DR Jean Duby FIA Medical Delegate - France

1. DR Jean Duby FIA Medical Delegate - France

2. Dr Jean Duby FIA WRC Permanent Medical Delegate

3. EQUIPMENT: Helicopters Medical Intervention Cars Ambulances Service Park Medical Unit HUMAN ELEMENTS: CMO Doctors Paramedics ACCIDENTS CONCLUSIONS

5. HELICOPTERS: - 1 Casualty: ADAC-FIN-GB-GR- IT-TURK-MEX-ESP, but sometimes 2 helicopters with 1-casualty capacity or 1 on standby with 2-casualty capacity - 2 or more Casualties: ARG-JAP-JORD-NZ - WINCH: FR-IT–JORD sometimes on request: GR-ARG-ESP - GB no night flying S.P. MEDICAL UNIT: ALL rallies, most often of a superior standard EXCEPT FR-TURK but Hospital 1 km away in Turkey, more difficult to reach in FR

6. M.I.C: Most often suitable and of a superior standard, either Medical only and followed by Rescue Cars: MEX-TURK-JP-IT- or Mixed: GB-FIN-ESP-NZ-ADAC Deficient: FR: poorly equipped, badly positioned, badly identified GR: poorly equipped on the first day JORDAN: non-existent GB: 1 absent: distance of almost 20 km R.A.: Always Resuscitation only, and most often of a superior standard except: FR: poorly equipped, GR: poorly equipped on the first day. Sometimes satellites FIN or ONLY satellites NZ. DISTANCES: too great > 13 km except ADAC–ESP and especially ITALY: 7.5 km

7. C.M.O.: Most often remarkable. ADAC: Medical Book +++ FR: No Medical Safety plan, no correct setting up. The reality in the field did not match the MQ. GR: Times and setting up imperfect FIN: Setting up a little late NZ: CMO in Helicopter but assistant at HQ ESP: did not speak English DOCTORS: The vast majority were excellent, often late in GR, did not speak English in IT PARAMEDICS: Most often excellent

8. The WRC is very prone to accidents: only GR-JORD and MEX without a Medical Intervention. THAT MAKES THREE WRC EVENTS out of FOUR with Medical Interventions for CASUALTIES Difficulties liaising with the CMO in Finland, with unawareness of the accidents that happened the same day All the interventions, even the most serious ones with disincarceration, were carried out perfectly, without secondary injuries or excessive delays ACCIDENTS: - ADAC: 1 seeded driver: Fracture of the hip (neck of femur), and 1 non-seeded co-driver: Stable fracture of L2. - ARG: Non-seeded crew, not serious. - ESP: Driver “with limited abilities“: Concussion +++ and his co-driver: Fracture of the right collarbone and right hemi-thorax.

9. ACCIDENTS: - FR: A few minor injuries - FIN: Among the Spectators: 1 heart attack and 2 falls Non-seeded co-driver: Concussion and lumbar trauma, not serious Non-seeded driver: Loss of Consciousness for 10 minutes and unstable Fracture of L1, operated on. Seeded driver: HANS stuck for several minutes between the seat and the broken rollbar! Luckily, there was no fire.

10. ACCIDENTS: - GB: - A marshal suffered a cranio-facial injury from a stone thrown up by a car - Accident on a road section, closed road, non-seeded drivers and co-drivers wearing neither helmets nor safety belts!: driver had a fractured ankle, osteosynthesised; co-driver: major multiple trauma - IT: - Non-seeded co-driver: stable fracture of L2 - JP: - Seeded co-driver: severe multiple trauma with fractured pelvis and massive internal haemorrhaging - TURK: False journalist injured by a competitor. Multiple trauma, major TC and fractures of the limbs, one of them open.

