Download - Medical S ervices in Rallies
Medical Services in Rallies
Cem Boneval, MDFIA Medical Commission MemberChief Medical Officer F1 Turkish GP, WRC Rally of Turkey
European Rally Safety Seminar – Istanbul, 24-26.01.2014
CONTENTS• Special circumstances, risk
factors & definition of the problem
• Preventive safety features• Principal elements of medical
support, tasks & providers• Organization before, during &
after the event• Questions & comments
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Motorsport is Dangerous• Performance vehicles optimized for speed• High top speeds, cornering speeds, G forces• Slippery, rough and difficult terrain• Changing circumstances due to weather &
weather related conditions: Heat exhaustion, impaired visibility in rain, snow, fog
• Ambitious drivers determined to win• High adrenalin levels during competition -
“superman” effect• Effect of revenues!?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Motorsport is Dangerous• Performance vehicles optimized for speed• High top speeds, cornering speeds, G forces• Slippery, rough and difficult terrain• Changing circumstances due to weather &
weather related conditions: Heat exhaustion, impaired visibility in rain, snow, fog
• Ambitious drivers determined to win• High adrenalin levels during competition -
“superman” effect• Effect of revenues!?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Motorsport is Dangerous• Performance vehicles optimized for speed• High top speeds, cornering speeds, G forces• Slippery, rough and difficult terrain• Changing circumstances due to weather &
weather related conditions: Heat exhaustion, impaired visibility in rain, snow, fog
• Ambitious drivers determined to win• High adrenalin levels during competition -
“superman” effect• Effect of revenues!?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Motorsport is Dangerous• Performance vehicles optimized for speed• High top speeds, cornering speeds, G forces• Slippery, rough and difficult terrain• Changing circumstances due to weather &
weather related conditions: Heat exhaustion, impaired visibility in rain, snow, fog
• Ambitious drivers determined to win• High adrenalin levels during competition -
“superman” effect• Effect of revenues!?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Motorsport is Dangerous• Performance vehicles optimized for speed• High top speeds, cornering speeds, G forces• Slippery, rough and difficult terrain• Changing circumstances due to weather &
weather related conditions: Heat exhaustion, impaired visibility in rain, snow, fog
• Ambitious drivers determined to win• High adrenalin levels during competition -
“superman” effect• Effect of revenues!?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Motorsport is Dangerous• Performance vehicles optimized for speed• High top speeds, cornering speeds, G forces• Slippery, rough and difficult terrain• Changing circumstances due to weather &
weather related conditions: Heat exhaustion, impaired visibility in rain, snow, fog
• Ambitious drivers determined to win• High adrenalin levels during competition -
“superman” effect• Effect of revenues!?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
What to Do
• Make the racing environment safer– Stages– Race car– Driver outfit
• Provide adequate/efficient medical support• Attitude (wishful thinking?):
Safety comes before performance !!!
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Stage safety
???
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Racing car safety
• Roll cages• Special seats• 6 point seat belts• Fire extinguishing systems• Remote monitoring and
telecommunications
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Driver safety
• Fire proof outfit• Helmet• Head and Neck Restraint
System (HANS)• Top physical condition
European Rally Safety Seminar – Istanbul, 24-26.01.2014
FACT:Despite all precautions and safety measures accidents happen with
morbidity & mortality
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Fatal WRC Accidents
European Rally Safety Seminar – Istanbul, 24-26.01.2014
What now?
Medical support, on site, now!
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical support guidelines are outlined in
International Sporting CodeAppendix H
www.fia.com Sport Regulations Medical
European Rally Safety Seminar – Istanbul, 24-26.01.2014
European Rally Safety Seminar – Istanbul, 24-26.01.2014
European Rally Safety Seminar – Istanbul, 24-26.01.2014
“Medicine in Motor Sport” – The BookExcellent Reference for Physicians
http://medicineinmotersport.fiainstitute.com/
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
• Approved by the ASN, under the authority of the CoC• Name must appear in the Supplementary Regulations• Responsible for the recruitment, implementation, operation and
running of the medical services and evacuation. • All the medical and paramedical personnel, including those
recruited by the ASN, are concerned by his decisions. • Remains at rally control in dialogue and collaboration with the CoC
in the event of an accident. • It should be always possible to contact him. • The organisers are obliged to provide him with all the material
and administrative means necessary for the performance of his duties.
