaving behind a legacy of improved safety and sustainability in motor sport championships around the world.

FIA Institute timeline

2004: FIA Institute for Motor Sport Safety formed with a grant from the FIA Foundation and Prof. Watkins as President.

2005: Launches the Medical Training Working Group to improve education and training for motor sport medics and marshals.

2005: Develops new high performance wheel tethers for F1.

2005: Appoints the Paul Ricard High Tech Test Track as its first Centre of Excellence.

2005: Ele GĂŠrard Sa Deputy P

ects Prof. aillant as President.

AUTO+MEDICAL FEATURES

At the end of 2016, the FIA Institute will hand over the responsibility for its safety research and education initiatives to the Global Institute for Motor Sport Safety and the FIA respectively. It will be doing so having hugely improved motor sport over the last 12 years, with a series of research and education programmes that will have a lasting impact. “The legacy of the FIA Institute is that it created a worldwide culture of safety,” says Dr Terry Trammell, one of the Institute’s Founding Fellows. That cultural shift was instigated by the FIA Institute’s first President, Professor Sid Watkins, who was instrumental in bringing a professional attitude to motor sport safety and medicine. He was at the forefront of many research studies the Institute carried out and completed, the results of which were subsequently

2006: Launches ‘Race True’ anti-doping campaign launched in partnership with World Anti-Doping Agency (WADA).

2006: Delivers new CIK bodywork specifications for international karting.

2006: Wins Safety Innovation of the Year award at the Professional MotorSport World Expo Awards for the development of a new high-speed safety barrier.

2007: Launches Medical Faculty, consolidating the expertise of motor sport doctors and medical staff around the world.

AUTO+MEDICAL FEATURES

implemented into the rules of many high profile championships. In Formula One, the Institute’s work can be seen in almost every area of the sport: highperformance wheel tethers, advanced side impact systems, award-winning high-speed barriers, increased cockpit protection and reinforced helmets are just a few of the projects that have been brought to fruition. But it is not just at the top level that the Institute has been working. With the support of the FIA Foundation, which has provided an annual grant for research projects, the Institute has improved safety at every level of the sport, from karting to touring cars and electric racing to rallying. “The FIA Institute’s legacy is the promotion, on a world-wide stage, of the concept that the risk of injury and death in motor sport is not inevitable or that it is influenced largely by luck and common sense,” says Dr Michael Henderson, another Founding Fellow. “But that risk can best be managed by the application of science based on well-established biomechanical and biomedical principles.” Safety technology for up-and-coming drivers was the subject of a number of the Institute’s research projects over the years. This focus led to a pioneering study to develop a crash helmet specifically for young drivers. Previously it was thought that a young driver helmet should just be a smaller version of an adult one but tests proved that this was not the case due to the way the human neck develops.

2007: Strengthens F1 chassis specifications with addition of secondary zylon panels.

2007: Appoints Bahrain International Circuit as Centre of Excellence.

Dr Michael Henderson hailed the Institute for changing perceptions

Dr Terry Trammell feels that the Institute created a culture of safety

For Trammell, the young driver helmet study is a project he is particulatrly proud of, as it brought together researchers from different parts of the world to improve safety for young competitors. “The development of the youth helmet has probably impacted the future of the most lives,” he explains. “This project demonstrated the power of the FIA Institute to bring together resources on both sides of the pond, in that myself and my wife Rhonda and Dr Stephen Olvey did the anthropometric studies to define the size and shape of a child’s head. This proved beyond a doubt that a child is not a small adult and that simply ‘shrinking’ an adult proportioned helmet was not appropriate or scientifically valid. Using this information the engineers – Andy Mellor most notably – were able to write a specification for the appropriate proportions and through the Industry Liaison Group bring the helmet to market.” Trammell believes that the Institute’s work to

2007: Completes groundbreaking project to develop a crash helmet specifically for use by young drivers, certified as the 8859 standard.

2008: Launches extrication and rescue programme.

2008: Develops new side-impact safety system for cars in the FIA World Rally Championship.

200 to r and ph Toy

AUTO+MEDICAL FEATURES

Graduates from the Young Driver Excellence Academy include F1's Stoffel Vandoorne, WRC's Andreas Mikkelsen, Indycar's Alexander Rossi, WRX's Timmy Hansen and Formula E's Robin Frijns

“

The legacy of the FIA Institute is that it created a worldwide culture of safety Terry trammell

08: Utilises computer simulation recreate high-speed accidents d their effects on human hysiology, in conjunction with yota Motor Corporation.

”

2008: Wins second Safety Innovation of the Year award at the Professional MotorSport World Expo.

shift the sport’s philosophy towards making safety a top priority over the last 12 years inspired other organisations to create their own enterprises to promote that message around the world. “The impact of the Institute on the sport worldwide has been enormous, not only with the introduction of safety devices such as the

2008: Is appointed to manage the programmes of the Motor Sport Safety Development fund.

2008: Introduces Accident Data Recorders (ADRs) into the FIA World Touring Car Championship for the first time as part of a programme to bring the technology to all forms of racing.

