I should have known . . .

It’s fairly evident that I really REALLY need to clarify what I meant, and what I didn’t mean, by my comments concerning “errors in judgment”. I see that I’m being quoted a lot, in lots of outlets. That’s not a problem of course, but it becomes problematic when what i wrote is turned into something that I most certainly did not say.

1) I am strictly referring to the period of management BEFORE Michael was admitted to Grenoble. As I said on 30 December, the people taking care of Michael in Grenoble can take care of any member of my family any day. They are professional and more than competent. This is an impressive team and they deserve to be recognised as such.

2) I am in no way criticising ANY member of the care team(s) dispatched to fetch Michael on the slope, nor of those involved in transferring him from Moutiers to Grenoble. As I made clear, prehospital medicine is difficult under the best of conditions. It’s not hard to imagine the added stress faced by the guys on the slopes, confronted with a clearly injured mega-star, and what must have been a VERY difficult entourage to manage. I don’t have sufficient facts of any kind, and it’s neither my job, my business, nor my intention to question the individual medical care provided by my colleagues.

What then exactly AM I saying, and almost as importantly, WHY am i saying it here, and why now? These are valid questions, and they deserve an answer.

3) I am very clearly criticising a system that allows head injured patients to be brought to non-neurosurgical centers, in the absence of other clear reasons to do so.

4) The failure to adequately control an agitated patient prior to flight, as well as the delays in adequate control of the airway likely indicate insufficient training, insufficiently robust protocols, and perhaps insufficient experience under difficult circumstances (again, a mega-star patient with a difficult, demanding and perhaps even frankly hostile entourage). I am very clearly criticising a system that allows this to happen.

5) It is impossible to quantify the impact of the above on outcome in Michael’s case. Obviously. It is also obvious that someone whose neurosurgeon, the day after the trauma, describes his condition as “hematomas left, right and centre” is likely not to do particularly well. This should be obvious, at least to the “journalists” who disingenuously (at best!) implied that I said that Michael’s current situation is because of these aspects of his initial care. The delay in admission to a neurosurgeon, as well as deferred airway control, cannot have been good for a severely injured brain. Especially in a situation where the intracranial pressure has risen so high that parts of the brain are literally being squeezed out of the cranial vault. That said, in terms of prognosis, this likely pales in significance compared to the 2000-and-some-odd joules of impact energy against that goddamned rock.

The world of medicine, including the practice of prehospital medicine, has become more and more evidence- and protocol-based. This requires constant attention to new developments, and elaboration of consensuses that are often universal (for example, the algorithms of basic and advanced life support). Intense and rigorous adherence to these protocols, with the training that this implies, has been shown to very favourably impact on the outcome after trauma. I will simply say that the French have been remarkably, and unexplainably, recalcitrant to this notion of protocol-based medicine.

Why have I said this now?

I want to make it clear that the furthest thing from my mind was causing Michael’s family added pain. Malpractice? Hey, I work in Europe, which is far from having gone as nuts as the USA with this. In any event, I don’t give a shit about MAL practice. What I’m concerned with is GOOD practice. I want people who’ve not thought about it previously to now think, before heading down the hill on their skis or boards, “am I going to be well looked after, by people with sufficient knowledge, skills and maturity, if I have an accident”? And I want the answer to be yes. Wherever, whenever.

Those of you who know me a little know that if I’ve contributed anything to motorsport medicine, it’s been mainly down to education and training. The book, the systematic simulation exercises at every Grand Prix, etc. Doctors are nothing if not people who never stop, and never want to stop, learning. I think we need once again to make sure that people who do prehospital medicine, who routinely face life-threatening situations, are sufficiently trained, equipped, and mature, to carry out their duties impeccably.

With that in mind, I need to send a quick and heartfelt shout out to General Zin and the medical team at the Grand Prix of Malaysia. These guys have created a society for motorsport and traffic medicine, with a goal to fostering best practice in the community of caregivers doing this type of medicine. BRAVO!!! These guys are tops, and have been for some time. To illustrate how “on it” they are, they have the only circuit medical centre to be ISO certified. And they’re my friends!

It’s just a pity that the national federations are left alone to carry out initiatives like this (needn’t remind you of my attempts at organising an international society!), without leadership from Paris. Again Mr. Todt, it’s not because you gave your mates fancy titles that they have, by magic, acquired competency in this field. Motorsport medicine is stagnating, and will continue to do so as long as there is a total lack of leadership from the top.