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
Before the event: • Medical Safety Plan, with the CoC and the Safety Officer.• Check all special stages well ahead of the rally, with the Safety
Officer and/or the Clerk of the Course, in a car similar to the medical intervention car to establish the right position for the start and intermediate points
• Ensure the viability and quality of the ambulances, the medical helicopter and fire vehicles.
• Ensure that the equipment and supplies in the medical and rescue cars are in perfect working order.
• He is responsible for the capacity and the quality of the hospitals designated to cover the rally.
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
During the event: • Each evening he must examine all drivers and co-drivers who had an
accident during the day, even if no medical intervention was necessary, to be sure that they can start the next day
After the event: • During the two weeks following the rally, he must send the FIA, for
the attention of the Medical Delegate and the Medical Commission, a report on all the medical interventions on drivers, officials and spectators. This report must explain the circumstances of the incident or accident, the timing of the interventions, the initial medical status, the treatment and the medical follow-up.
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
Chief Safety Officer
Clerk of the Course
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
Chief Safety Officer
Clerk of the Course
Extrication/Rescue Team
Medical Intervention Vehicle (MIV)
Service Park Medical Unit
Resuscitation Ambulances
Ambulance Helicopter
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Medical Support - Principal ElementsChief Medical Officer (CMO)
Chief Safety Officer
Clerk of the Course
Extrication/Rescue Team
Medical Intervention Vehicle (MIV)
Service Park Medical Unit
Resuscitation Ambulances
Referral Hospital
Ambulance Helicopter
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Running of the event
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Pre-event preparations• Drive through the stages with the safety officer• Evaluate and prepare the medical plan
– Points of placement for medical cars– Efficiency of radio contact– Evacuation roads– Helicopter landing points– Porperties of terrain for selection of proper vehicles– Referral hospitals in the area
• Implement the medical plan into the safety plan• Collect & train his medical team
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Medical Intervention Vehicle/Team• Doctor and/or paramedic competent in ATLS
(Advanced Trauma Life Support) and pre-hospital trauma care
• Highly skilled driver with rally experience• All necessary equipment for ATLS and field
intervention (App H Suppl 3)• On standby at road side at stage starts and at
midpoints for stages exceeding 15 kms• Targeted approach time <10 min on rally stages• May be combined medical + rescue• Light desincarceration equipment if solely medical
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Stage Setup at Rallies
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Stage Setup at Rallies
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Stage Setup at Rallies
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Medical Intervention Vehicle/Team• Approach and evaluate the scene• The team is responsible for the safety of:
1st - themselves2nd - the scene3rd - the patient(s)
• Evaluate the victim• Begin care immediately – in car if necessary• Take the victim out of the car…• CAVEAT: Spinal injuries are not rare and preventive
immobilization is of outmost importance.
European Rally Safety Seminar – Istanbul, 24-26.01.2014
All elements of safety are also an obstacle for the medical team!
Nonremovable steering wheel
Position of seat vs. B pillar
Seat head supportSeat shapeBars of the roll-cage
How shall we get the victim out?
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Extrication• Extrication is the procedure of removing the victim
from the racing vehicle • The goals of extrication are:
– to remove the victim from the vehicle as rapidly as his or her condition allows
– to allow care to continue– to avoid creating or aggravating injuries - mainly, but not
only, to the spine• Extrication is an important step of the flow of
medical care, never consider extrication to be an aim in itself!