AUTO+MEDICAL FEATURES

“

The FIA will continue the good work of the education programmes

2008: Holds Medicine in Motor Sport summit at the Bahrain International Circuit to help improve medical facilities and safety in motor racing worldwide.

”

2009: Helps NASCAR to host its inaugural officials’ safety internship.

2009: Is nominated for the ‘Safety Initiative of the Year’ award at the Professional MotorSport World Expo for its book on Medicine in Motor Sport.

2009: First-ever Motorsport Development Workshop takes place.

2009: Appoints first Regional Training Providers – UK’s MSA and Australia’s CAMS – who are used to help increase the safety and training standards of motor sport officials across the world.

AUTO+MEDICAL FEATURES

Head And Neck Support device, now the Frontal Head Restraint, but more importantly with the cultural change to one of safety first,” he says. “This cultural change has strengthened the links amongst organisations dedicated to driver safety and development, such as the International Council of Motorsport Sciences; the Road Racing Drivers Club’s SAFEisFAST portal; and the Motorsports Safety Foundation." In addition to its safety work, educational and environmental initiatives have been a core part of the Institute’s mission over the years. In 2005, the Medical Training Working Group was launched with a remit to raise the standards of medical training in motor sport around the world. This was followed by the ‘Race True’ antidoping campaign that was run in partnership with the World Anti-Doping Agency in 2006, and the extrication and rescue programme that was offered to over 160 race circuit marshals and medical personnel from around Europe in 2008. The Institute was also put in charge of managing the programmes of the Motor Sport Safety Development fund, which distributed $60 million for the benefit of motor sport development worldwide, from 2008 to 2014. To help with this the Institute held a series of Motorsport Development Workshops in Asia, Africa, South America and the Middle East. In 2009, the Institute expanded its remit to include motor sport’s impact on the environment. Its Sustainability Programme has helped to encouraged numerous stakeholders to improve their environmental performance through an accreditation programme that asks

2009: Expands remit to include motor sport sustainability as well as safety.

2010: Launches Young Driver Excellence Academy.

2011: Publishes Medicine in Motor Sport book worldwide.

2011: Publishes Driver’s Guide to Safer Motor Sport, a handbook for drivers that serves as a reminder of important safety measures before, during and after they race.

2011: Appoints motor sport medical expert Dr Paul Trafford as medical adviser.

AUTO+MEDICAL FEATURES

organisations to meet a series of best practice principles. Currently, there are 19 organisations that have achieved accreditation – including the McLaren Formula One team, the Formula E championship, and several World Rally events. Interest in this scheme, which will continue under the FIA, is growing. The Mahindra Formula E team became the latest organisation to be accredited and Garry Connelly, the FIA Institute’s Deputy President and Environmental Ambassador, has called on more motor sport stakeholders to make similar commitments. “When it comes to the environment there is always more that we can do,” he said. “I therefore encourage others to follow the example set by the accredited organisations that are already involved and sign up to join the programme going forward.” One of the highlights of the Institute’s education programme was the Young Driver Excellence Academy, which aimed to develop talented young drivers from across the world with a programme that would encourage safety and responsibility as well as speed. Many of the Academy’s graduates have gone on to achieve great success, including F1 driver Stoffel Vandoorne, WRC driver Andreas Mikkelsen and Indy 500 winner Alexander Rossi. “The educational programmes have drawn attention to the body of knowledge that the Research groups built,” adds Trammell. “The ability to use the FIA Institute as an information distribution centre has brought the safety message to the world stage.”

2011: Prof. Sid Watkins retires from Institute Presidency after eight years; Prof. Gérard Saillant elected as new President.

2012: Launches global sustainability certification programme for motor sport stakeholders to help them measure, improve and be recognised for their environmental performance.

There are 19 organisations accredited in the Institute's Sustainability Programme

2012: Launches accreditation scheme for Young Driver Safety Programme.

2012: Holds Medicine in Motor Sport Summit in Istanbul focusing on the pathway to medical care and accident data collection.

2013: Formula One team becomes the first motor stakeholder to be accred highest level in the Instit Sustainability Programm

m McLaren r sport dited at the tuteâ&#x20AC;&#x2122;s me.

AUTO+MEDICAL FEATURES

2013: Young Driver Excellence Academy qualifying events expanded to five, enabling more drivers than ever the opportunity to benefit from training.

2013: Develops new advanced side impact protection system for use on all Formula One cars.

2013: Launches Medical Accreditation Programme for ASNs to benchmark themselves against the highest standards of medical training.

2013: Creates Formula One extrication simulators that are sent to circuits around the world for teams to practice and train ahead of international motor sport events.

AUTO+MEDICAL FEATURES

The advanced side impact protection system was developed for F1 in 2013 to reduce the risk of injuries occurring during crashes such as this at the 2010 Belgian GP

2013: Rally Australia becomes first motor sport event to receive highest award in the Environmental Certification scheme.

2014: Launches online Carbon Management Portal to enable motor sport stakeholders to reduce their carbon footprint.

2014: Launches AUTO+ Medical, a new journal that helps to provide the latest news and information to medical and safety personnel worldwide.

