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Medical S ervices in Rallies Cem Boneval, MD FIA Medical Commission Member Chief Medical Officer F1 Turkish GP, WRC Rally of Turkey.

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Presentation on theme: "Medical S ervices in Rallies Cem Boneval, MD FIA Medical Commission Member Chief Medical Officer F1 Turkish GP, WRC Rally of Turkey."— Presentation transcript:

1 Medical S ervices in Rallies Cem Boneval, MD FIA Medical Commission Member Chief Medical Officer F1 Turkish GP, WRC Rally of Turkey

2 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

3 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!?

4 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!?

5 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!?

6 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!?

7 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!?

8 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!?

9 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 Provide adequate/efficient medical support Attitude (wishful thinking?): Safety comes before performance !!!

10 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Stage safety

11 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

12 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Driver safety Fire proof outfit Helmet Head and Neck Restraint System (HANS) Top physical condition

13 European Rally Safety Seminar – Istanbul, 24-26.01.2014 FACT: Despite all precautions and safety measures accidents happen with morbidity & mortality

14 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Fatal WRC Accidents

15 European Rally Safety Seminar – Istanbul, 24-26.01.2014 What now? Medical support, on site, now!

16 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical support guidelines are outlined in International Sporting Code Appendix H www.fia.comwww.fia.com Sport Regulations Medical Medical support guidelines are outlined in International Sporting Code Appendix H www.fia.comwww.fia.com Sport Regulations Medical

17 European Rally Safety Seminar – Istanbul, 24-26.01.2014

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19 Medicine in Motor Sport – The Book Excellent Reference for Physicians http://medicineinmotersport.fiainstitute.com/

20 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief Medical Officer (CMO) Approved by the ASN, under the authority of the CoC Approved by the ASN, under the authority of the CoC Name must appear Name must appear in the Supplementary Regulations Responsible for the recruitment, implementation, operation and running of the medical services and evacuation Responsible for the recruitment, implementation, operation and running of the medical services and evacuation. All the medical and paramedical personnel are concerned by his decisions All the medical and paramedical personnel, including those recruited by the ASN, are concerned by his decisions. Remains at rally control Remains at rally control in dialogue and collaboration with the CoC in the event of an accident. always possible to contact 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. The organisers are obliged to provide him with all the material and administrative means necessary for the performance of his duties.

21 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief Medical Officer (CMO) Before the event: Medical Safety Plan Medical Safety Plan, with the CoC and the Safety Officer. Check all special stages medical intervention car right position 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.

22 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief 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.

23 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief Medical Officer (CMO)

24 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief Medical Officer (CMO) Chief Safety Officer Clerk of the Course

25 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief Medical Officer (CMO) Chief Safety Officer Clerk of the Course Extrication/ Rescue Team Extrication/ Medical Intervention Vehicle (MIV) Service Park Medical Unit Resuscitation Ambulances Ambulance Helicopter

26 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Medical Support - Principal Elements Chief Medical Officer (CMO) Chief Safety Officer Clerk of the Course Extrication/ Rescue Team Extrication/ Medical Intervention Vehicle (MIV) Service Park Medical Unit Resuscitation Ambulances Referral Hospital Ambulance Helicopter

27 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Running of the event

28 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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

29 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Medical Intervention Vehicle/Team competent in ATLS (Advanced Trauma Life Support) and pre-hospital trauma care Doctor and/or paramedic competent in ATLS (Advanced Trauma Life Support) and pre-hospital trauma care Highly skilled driver with rally experience (App H Suppl 3) 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

30 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Stage Setup at Rallies

31 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Stage Setup at Rallies

32 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Stage Setup at Rallies

33 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Medical Intervention Vehicle/Team Approach and evaluate the scene The team is responsible for the safety of: 1st - themselves 2nd - the scene 3rd - 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. CAVEAT: Spinal injuries are not rare and preventive immobilization is of outmost importance.

34 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 support Seat shape Bars of the roll-cage How shall we get the victim out?

35 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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! Extrication is an important step of the flow of medical care, never consider extrication to be an aim in itself!

36 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Extrication Types of extrication: – Emergency – Urgent/Rapid – Elective

37 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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 dieTake him out or let him die" Fast manual extrication with bare hands Mostly without any time for immobilization Beware: 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

38 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Emergency Extrication

39 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Emergency Extrication

40 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Emergency Extrication

41 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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

42 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Elective Extrication Kendricks Extrication Device

43 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Elective Extrication

44 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Elective Extrication

45 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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

46 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Urgent Extrication

47 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Urgent Extrication

48 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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 at http://www.rally-safety.com/files/extrication_guide_web.pdf

49 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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

50 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Ambulances

51 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support 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.

52 Principal Elements of Medical Support 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

53 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Vehicle Tracking System Principal Elements of Medical Support Principal Elements of Medical Support Rally Control - WRC

54 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Principal Elements of Medical Support Principal Elements of Medical Support Rally Control - WRC Clerk of the Course Chief Safety Officer Chief Medical Officer Radio contact with all teams on the field ((((((((((((((((((((((((((((

55 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 Principal Elements of Medical Support Problems & Shortcomings

56 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 Principal Elements of Medical Support Problems & Shortcomings

57 European Rally Safety Seminar – Istanbul, 24-26.01.2014 High-tech safety cars, great obstacle for intervention Principal Elements of Medical Support Principal Elements of Medical Support Problems & Shortcomings

58 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 Principal Elements of Medical Support Problems & Shortcomings

59 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 Principal Elements of Medical Support Problems & Shortcomings

60 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 Principal Elements of Medical Support Problems & Shortcomings

61 Universal Medical Questionnaire

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64 European Rally Safety Seminar – Istanbul, 24-26.01.2014 Thank You for Your Attention Questions? Comments?


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