12. HELICOPTERS: 1 casualty: PORT – IT – IRE – GR GB –FIN – ESP –AUST, but sometimes 2 helicopters or a transport helicopter on standby. 2 casualties: ARG – BULG – CHY Sometimes WINCH: ARG – AUST – IT- CHY or on request: ESP – GR – No night flying: GB – IRE No helicopter: NOR – POL only on request S.P. Medical Unit: All the rallies except BULG: 2 R.A. and FIN +/- the same as GB: SP fragmented and huge

13. M.I.C.: Most often excellent, either Medical only ARG – IRE – ITA –PORT or Mixed: POL – NOR – GB – FIN – ESP – AUST – GR Absent: CHY only Rescue Cars R.A. : Always of very good or superior standard Sometimes with traditional: ESP – GRE, or satellite: FIN, or transport ambulances: ITA - DISTANCES: Still too great, especially CHY – NOR, but sometimes much shorter: ITA – GB: with alternation of R.A. / M.I.C.

14. C.M.O.: Most often excellent Did not speak English: ESP Inexperienced: NOR ABSENT: CHY, Assistant present at HQ DOCTORS: The vast majority were excellent, did not speak English in ITA, did not wear appropriate clothing in ARG, a paramedic in place of a doctor at an intermediate point in CHY, clear improvement in GR PARAMEDICS: Most often excellent EXERCISES: Helicopters: ITA +++ Extrications: Everywhere, but of very high standard in ITA – GB – FIN – ESP – ARG

15. ACCIDENTS: Best year: ARG – AUS – CHY – ITA – NOR with no accidents, i.e. fewer than TWO out of THREE with Medical Intervention. ACCIDENTS IN 2009: - ESP: A Cameraman with a Marshal trying to reason with him! Injured by a competitor: Cameraman very slightly, but the Marshal suffered thoracic trauma with haemothorax. - FIN: 2 non-seeded competitors. One Driver suffered lumbar trauma, not serious. One Co-driver suffered cervical and lumbar spinal injury, with swift secondary appearance of regressive neurological damage.

16. ACCIDENTS IN 2009: - GB: one co-driver poisoned by exhaust fumes. - GR: numerous interventions, not serious. - IRE: non-seeded driver, secondary loss of consciousness, not serious. - ITA: some incidents among the marshals, not serious. - POL: non-seeded driver: Cervical spinal and Abdominal trauma, not serious.

17. ACCIDENTS IN 2009: - PORTUGAL: • A non-seeded crew: Driver: left elbow, Co-driver: right shoulder and thorax. Very high energy accident: both HANS broken. • A Photographer was knocked down: dislocation fracture of the right shoulder and multiple injuries to both legs, trauma to the ankles and pelvis. • A non-seeded co-driver suffered severe concussion after an accident involving a spectator. • Very spectacular run-off by a seeded crew. No injuries. ImPact test on the driver the following day, but the Co-driver had unfortunately already left.

19. HELICOPTERS: 1 casualty: GER – FIN – PORT TURK – MEX 2 or more casualties: S – JORD – NZ – BULG WINCH: Military equipment JORD and BULG S.P. MEDICAL UNIT: - Improvements: Presence in BULG - Status Quo: FIN - Deterioration: Sweden and NZ: disappeared PORT: not so good

20. M.I.C.: Most often excellent, either Medical only MEX – JORD – TURK – PORT – or Mixed SWEDEN – NZ – FIN – GER or Absent BULG, only Rescue Cars and R.A.s with Doctors but very close R.A.: Always of a very good or superior standard, with sometimes: SWEDEN Specialised Paramedic in place of the Doctor, Satellites: PORT – FIN – GER or Absence at intermediate points NZ DISTANCES: Still too great, especially SWEDEN, but sometimes much shorter: BULG – GER: with alternation of R.A. / M.I.C. but errors in positioning and in naming the locations

21. C.M.O.: Most often excellent None at HQ: NZ One more in the SP: BULG DOCTORS: the vast majority were excellent, did not speak English in IT, did not wear appropriate clothing in SWEDEN – MEX – JORD and +++ Training of young doctors in TURK PARAMEDICS: Most often excellent A paramedic in place of a Doctor at an intermediate point: SWEDEN EXERCISES: Extrications: Everywhere except PORT, but of a very high standard: SWEDEN – JORD – TURK – FIN (Very satisfactory test on the ARAI system) – GER First on Scene: TURK – PORT – BULG – FIN – ADAC