2014: UK Motor Sports Association becomes first ASN to gain highest accreditation in Sustainability Programme.

2015: Launches first Watkins Scholarship in honour of the safety pioneer.

AUTO+MEDICAL FEATURES

By the start of 2016, the Institute’s education programmes had expanded to include officials, medical and young driver safety training courses that aimed to advance the development of participants at all levels in the sport. National Sporting Authorities could also sign up to become accredited Regional Training Providers for these programmes and help teach the latest techniques and theories to new officials, drivers and medical personnel. Dr Paul Trafford, who was appointed as a medical adviser to the FIA Institute in 2011, hailed the Institute’s education initiatives and the impact they have had on motor sport. “The Institute has educated marshals, officials and competitors and helped ASNs to develop training programmes aligned to a high uniform standard, which can only be a good thing for the sport,” he says. “I have been fortunate to be involved in implementing some of the training and working with young drivers from all over the world, seeing how important it is to make them aware of issues concerning safety and driving.” “I think ex-Formula One and WEC driver Alex Wurz and former WRC codriver Robert Reid did a tremendous job xxxxx with the Young Driver Excellence xxxxxxx Academy. More recently thexxxxxxx environmental programmes have been

2015: Completes Formula One high speed camera study in conjunction with the new Global Institute. Technology is incorporated into the championship for the start of 2016.

2015: The all-electric Formula E series becomes the first championship to be accredited in the Sustainability Programme, with Achievement of Excellence.

“

we are immensely proud of the work The Institute has completed over the last 12 years

”

developed, which is important in motor sport to show we aren’t just focussed on burning fossil fuels. There is a long way to go and the FIA will continue the good work with these education programmes.” From 2017, the FIA will take on the education programmes and the Global Institute will handle safety research. This ensures the legacy of the Institute will be maintained and its hard work will be seen in motor sport competition for many years to come. “Although the FIA Institute will close at the end of 2016, we are immensely proud of the work we have completed over the last 12 years,” said Gérard Saillant, President of the FIA Institute. “This could not have been achieved without the enduring support of the FIA Foundation, which has backed our activities throughout. We look forward to this work being continued by the Global Institute and the FIA.”

2015: Completes racing net study to reduce the risk of injury to touring car and GT drivers during side impacts.

2016: Five more ASNs, six WRC events and a championship gain accreditation in the Sustainability Programme.

AUTO+MEDICAL FEATURES

On the scene: motor sport paramedics Paramedics are the unsung heroes of motor sport. Without them many races would not go ahead. They are often stationed at various points on a course or circuit, ready and waiting to respond to any incident including those involving competitors, officials or spectators. AUTO+ Medical spoke to three paramedics from around the world about their experience of working as a first responder at a major motor sport venue or event.

Silverstone circuit John Atkins I have been involved in the provision of emergency medical care at motorsport events both on land and on the water for over 25 years, but I was invited to join the Silverstone Medical Team after attending an advanced trauma life support (ATLS) course there at the beginning of 2015. In addition to the ATLS course, which was delivered at the Circuit Medical Centre by a faculty of highly experienced motor sport doctors, I completed a full circuit orientation covering all aspects of the roles I would undertake. Paramedics working in motor sport should be competent in advanced life support and trauma life support but also need to understand and be familiar with the differences between standard â&#x20AC;&#x2DC;road traffic collisionsâ&#x20AC;&#x2122; and incidents involving racing cars or bikes. The kinematics of a high-G impact and an adrenaline-fuelled racing driver 32

AUTO+MEDICAL FEATURES

Atkins has worked at many events including the World Endurance Championship

wearing a helmet and HANS strapped into a cramped single-seater car present a very different scenario to an incident involving a driver slumped over the steering wheel of a typical family saloon car. As a Paramedic working in UK motorsport I hold a UK Motor Sport Association official’s licence and I am fortunate that this has enabled me to attend several MSA training days covering rescue and extrication techniques, and equipment associated with those practices, which are unique to or have been adapted for motor sport. In addition to working at Silverstone, I am also a member of the travelling medical and safety team for Formula E and this has involved further specific training in the electrical hazards unique to this all-electric single-seater racing series. I can be allocated to work on one of the circuit’s three medical cars, which are

normally crewed by a paramedic and a doctor. These are deployed by Race Control and are the first medical resource at the scene of an incident. Alternatively, I can be allocated to work on one of the circuit’s four ambulances, alongside another paramedic or a technician. These are there to support the extrication and initial treatment of the injured and to transfer casualties to the circuit’s medical centre, or sometimes move them onwards to a local hospital. In addition to trackside cover, I have also worked in a response car covering the crowd at some of the larger events where the Silverstone medical team personnel work alongside British Red Cross volunteers. I have worked at many different events at Silverstone, both large and small. These events have included the Hankook 24 Hour races, the World Endurance Championship, British Super Bikes and MotoGP, British 33