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Extrication• Types of extrication:
– Emergency– Urgent/Rapid– Elective
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Emergency Extrication• First choice when victim is in a life threatening
situation (e.g. CP arrest or presence of fire etc)“Take him out or let him die"
• Fast manual extrication with bare hands• Mostly without any time for immobilization• Beware:
Trauma to the spine may be aggravated and the rescuer has to deal with this responsibility
• Very rarely used• A quick modified Rautek maneuver may be
applied if the chassis does permit it
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Emergency Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Emergency Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Emergency Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Elective Extrication• Victim is in relatively stable condition• Several options of spinal immobilization and
desincarceration:– KED, – with seat, – with back of seat removed, – from the back,– from the top,– ……????
• The chassis may be cut clean
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Elective ExtricationKendrick’s Extrication Device
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Elective Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Elective Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Urgent Extrication• Somewhere in between the preceeding two
modalities• The victim is stable at first sight but
shows rapid detoriation• Time has to be used as effective as possible:
–Manual inline immobilization,–Removal of helmet & HANS, –Rapid application of a cervical collar –Take-out on a spinal board
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Urgent Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Urgent Extrication
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Extrication• Video excerpts form FIA Extrication Training Seminar
performed in Zlín with the Medical Rescue service of Zlín Region
• Comprehensive Booklet available athttp://www.rally-safety.com/files/extrication_guide_web.pdf
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
After Extrication• Stabilize patient(s)• Call-in ambulance (air/road)• Refer to hospital
– using ambulance on evacuation roads– using helicopter– using both
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Ambulances
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Ambulances• Medically equipped to treat vital distress• Able to provide intensive care standarts during
transport either by air or land.
Principal Elements of Medical Support
Referral Hospital
• Trauma Management Center
• Reserved ICU Beds• Trauma Team on standby• Easy access by road/air
(Heliport)• Familiar to media
management protocols
European Rally Safety Seminar – Istanbul, 24-26.01.2014
• Vehicle Tracking System
Principal Elements of Medical Support
Rally Control - WRC
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Principal Elements of Medical Support
Rally Control - WRC
Clerk of the CourseChief Safety OfficerChief Medical Officer
Radio contact with all teams
on the field(((((((
European Rally Safety Seminar – Istanbul, 24-26.01.2014
• Up to 10 min arrival time• Difficult terrain, delay in approach inevitable
Principal Elements of Medical Support
Problems & Shortcomings
European Rally Safety Seminar – Istanbul, 24-26.01.2014
• Many/long stages = Many Teams• Every team consists of only 2-3 persons
(driver, doctor, paramedic)• Difficulties in management, especially during
extrication• Close collaboration with rescue teams is
needed – use of disincarceration equipment• Training (Accreditation of Extrication Teams?)
– Coordinated extrication in cooperation w/rescue teams & Marshalls
Principal Elements of Medical Support
Problems & Shortcomings
European Rally Safety Seminar – Istanbul, 24-26.01.2014
• High-tech safety cars, great obstacle for intervention
Principal Elements of Medical Support
Problems & Shortcomings
European Rally Safety Seminar – Istanbul, 24-26.01.2014
• Recruitement– Many teams– Up to 4 days– Inadequate payment?
• Liability issues– Malpractice not defined– Professional liability insurance
• Who• How
Principal Elements of Medical Support
Problems & Shortcomings
European Rally Safety Seminar – Istanbul, 24-26.01.2014
• Coverage of crowded spectator areas• Mass casualities –colloboration with local
authorities• Normal stages (spectator rally!)
Principal Elements of Medical Support
Problems & Shortcomings
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Consider: • Who is first at accident site?• The following rally car• Train rally teams for emergency extrication
and basic life support• Basic Life Support Training for Marshalls???
Principal Elements of Medical Support
Problems & Shortcomings
UniversalMedical
Questionnaire
European Rally Safety Seminar – Istanbul, 24-26.01.2014
Thank You for Your AttentionQuestions?Comments?