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Medical S ervices in Rallies

Medical S ervices in Rallies. Cem Boneval , MD FIA Medical Commission Member Chief Medical Officer F1 Turkish GP , WRC Rally of Turkey. CONTENTS Special circumstances , r isk factors & d efinition of the problem Preventive safety features

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Medical S ervices in Rallies

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  1. Medical Servicesin Rallies Cem Boneval,MD FIA Medical CommissionMember Chief Medical Officer F1 Turkish GP, WRC Rally of Turkey

  2. CONTENTS • Specialcircumstances, riskfactors & definition of the problem • Preventivesafetyfeatures • Principalelements of medical support, tasks & providers • Organizationbefore, during & aftertheevent • Questions & comments

  3. Motorsport is Dangerous • Performance vehicles optimized for speed • High top speeds, corneringspeeds, 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. Motorsport is Dangerous • Performance vehicles optimized for speed • High top speeds, corneringspeeds, 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. Motorsport is Dangerous • Performance vehicles optimized for speed • High top speeds, corneringspeeds, 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. Motorsport is Dangerous • Performance vehicles optimized for speed • High top speeds, corneringspeeds, 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. Motorsport is Dangerous • Performance vehicles optimized for speed • High top speeds, corneringspeeds, 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. Motorsport is Dangerous • Performance vehicles optimized for speed • High top speeds, corneringspeeds, 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. Whatto Do • Make the racing environment safer • Stages • Race car • Driver outfit • Provide adequate/efficientmedicalsupport • Attitude (wishfulthinking?): Safety comes before performance !!!

  10. Stagesafety ???

  11. Racing car safety • Rollcages • Specialseats • 6 pointseatbelts • Fire extinguishingsystems • Remotemonitoringandtelecommunications

  12. Driversafety • Fire proof outfit • Helmet • Head and Neck Restraint System (HANS) • Top physical condition

  13. FACT: Despite all precautions and safety measures accidents happen with morbidity & mortality

  14. Fatal WRC Accidents

  15. Whatnow? Medicalsupport, on site, now!

  16. Medical supportguidelinesareoutlined in International SportingCode Appendix H www.fia.com Sport  Regulations  Medical

  17. “Medicine in Motor Sport” – TheBookExcellentReferenceforPhysicians http://medicineinmotersport.fiainstitute.com/

  18. Medical Support - PrincipalElements Chief 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 medicalservices 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 CoCin the event of an accident. • It should be alwayspossible to contact him. • The organisers are obliged to provide him with all the material and administrative means necessary for the performance of his duties.

  19. Medical Support - PrincipalElements Chief Medical Officer (CMO) • Before the event: • Medical Safety Plan, withthe CoCand the Safety Officer. • Checkall 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 • Ensurethe viability and quality of the ambulances, the medical helicopter and fire vehicles. • Ensurethat 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.

  20. Medical Support - PrincipalElements 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.

  21. Medical Support - PrincipalElements Chief Medical Officer (CMO)

  22. Medical Support - PrincipalElements Clerk of theCourse Chief Medical Officer (CMO) ChiefSafetyOfficer

  23. Medical Support - PrincipalElements Clerk of theCourse Chief Medical Officer (CMO) ChiefSafetyOfficer Extrication/ RescueTeam Medical InterventionVehicle (MIV) ResuscitationAmbulances AmbulanceHelicopter Service Park Medical Unit

  24. Medical Support - PrincipalElements Clerk of theCourse Chief Medical Officer (CMO) ChiefSafetyOfficer Extrication/ RescueTeam Medical InterventionVehicle (MIV) ResuscitationAmbulances AmbulanceHelicopter Service Park Medical Unit ReferralHospital

  25. Running of theevent

  26. Principal Elements of Medical SupportPre-eventpreparations • Drivethroughthestageswiththesafetyofficer • Evaluateandpreparethe medical plan • Points of placementfor medical cars • Efficiency of radiocontact • Evacuationroads • Helicopterlandingpoints • Porperties of terrainforselection of propervehicles • Referralhospitals in thearea • Implementthe medical plan intothesafety plan • Collect & train his medicalteam

  27. Principal Elements of Medical SupportMedical Intervention Vehicle/Team • Doctor and/or paramedic competent in ATLS (AdvancedTrauma 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 stagestartsand at midpointsforstages exceeding 15 kms • Targeted approach time <10 min on rally stages • May be combined medical + rescue • Lightdesincarcerationequipmentifsolely medical

  28. PrincipalElements of Medical SupportStageSetup at Rallies

  29. PrincipalElements of Medical SupportStageSetup at Rallies

  30. PrincipalElements of Medical SupportStageSetup at Rallies

  31. Principal Elements of Medical SupportMedical Intervention Vehicle/Team • Approach and evaluate the scene • Theteam is responsible for the safety of: 1st - themselves 2nd - thescene 3rd - thepatient(s) • Evaluate the victim • Begincare immediately – in car ifnecessary • Takethevictimout of the car… • CAVEAT: Spinalinjuriesare not rareandpreventiveimmobilization is of outmostimportance.

  32. Allelements of safetyarealso an obstacleforthe medical team! Nonremovablesteeringwheel Position of seat vs. B pillar Seatheadsupport Seatshape Bars of theroll-cage Howshallwegetthevictimout?

  33. Principal Elements of Medical SupportExtrication • Extrication is theprocedure of removingthevictimfromtheracingvehicle • 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, tothespine • Extrication is an important step of the flow of medical care, neverconsider extrication to be an aim in itself!

  34. Principal Elements of Medical SupportExtrication • Types of extrication: • Emergency • Urgent/Rapid • Elective

  35. Principal Elements of Medical SupportEmergencyExtrication • Firstchoicewhen victim is in a life threatening situation (e.g. CP arrestor 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 rarelyused • A quick modifiedRautek maneuver may be applied if the chassis does permit it

  36. Principal Elements of Medical SupportEmergencyExtrication

  37. Principal Elements of Medical SupportEmergencyExtrication

  38. Principal Elements of Medical SupportEmergencyExtrication

  39. Principal Elements of Medical SupportElectiveExtrication • Victim is in relatively stable condition • Several options of spinal immobilization anddesincarceration: • KED, • with seat, • with back of seat removed, • from the back, • from the top, • ……???? • The chassis may be cut clean

  40. Principal Elements of Medical SupportElectiveExtrication Kendrick’sExtricationDevice

  41. Principal Elements of Medical SupportElectiveExtrication

  42. Principal Elements of Medical SupportElectiveExtrication

  43. Principal Elements of Medical SupportUrgentExtrication • Somewhere inbetween thepreceedingtwo 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-outon a spinal board

  44. Principal Elements of Medical SupportUrgentExtrication

  45. Principal Elements of Medical SupportUrgentExtrication

  46. Principal Elements of Medical SupportExtrication • Video excerpts form FIA Extrication Training Seminarperformed in Zlín withtheMedical Rescue service of Zlín Region • ComprehensiveBookletavailable at http://www.rally-safety.com/files/extrication_guide_web.pdf

  47. Principal Elements of Medical SupportAfterExtrication • Stabilize patient(s) • Call-in ambulance (air/road) • Refertohospital • usingambulance on evacuationroads • usinghelicopter • usingboth

  48. PrincipalElements of Medical SupportAmbulances

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