AUTO+MEDICAL FEATURES

The medical centre at the Silverstone circuit

airway, breathing and circulation – including catastrophic haemorrhage – and a range of splints and other devices to immobilise the head, spine and limbs. The circuit’s medical centre is staffed by doctors and nurses during race meetings and includes a comprehensively equipped four-bed resuscitation room, two-bed minor treatment area, an x-ray imaging suite and burns unit, with a helipad right outside. Though it is true to say there are periods of inactivity when providing medical cover for motor sport, I have responded to numerous incidents, both on and off the track. These

“

one of the best things about being a member of the Silverstone Medical Team is the sense of being a member of a family Racing Trucks, World Series by Renault [now Formula V8 3.5] and the Formula One British Grand Prix. In addition to the weekend race meetings, medical staff are present during the week too, and we cover track days, corporate track hire and driving experiences, TV filming and Formula One testing. Whenever there is track activity, medical cover has to be provided. The medical cars and ambulances that we use at Silverstone are fully equipped with a comprehensive range of medical and rescue equipment to enable immediate life-saving treatment to be performed at the scene, and safe and expeditious extrication to be achieved. This includes equipment and drugs to manage problems affecting 34

”

have included drivers and riders with all manner of racing related injuries large and small, but also marshals and circuit staff, and members of general public with a wide range of injuries and illnesses, from minor cuts and bruises to heart attacks. Given the size of the crowds at some of the larger events – approximately 140,000 attend the British Grand Prix – you can expect to see most things at Silverstone. However, I’m told we’ve yet to have a baby born at the circuit! Working in motor sport medicine isn’t for everyone but one of the best things about being a member of the Silverstone Medical Team is the sense of being a member of a family.

AUTO+MEDICAL FEATURES

Abu Dhabi Grand Prix Darren Green My role as a clinical operations supervisor with National Ambulance Abu Dhabi requires me to plan the day-to-day medical provision at the Yas Marina Circuit. The Abu Dhabi Grand Prix is the biggest event in the sporting calendar and I have been fortunate enough to play a key role in the planning of the event, as well as operating during the event as a paramedic. The FIA Instituteâ&#x20AC;&#x2122;s Formula One extrication simulator is a fantastic piece of equipment and we are fortunate enough to have one at the Yas Marina Circuit medical centre. It is used by the medical team in preparation for

Green at the 2014 Abu Dhabi GP

The Abu Dhabi Grand Prix attracted 60,000 spectators in 2015

AUTO+MEDICAL FEATURES

Max Verstappen at the 2015 Abu Dhabi Grand Prix

the Formula One race, and it has given me the opportunity to get a feel for the unique difficulties faced when dealing with incidents involving single seater cars, as well as the injury patterns associated with the sport. The Yas Marina circuit is a busy motor sport venue, so when not operating the Formula One event, we are able to continuously practice, learn and refine our approach to motor sport incidents, and simulate scenarios using the excellent facilities we have access to. If someone asked me what skills paramedics working at a Grand Prix event need to have, then I’d say, in one word: patience! The medical team is on duty for long shifts over a four-day period. Thankfully, Formula One is renowned for its safety, so it’s not all fast paced action for the medical team. Of course, 36

this can change in a split second, so I would say the most important skills a paramedic needs to have are the ability to keep calm under pressure, excellent communication skills and the ability to work well within a multi-disciplined team. The event is televised, high profile, loud and long, with lots of people working together for the first time. So it’s challenging, but for most, that’s the draw. I would describe my experience of working at the Abu Dhabi Grand Prix as surreal. Grand Prix meetings around the world are exciting events with an excellent fan base, but the Abu Dhabi organisers really do know how to add finesse to the final race meeting of the season. In 2014, I was based in the pit lane; it was all down to the last race to decide the driver’s championship and the

AUTO+MEDICAL FEATURES

excitement and apprehension was palpable, a truly unforgettable experience. I have been fortunate enough to have witnessed the world’s greatest drivers push themselves and their cars to the limit, all the while knowing that I could be dispatched to an incident involving them at any second. It’s enough to keep us all on our toes. The training, preparation and knowledge that an excellent medical team surrounds me helps to ease the pressure. Safety and communication are of paramount importance during the event. The equipment we carry includes a radio, headset, flame retardant overalls, and

“

I would definitely encourage anyone considering working as a paramedic at motor sport events to give it a go

”

specially designed KERS gloves, and boots are essential when operating as a paramedic, particularly when on foot in the pit lane. The equipment I carry is a condensed version of what a frontline emergency ambulance would have. The advantage of having all of the key pieces of kit in a purpose built and designed ‘grab bag’ means that as a paramedic I am able to quickly respond to an incident and conduct life saving interventions. The intention is to stabilise critically ill or injured patients and ensure safe packaging before they are transported to definitive care. Given the risk of serious trauma, the grab bags are kitted with drugs and equipment to prevent life threatening blood loss and