22. ACCIDENTS: MEX – JORD – PORT – FIN – GER SWEDEN – TURK – NZ – BULG without any accidents, i.e. ONE in TWO with Medical Intervention since the start of the year ACCIDENTS IN 2010: - MEX: Seeded competitor +++ no injuries - JORD: 5 non-seeded competitors: One driver, stable fracture of L1 One co-driver, unstable fracture of L1 operated on Contusions, not serious, for the others

23. ACCIDENTS IN 2010: - PORT: 2 non-seeded competitors: One driver: Cervical spinal injury and Fracture of the left collarbone. The crew did not get out of the car! Collision on a road section, Drivers with multiple contusions and Co-driver with basi-thoracic contusion. - FIN: Seeded competitor: Contusions, not serious 3 non-seeded competitors: contusions, not serious

24. ACCIDENTS IN 2010: Germany: One seeded competitor: Driver suffered contusions to the left shoulder, Co-driver fractured 2 right ribs. 3 non-seeded competitors: THREE FIRES, 2 spontaneous without injuries and 1 after a lateral collision against a tree. The one with a collision – Driver: 2nd degree deep burns to the face, and Co-driver: 2nd and 3rd degree deep burns to the face and hands (no gloves) and “stilo“ type helmet which does not protect the lower half of the face.

27. THE WRC IS VERY ACCIDENT-PRONE: DO NOT LET UP QUALITY: APPENDIX H IS EXCELLENT – RESPECT IT IMPROVEMENT overall, but some things have DETERIORATED due to MISPLACED ECONOMIC concerns DISTANCES BETWEEN MEDICAL POINTS: most often RESPECT THE 10‘ OR 10 km, except on asphalt events Too many PHOTOGRAPHERS INVOLVED INJURIES to NON-SEEDED CREWS: Lumbar and Cervical Spine: Tightening of the Seatbelts? EQUIPMENT: - HELICOPTER to DROP OFF DOCTORS - Alternation of M.I.C. and medical R.A. - GLOVES MANDATORY - STILO HELMETS TRAINING OF YOUNG DOCTORS EXTRICATION EXERCISES: MANDATORY CONTINUE WITH THE “FIRST on SCENE“ TRAINING

28. LE CENTRE MEDICAL CIRCUIT BUGATTI AUTOMOBILE CLUB DU MANS

29. LE Centre Médical: Inauguré en Mai 2010, le centre médical s’articule autour de trois zones : - une zone des soins, - une zone administrative, - une zone de repos,

30. La zone des soins: 4 salles de soins et 2 salles de déchoc; toutes sont accessibles de l’extérieur.

31. La zone des soins: Le couloir intérieur qui permet aux personnels d’accéder aux différentes salles de soins.

32. La zone des soins: Une des deux salles de déchoc.

33. La zone des soins: La pharmacie se situe entre la zone des soins et la zone administrative. Elle est informatisée (code barre), ce qui nous permet de tracer chaque drogue utilisée et d’établir un état financier en fin d’épreuve .

34. La zone des soins: Une salle de soins où sont effectués les gestes courants sur un circuit.

35. La zone de nettoyage: Chaque ambulance est désinfectée après une intervention et réarmée avant de retourner à son poste.

36. La zone administrative: La deuxième zone est constituée par la salle de régulation où les alertes sont traitées. Le médecin décide des moyens et de la destination du blessé.

37. La zone administrative: La salle de régulation, informatisée, reçoit un appel toutes les deux minutes lors des 24 h moto. Elle est en liaison téléphonique ou radio avec les différents intervenants. Sur les 1500 interventions effectuées, seules 50 évacuations vers un centre hospitalier sont dénombrées.

38. La zone de repos: Située à l’arrière du bâtiment, le personnel dispose d’une salle de restauration totalement équipée et d’une terrasse.

39. La zone de repos: 5 chambres de garde de 4 lits sont à la disposition des intervenants.

40. LE CENTRE MEDICAL: Décrit de façon très succincte, ce centre médical est dans la réalité un très bel outil, d’une surface de 500 m². Fonctionnel, il est apprécié par tous les intervenants.