“Standby Medical Car”: the system

Another season is underway, and watching Pastor scooping up and flipping Esteban Guttierez over in Bahrain, I thought it might be interesting to go over the steps involved in the response to an accident at a race. I did this when I first started using Twitter, but we’ll go over the concepts a bit more in detail. This way, you’ll have a pretty good idea of what’s going on if there’s a rescue response to an incident on the circuit. I’ll do this in a series of posts, and we’ll culminate with the race weekend in Shanghai next week.

As a travel companion through these posts, those interested could pick op a free pdf copy of the Medicine in Motorsport manual:

http://medicineinmotersport.fiainstitute.com

First, let’s understand how things are set up from a medical/rescue standpoint.

COMMAND, CONTROL, COMMUNICATIONS

The eyes, ears and brain of the operation are, of course, located in race control.

Image

For Formula 1 events, the FIA Race Director, his Deputy, and the ops coordinator are up here, along with the Medical Delegate. The local circuit command is also here – the Clerk of the Course (CoC, the guy who is usually the Race director when we’re not in town), Chief Marshal, Chief Medical Officer, etc. Every inch of the circuit is covered by cameras that can pan, tilt and zoom. The locals, at least at the more “mature” circuits, know which cameras cover the usual problem areas, and have them pre-set to cover precisely those zones. Remember that depending on the circuit, these local race control guys might be doing this every two weeks for years now (Spa, Silverstone, Hockenheim, etc). Also remember that each camera is connected to a DVR, so every second of every camera gets recorded . . . just in case.

Nothing, but nothing happens on track without it being decided, approved, and ordered by race control. From the moment the circuit is made active (usually by a red flag being displayed on a course car driven around the circuit) until circuit discipline is “relaxed” (yep, by a green flag “opening” the circuit), trackside personnel are behind the rail, vehicles are in standby position, engines running, and no one moves unless race control says so. The only exception is the flag marshal, signalling events in his or her sector – but even these events are immediately reported to race control. Here’s what happens when that rule isn’t obeyed:

The FIA team is in radio contact with the Medical Car and the Safety Car (which is not used during practices and qualifying, of course). They also have private comms to each team’s pitwall, and listen to all driver comms during a session. The local circuit team is in radio contact with all local resources through their own dedicated radios.

As you can see, from a systems standpoint, one of the potential barriers to seamless function in race control lies in the parallel nature of the FIA and local systems. There just aren’t a lot of built-in connection points between Charlie/Herbie (FIA) and the Clerk of the Course (local). Failure of timely and high quality crossovers between the systems can lead to deployment of local resources before the circuit is properly secured on the one hand, or a delay in the arrival of necessary reinforcements if the FIA “network” is activated without this happening with local resources.

In terms of this “connection node” between the FIA and the local team, Charlie, Herbie and the CoC are usually sitting in very close proximity, each with big headphones on (very isolating in terms of real conversations). The most important interface obviously depends very strongly on Charlie and Herbie’s rapport, confidence and ease of interaction with the CoC.

Note to self: this node needs to be STRUCTURAL and as independent as possible of human foibles. Like the structures that govern relations between aircrew members – predefined, unambiguous, etc.

Another note to self: since each CCTV screen in race control has its own DVR, these could be used to PLAY recordings of accidents back onto the screens. Race control could be used as a giant simulator. This could even be integrated with the medical/rescue simulation we do every Thursday afternoon of every Grand Prix weekend.

THE RESPONDERS

Because of the international nature of Formula 1, the response to an incident at a Grand Prix has, since being organised by “the Prof”, Sid Watkins, is based on a fully manned, equipped and competent local medical team. Let’s take a bit of time to look at the elements of this local team, and to introduce the FIA Medical Car.

The regulations governing all of this are found in Appendix H of the FIA’s International Sporting Code. This includes organisational details as well as the equipment required for the various components of the medical/rescue response system. Here’s a link to the regs:

http://www.fia.com/sites/default/files/regulation/file/14.01.02_ANNEXE%20H%202014_publié%20le%2002.01.2014.pdf

Medical intervention cars (MICs)

MIC brazil

The first properly medical contact the victim of an accident will have will be with the crew of a medical intervention car. These vehicles will carry a doctor and a nurse or paramedic and be driven by a driver experienced at the circuit and with high performance driving. The MIC carries sufficient equipment to expeditiously handle problems with the airway, with breathing, and with circulation. Just what you need to keep things from getting worse in moving from the accident site to the medical centre. Details on this in a subsequent post.

A circuit will usually have between 3 (for VERY short circuits) to 6 MICs. They are arranged around the circuit in order to divide it into sectors that take roughly the same amount of time for the vehicles to cover. So a sector that’s got a lot of corners, and is therefore slower, will be shorter than the sector of an MIC that covers mainly straights and fast curves. Remember that the Prime Directive at a circuit is: no one EVER goes the “wrong way” on a circuit. EVER. EVER. As an example of a med team’s deployment map, here’s the circuit diagram for Abu Dhabi, from a few years ago:

Abu Dhabi circuit diagram

Let’s also note that the FIA Medical Car always has a local doctor on board. Because he is in radio contact with the CoC, the Med Car is another connection point between the FIA network and the local team. In my experience this functions extremely well when the following conditions are met:

  • both docs are experienced in prehospital medicine AND comfortable in the motorsports environment
  • both docs have explicitly considered their responses to a range of possible situations
  • language is not a problem

As you can imagine, these conditions are not always met; in addition, remember that the medical car intervenes AFTER deployment is decided. The upstream processes are therefore still vulnerable to “parallel functioning”.