assist with seriously compromised airways, as well as pelvic binders and C-Collars. I would also carry an automated external defibrillator (AED); this is a lighter, more compact version of the defibrillators in each of the ambulances, allowing life saving treatment of patients in cardiac arrest. Last year there was a big crash during the GP2 support race, but thankfully all the drivers involved walked away from the incident without any serious injuries. This is quite often the case because of how, in relative terms, safe, the sport has become. Working at the Abu Dhabi Grand Prix and other big race meetings has, however, taught me an invaluable lesson as a paramedic at motor sport events that I can transfer into my day-to-day practice. The obvious high-risk event is happening in front of you, packed with adrenaline and big crowds. It is very easy to become consumed by the race and focus on the participants involved when a collision occurs. Paramedics don’t routinely witness the incident they respond to, so it is an unusual environment to operate in. I have attended incidents as a result of debris from collisions that appear minor, but result in injuries to those nearby, or in some cases, quite some distance from the scene of the incident itself. It’s an important lesson in making sure you have situational awareness and take in the whole picture. Working at the Abu Dhabi Grand Prix has given me the opportunity to explore an area of pre-hospital emergency care as a paramedic that is unique. I have learned – and laughed – a lot. I have met and worked alongside people that I now consider to be friends. I’d definitely encourage anyone considering working as a paramedic at motor sport events to give it a go. 37

AUTO+MEDICAL FEATURES

Rally Finland Esa Kokko I work as a teacher at the Emergency Services College in Kuopio, where most of Finlandâ&#x20AC;&#x2122;s fire-fighters and paramedics are trained. Our college was offered a chance to work at the Neste Rally Finland rescue organisation. In my job I guide our students and participate in this type of training exercise every week at the college. We discuss the exercises with the students, give them feedback and also develop the exercises with the other teachers, in order to make them as

Kokko, third from the right with WRC star Jari-Matti Latvala

AUTO+MEDICAL FEATURES

Kokko covers rescue drills every week with the ESC in Kuopio

close to real-life as possible. I also work at the local fire department whenever I can, to keep in touch with fieldwork. In general, the rescue staff trains for motor sport accidents periodically and for Neste Rally Finland we have a common training day before the event. The rally organisation requires toplevel qualifications according to national laws, and obviously we need to know our way around with any special equipment required by the FIA that is used at the event. It is very important to have a broad understanding of how the rescue services work together in Finland and to be a team player. Working at Rally Finland is a fantastic opportunity to work in a multi-authority environment together with a great team of professionals. Paramedics working at Rally Finland use an advanced level paramedic unit according to national healthcare laws, which includes all the necessary equipment and medicines. We also carry some extra

equipment as per FIA regulations, some of which are non-standard in Finland, or we use a different system for the same purpose. When it comes to particular incidents that I’ve had to respond to and deal with during a Rally Finland event I can recall nothing out of the ordinary, really. There have been normal cases of accidents and acute illnesses – mainly among the spectators or residents, but not that much with the drivers. It is great to work in a team that really wants to make everything work perfectly, and wants to do it together. There is a true team spirit among the paramedics, doctors, organiser’s staff and the stage teams – I think that all of this makes Neste Rally Finland one of the best events in the WRC. Would you like to work as a paramedic at a motor sport event? Write in to AUTO+ Medical at: medical@fiainstitute.com

AUto+mediCAL feAtURes

on sIte: 2016 cIk-FIa JunIor world chaMpIonshIp AUTO+ Medical takes a look at the facilities and personnel put in place for the final CIK-FIA junior karting event of the 2016 season Last month, the fi nal 2016 CIK-FIA Junior World Championship karting event took place at the Bahrain International Karting Circuit, a 1.415km 14-turn track built at the Sakhir circuit that hosts the Formula One Bahrain Grand Prix. The karting venue holds eight ‘Arrive and Drive’ rounds using 13hp rental kart racing machines each year, along with six Rotax events that feature professionalgrade karts of up to 32hp, and three Endurance races. The fi nal discipline is split into two races of three hours and one that lasts 24 hours. The facility can be arranged into six diff erent layouts, and has been awarded a CIK Category A license. For the Junior World Championship event, the Bahrain International Circuit’s (BIC) medical centre was ready to be utilised in the event of a competitor needing medical treatment after a crash, or if they needed to be observed before being discharged. The BIC medical centre was also prepped to deal with any anti-doping tests that may have been needed. Before the karting event took place, the Bahrain Motor Federation arranged two standby hospitals to be ready to receive any driver injured in an incident at the track. There was also a pre-event simulation of transporting a patient away from the track to train the medical team in the best method of patient evacuation.

AUTO+MEDICAL FEATURES

AUto+mediCAL feAtURes

1) The medical team of the BMF at the CIKFIA karting event was made up of six doctors â&#x20AC;&#x201C; including the Chief Medical Offi cer â&#x20AC;&#x201C; eight nurses, six paramedics and two emergency and critical care ambulances.

4) The medical team was split into four onfoot teams distributed at the four corners of the karting circuit. Each team was made up of one doctor, nurse and a paramedic.

2) In the run-off area in the middle of the track, a golf cart was positioned that was to be used to evacuate any injured driver.

5) The CMO of the event was stationed in the Race Control room along with chief paramedics.

3) The medical clinic accommodated two crash beds, one crash cart and all the necessary equipment for an initial management of any medical or traumatic injury before the injured party was transported to the standby hospitals as per CIK regulations.

6) The medical room was staff ed with a qualifi ed surgeon, an emergency physician and two emergency and critical care nurses.

AUto+mediCAL feAtURes

7) Medical coverage for the spectators attending the event was provided and a satellite clinic was put in place in the vending area.

8) In addition to covering the days of the practice and the race, medical coverage was provided in the garage area for six days from the 14 November, with personnel on standby during the pre-event setup of the teams.

The medical team for the event included bahrain cMo dr amjad obeid, Fia's dr Jacques Tropenat and ciK cMo dr osama awad

AUTO+MEDICAL FEATURES

The road back:

James Hinchcliffe The IndyCar star looks back on the near-fatal injury he sustained during practice for the 2015 Indianapolis 500 and offers his perspective on returning to racing

During the post-qualifying practice session for the 99th edition of the Indianapolis 500, Schmidt Peterson Motorsports driver James Hinchcliffe crashed heavily at the track’s third corner when his suspension failed at over 220mph. The impact caused a suspension component to pierce the Canadian driver’s cockpit and pin him to the side of the chassis, which severed an artery in his leg and left him losing blood at an alarming rate. The 29-year-old survived after emergency surgery and returned to IndyCar action at the start of 2016, before going on to claim an emotional pole position for this year’s Indy 500. He spoke to AUTO+ Medical about the incident and his recovery. AUTO+Medical: What happened during your crash in the practice session for the 2015 Indy 500? James Hinchcliffe: A suspension component failed mid corner causing me to strike the wall at over 220 MPH. As a result, part of the suspension shot through the tub and penetrated my body. I’ve said before that I was pinned to the car like a shish kebab because I hit the wall and the impact forced a metal rod through my lower right thigh and it came out of my upper left thigh. It went in one leg, hitting an artery on the way, and it came out clean on the other side. 44

A+M: What do you remember about the accident? JH: Absolutely nothing. I suffered a severe concussion and have no memory of the accident, so it was a case of waking up in the hospital. A+M: Do you know what medical care was given to you at the circuit? JH: Well, although I have no memory of the crash, I have no doubt that the safety crew at the Indianapolis Motor Speedway saved my life that day. I know they had a lot of difficulty getting me out of the car because I was literally pinned to the side of it by the suspension part. But they worked hard and fast and got me out of the car and into an ambulance. At that point they realised just how bad my condition was when they saw how much blood I was losing. Because of the severity of my condition we broke the protocol of going to the infield medical center and instead went straight for Methodist hospital as soon as I was in the ambulance. A+M: What treatment did your receive in hospital? JH: The first thing they did was to get blood back into me. I have since found out that when I was brought in by the ambulance crew, I was taken straight into the emergency treatment room, where they put me onto a

AUto+mediCAL feAtURes

hinchcliffe crashed at 220mph during post-qualifying practice for the 2015 indy 500

AUTO+MEDICAL FEATURES

transfusion machine to start pumping blood back into me. So, once I was hooked up to blood machines, the next thing was to get me into surgery to fix the artery that had been hit. Once I was out of surgery things were mainly focused on caring for my wounds in the ICU room where I spent the next two days.

be in hospital for a month and I wouldn’t drive a car for six months. But I walked on day four, was out of hospital on day ten and went on to drive a car four months later.

A+M: What did they tell you to do to aid your recovery process? JH: The biggest thing was rest. They knew I’d want to push myself to get better as fast as A+M: When did you realise how severe your possible, but pushing yourself too hard, too injuries were? soon would do more harm than good, so I had JH: I remember that one of the first questions I to focus on giving my body the time it needed asked when I woke up in ICU was, “when can I to fully heal. get back in the car?” and the doctors just stared at me in complete disbelief. But a few A+M: You missed the rest of the 2015 days after the accident I had a very candid season, what did you do in that time to conversation with my parents and my surgeon recover from your injuries? and that’s when I really started to understand JH: I did as little as possible. Since rest was the the severity of it all. best thing for my body I made a game out of how much rest I could get in a day. The faster A+M: What did the doctors treating you tell my wounds healed, the sooner I could get back you about your injuries? Did they give you to training and preparing to be back in a car. a time frame for recovery? JH: They said I wouldn’t walk for two weeks, I’d A+M: What was it like when you got back in