Extrication units

Extric team

FIA-spec extrication units are physician led six-man teams whose task is to remove an incapacitated driver, or one in whom spinal injury is considered to be a possibility, from a car with a minimum of motion of the vertebral column and spinal cord. They are highly trained in the various techniques of extrication (more on this in subsequent posts, of course), and carry the necessary equipment to carry out their mission. There are at least two, and often three, extrication units at a Formula 1 circuit, depending again on the length of the circuit.

Ambulances

For a Formula 1 event, there is at least one ambulance at each MIC location. In addition to transport from the scene to the Medical Centre, the ambulance also can serve as a covered work area if the victim needs “packaging” after extrication but prior to transport to the medical centre.

Medical Centre

The medical centre is the headquarters of the medical team. It’s where they meet, stand down, relax, and practice. It is also where “routine” medical care is initiated during the race weekend, for all race and associated personnel. And of course, it’s where accident victims are first transported, before being evac’d to the receiving hospital. Medically the goal is to rapidly figure out just how injured the victim is, and what resources he or she is likely to need to stabilise the situation. This then determines the urgency of evac. The med centre is staffed and equipped to be able to apply a series of sophisticated life-saving diagnostic and therapeutic techniques.

Medical centres range from the rudimentary but functional to the virtually opulent. Here’s a typical “Tilke” centre, and a typical resuscitation area:

Korea exterior 1Nurburgring resus area

We may have looked at the various elements of the mandated medical/rescue structure separately, but in fact each is a link in the sequence of care. The overall quality of an intervention will depend not on the STRENGTH of each link, but rather on the quality of the weakest link. That’s why we/I insist so much on education and (simulation-based) training. More in a few days!

Next post: “DEPLOY MEDICAL CAR!”

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16 thoughts on ““Standby Medical Car”: the system

  1. Excellent article, Gary.

    Your “Nothing, but nothing happens on track without it being decided, approved, and ordered by race control” was eerily timely, too – given the premature end of the race farce at this weekend’s Chinese Grand Prix.

    As a former marshal, I can attest that your statement is *mostly* true, although there are exceptions – mad priests and stray dogs come immediately to mind, although carelessness & unthinking-ness are probably far more likely.

    Whoever it was who displayed the chequered flag to Lewis Hamilton prematurely in Shanghai either did so:
    – inadvertently due to carelessness (as in “Oops, I meant to wave the blue flag”); or
    – inadvertently due to stupidity (“I honestly thought it was the last lap” -> “Did anyone tell you it was?” -> “No.”); or
    – because they were directed to.

    I went to F1.com and looked for official word on what happened and why, hoping to read what measures the FIA would promise to take to ensure such a mistake does not ever happen again. 22 hours after the race, there is NO MENTION of this incident or the repercussions, other than in the driver post-race interview quotes.

    That is, frankly, shocking.

    With no information provided, we cannot and should not draw any conclusions about who was to blame. But it does seem to suggest that F1 has a reason for not apologizing for the error, and my personal suspicion is that the answer lies in the text I quoted at the top of this post.

  2. FANTASTIC post! I wish we had these wonderful (and detailed!) behind the scenes views for each major component of F1!

    I hate that Michael’s accident is what caused me to find your blog, but I’m extremely happy I get to read all your updates now…

  3. Pingback: Haas has big plans for his F1 team – Busch | F1 Fanatic Round-up | Formula 1 News

  4. Pingback: F1 Fanatic round-up: Haas has big plans for his F1 team - Busch

  5. Brilliant stuff so far, I’m intrigued as to the correct procedures for entering and exiting the track and was unaware that you never ever travel against the direction of race flow even during an emergency, this is on of those ” obvious once you think about it” lines of thought that prevent me from being a doctor / astronaut / submarine captain, can’t wait for more, as always many thanks doc.

  6. In the Victorian Era and earlier it was usual for people to produce weekly to monthly instalments of writing for sale to the general public. Later publishers decided to collect and combine these issues and release the work in book format.

    Similarly academics having devised course material for lectures and after having delivered there lecture courses over a period of many years often decide to pull the material together into book format and get a publisher to sort out production etc.

    Maybe the good doctor will do something similar in the future. :)

    Here is something I found on the internet: “Hartstein has decided to tell the story about his time in F1, but rather than write a book, he has chosen to do so on film.”

    http://joesaward.wordpress.com/2013/05/17/memoirs-of-a-medical-man/

  7. Great article as always Doc. “Here’s what happens when that rule isn’t obeyed”: does that imply the medical car shouldn’t have been on track yet?

  8. As a self-confessed geek when it comes to the “inner workings” of a motorsport event, I love reading articles such as this. Yet another fascinating insight, Gary, and I’m thoroughly looking forward to the next post. Also I would like to echo KC’s comment above, if you were to write a book I would definitely be one of the first in the queue to buy it.

  9. Ditto. Having spent tine on-site with CART/ChampCar, this look at the methods in F1 will be most interesting. Would also like to know more about the Senna tragedy. What I saw vs. what has been reported.

  10. Gary
    What an incredible inside view. This journey is going to be amazing. Have you ever thought of writing a book about the F1 Doctor filled with your first hand experiences? Chapters could be about a particular driver/s, the incident, or a particular track, a particular race/season, the medical history behind F1 racing… I could go on…
    I look forward to this adventure
    KC

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