The impact occured at 220mph

AUTO+MEDICAL FEATURES

JH: No, I made a 100 per cent recovery with no lasting side effects. But I could have died in the crash and it’s really thanks to the help of a number of specially trained and dedicated medical professionals who treated me that I am still around today. A+M: You took pole for the 2016 Indy 500 one year after your crash, how did that Hinchcliffe with Dr feel? Timothy H. Pohlman, who helped stabilise JH: That was a very special moment for the him after the crash whole team. We all suffered through the last year together, so to go back to the place the car ahead of the 2016 season? How did it where it happened and show that we were feel driving the car for the first time? stronger than ever was an amazing feeling. JH: It felt great being back behind the wheel. It was the moment I’d been looking forward to for A+M: How would you rate the medical four months. I was anxious to see if there were care given to you at the circuit and later any issues, physically or mentally, and luckily in hospital? there were none. JH: I would definitely say it was ten-out-of-ten. I remember getting back into the car for the There’s no doubt in my mind that the quality first time, and it was a bit weird doing the of care I received kept me alive, got me back in installation procedure because I had not been the car quickly and assured I’d have no lasting through all of that stuff in such a long time. issues moving forward. When I went out on track I was going a bit slower than normal to make sure I got A+M: Do you think there is anything motor everything correct, and that also felt a bit weird. sport medics could learn from what I think it was because I was questioning how happened to you? just the installation lap could take so much JH: I think the lessons learned in the past mental capacity and then wondering what played a key role in my survival. The driving the car at top speed would be like. understanding of the situation and the ‘in the In total, I believe it probably took about five moment’ decisions made the difference laps before I was able to feel totally between life or death. Only decades of comfortable and the sensation of driving the experience can prepare a group for that. car took over again, but once I had got to that stage, it all came back pretty quickly. I started to A+M: What advice would you give to other push a little harder each lap until I was on the drivers who are recovering from an injury? limit once again. JH: Listen to your doctor! The biggest thing is to not push too soon. We all want to get back A+M: Did the injuries you suffered in the to work as soon as possible, but the body crash have any impact on your driving this needs what it needs to heal. There’s no season? shortcut to recovery. 47

AUTO+MEDICAL SCIENCE

Science

Physiological Responses of Female Motor sport Athletes to the Environment of the Cockpit: A Case Study

In a groundbreaking new study, Dr Edward Potkanowicz examines the physiological responses of female drivers to the unique conditions competitors endure in the cockpit. Corresponding Author: Edward S. Potkanowicz, Ph.D. Article reviewed by: Prof. Hugh Scully, Professor of Surgery & Health Policy, University of Toronto; and Dr Jonathan Wheelan, Consultant in Anaesthesia and Pre-Hospital Emergency Medicine

Susie Wolff is the most recent female driver to take part in an F1 Grand Prix weekend

ABSTRACT Driver science is the scientific examination of a racing driverâ&#x20AC;&#x2122;s response to the cockpit, and this term applies to both genders. After an exhaustive review of the literature for investigations involving female drivers, none were found. This case study is therefore offered to quantify the core body temperature, heart rate, and physiological strain of female drivers in real-time and also as an attempt to gather and include female driver data in the growing body of driver science work. For the study, two female drivers were observed during a 40-minute session on a 2.75-mile, 21-turn, clockwise course and their core body temperature and heart rate data were collected simultaneously and physiological strain values were derived from this data. 49

AUTO+MEDICAL SCIENCE

By examining the minute-by-minute data, it can be seen that female drivers are challenged to the same degree as their male counterparts. However, recommendations for how female drivers can prepare for the rigors of the cockpit are not as obvious, or available. Given that the genders differ in their response to uncompensable heat stress, one must consider gender in decisions around and involving driver training and preparation. Although there is overlap, gender specific recommendations also need to be made. Gender is one of many issues that need to be addressed in order for driver safety to become more comprehensive. Introduction The term driver science, which was first coined by Potkanowicz and Mendel (1), is defined as the objective and scientific examination of a driver’s physiological response to the cockpit from which databased recommendations can be made to improve driver safety, tolerance and performance. Although this term applies to both male and female drivers, an exhaustive review of the literature for investigations on the physiological response of the female driver to the environment of the cockpit yields nothing within the published literature. But when examining the motor sport driver community, women are found in just about every kind of racing and at just about every level. While there isn’t an exact figure to attest to an increase in the number of female drivers, anecdotally, the number is growing. This dearth of published work supports the contention that while we have learned 50

Pippa Mann at the 2016 Indy 500

“

Motor sport should strive to evaluate the responses of all drivers, male and female, to the cockpit environment

”

“some” about the male race car driver, we have learned nothing about the female race car driver (2,3,4,5,6,7,8). For example, where authors such as Brearly and Finn (2), Carlson, Ferguson, and Kenefick (3), and Potkanowicz (7) have confirmed the significant increase in

AUTO+MEDICAL SCIENCE

To that end, this case study is offered for the following two reasons: to quantify the core body temperature, heart rate, and physiological strain values of female drivers in real-time on a minute-by-minute basis, and, secondly, as an attempt to gather and include female driver data in the growing body of work relating to driver science.

core body temperature of male drivers, no such work exists for women. Where Jacobs, Olvey, Johnson, and Cohn (6) have demonstrated the metabolic demand of competitive driving, no such work exists for women. Ebben and Suchomel (5) offer training recommendations for the driver athlete, but, again, no such recommendations exist for the female driver athlete. If the motor sport community is truly interested in promoting safety, then the community should strive to examine, quantify, and evaluate the responses of all drivers to the environment of the cockpit, male and female.

Methods Participants Four female amateur Sports Car Club of America (SCCA) licensed drivers were recruited to participate in the study. As part of the SCCA licensing process, drivers are required to undergo a regular physical examination. As such, each of the four drivers was in good apparent health and of adequate fitness, with no reported conditions that would compromise their performance or thermoregulation. Each of the drivers volunteered and each were provided with, and signed, an informed consent in accordance with the human participant practices of the principal investigatorâ&#x20AC;&#x2122;s institutional review board. There was an equipment failure during the study and as a result only two driver data sets were used. The demographics and characteristics for those two drivers are provided in Table 1.

Table 1 Participant Demographics/Characteristics Characteristic

Driver #1

Driver #2

Age (yrs.)

Height (cm)

165.1

175.3

Weight (kg)

67.13

63.87

Body Surface Area (m2)

1.740

1.779

AUto+mediCAL sCienCe

a corTemp recorder was placed on each driver’s right hip

aPParaTuS The HQ CorTemp ingestible core temperature probe was used to assess driver core body temperature. Four hours prior to driving, each participant consumed the probe according to the manufacturer’s instructions. Using the HQ CorTemp Data Recorder, set in auto-run mode, body temperature was monitored in real-time. In the auto-run mode, a data point is logged every 60 seconds. The recorders were affi xed to the belt of each of the driver’s fi re suits and positioned above 52

the driver’s hips. In this position the recorder did not interfere with the driver’s safety harness or driving (see Figure #1). A Polar T-31 un-coded heart rate monitor was used to assess driver heart rate. The T-31 pairs with the HQ Data Recorder and allows for the simultaneous and synchronous collection of core temperature and heart rate. During the evaluation, the driver’s heart rates were measured every 60 seconds. To ensure the highest accuracy, a sampling rate of three heartbeats was chosen. At this

AUto+mediCAL sCienCe

values were substituted for rectal probe temperature values.

sample rate the recorder samples the number of beats chosen for the interval and extrapolates a heart-rate-per-minute value based on the time it took to sample the programmed number of beats. The Physiological Strain Index (PSI) was calculated using the equation of Moran, Shitzer, and Pandolf (9). The original equation, applicable to both men and women, was modifi ed to account for the use of the ingestible temperature probe (10). Therefore, ingestible temperature probe

ProcedureS The four female drivers were observed during a forty-minute driving session at the private motorsports facility in July 2015. Prior to the driving session, each driver sat quietly for thirty minutes in an air conditioned room with an ambient air temperature of 22째C and a relative humidity of 42 per cent. These values were determined using an Omega OMEL-USB-2-LCD-Plus temperature, humidity, and dew point data logger centrally positioned in the room and left to record the environmental conditions for the 12 hours preceding the baseline data collection period. At the end of the thirty-minute baseline period, resting data (i.e. heart rate, core temperature, and PSI) was collected. The drivers then made their way to their cars. Once all safety measures were confi rmed, the group of four drivers were released from the paddock to begin the forty-minute driving session, which took place between 14:00 and 15:00. Each driver drove either a race-spec closed cockpit Porsche 944 or Porsche 924. No driver used an external cooling device. Ambient air temperature during the driving session was 33.33째C and relative humidity was 22 per cent, as determined by the R6012 Series sling psychrometer. The track temperature immediately before the driving session was 52.5째C, and was measured using a Raytek Mini Temp MT6 Noncontact infrared handheld thermometer. The average cockpit temperature during the forty-minute session was 41째C, and it was measured using the Omega temperature, humidity, and dew point data logger, centrally positioned in the cockpit and left to record the environmental conditions for the entirety of the driving session. 53

AUTO+MEDICAL SCIENCE

Simona de Silvestro at the 2016 Paris ePrix

Results Statistical Analysis As a case study, the statistical analysis was limited to descriptive statistics. And because of an equipment failure, only two data sets are reported here. Core Temperature Pre-race core temperature (Tgi) data for drivers one and two was 37.15 and 37.02°C, respectively. Drivers one and two’s post-race Tgi was 38.28 and 38.21°C, respectively. The Tgi difference (pre vs. post) for drivers one and two was 1.13 and 1.19°C, respectively. The real-time, minute-byminute, Tgi data is presented in Table 2 and Table 3. 54

Heart Rate Pre-race heart rate for drivers one and two was 80.6 and 85.7 beats per minute (bpm), respectively. Drivers one and two had postrace heart rates of 152 and 113.4 bpm, respectively. The heart rate difference (pre vs. post) for drivers one and two was 71.4 and 27.7 bpm, respectively. Real-time, minute-by-minute, heart rate data for each driver is presented in Table 2 and Table 3. Physiological Strain Index Prior to leaving the paddock, PSI for drivers one and two was 2.03 and 2.57, respectively (minimal to low on the 0-10 scale). The PSI value at the end of the fortyminute session for drivers one and two was

AUTO+MEDICAL SCIENCE

Table 2

Table 3

Minute-by-minute core temperature, heart rate, and PSI data for driver 1.

Minute-by-minute core temperature, heart rate, and PSI data for driver 2.

Minute

Core Temp (Â°C)

Heart Rate (beats/min)

PSI

00:00

37.15

80.6

Baseline

Minute

Core Temp (Â°C)

Heart Rate (beats/min)

PSI