“Deploy Medical Car”: decision-making and roll-out

We all know that sinking feeling we get when the cameras covering practice, qualifying, or the race cut to an accident. The marshals scramble to the scene, the commentators comment, and everyone waits to see how the driver is. Sometimes, within moments, the television shows us the Medical Car heading to the accident. Let’s look at what happens from the moment of the accident until the medical and rescue system is activated.

First, a word about the FIA Medical Car. 

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I’m pretty sure that as far as race fans go, there aren’t many cars in the world as well known as the AMG C63 wagon in service as the Medical Car. It’s loud, powerful, superbly capable, and very fast. It’s not an easy car to drive, in an environment for which it was not made, but Alan van der Merwe makes it look easy. The car “belongs” to Allsport Management, the outfit that centralises much of F1 logistics, and also owns and operates the Paddock Club; AMG has two full-time technicians who travel to each race with the necessary kit (pic below). There are two MC’s (and two Safety Cars) at every race. And no, I don’t know what AMG does with them when they’re retired. The medical car has served since 2008 (if I’m not mistaken), with impressive reliability given how high a percentage of its mileage is flat out. Fuel economy? I remember once calculating it and came to something like 40-50 l/100 km, or 4.7-6 mpg.

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In terms of medical equipment, the MC is stocked with basically the same stuff as the other MICs around the circuit. This consists of the material we need to make sure that an accident victim’s airway is open and secure, that breathing is effective (either by the patient or by us!), and to access, and if necessary treat, the circulatory system. In fact, we’ve usually got two full sets of equipment on board – my kit as well as that of the local doctor assigned to ride in the FIA car. We do that for a few reasons. First of all, during the stress of an intervention, it’s better that the local doctor have his own kit, knows what’s where, etc. Secondly, since we have two doctors, we may as well be able to manage two victims, should we be be first on scene! 

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The car has four Recaro race seats and full harnesses front and back. Interestingly, we have 5-point harnesses in front, and 4-points in back. It was always reassuring to see what good care AMG took of . . . um  . . . well you get the idea. Alan and I are plugged into the car’s intercom/radio base station, so we speak to each other through our helmet boom mics and hear each other through our moulded earpieces (these double as noise attenuators when on scene). We each have a push-to-talk button for the main (digital) radio, and another for the backup (analog) set. Once we get out of the car, we need to unplug our earpiece/mic cable from the car and plug into our handsets. (I hear the ever so slight murmur – “he’s speaking in the present tense…”. He is. Indulge me. It just sounds weird and heavy using the correct tense).

The car also has three screens – two up front and one on the back of the central console. The rear screen is for our local colleague, whose weekend can be a bit lonely if language is a problem (especially with the front seat guys speaking in mere whispers over the intercom). The rear screen is “slaved” to the upper front; they can all receive the international TV feed (no sound, and usually on the top screen), the first timing screen (sectors and gaps, usually on the lower screen), the third timing screen (messages to teams), and the real-time gps locations of the cars around the circuit. This is obviously useful en route to an incident. At least in theory, because as you’ll see next time, we’re pretty busy when that happens, and switching screens is not the first priority.

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(By the way, this is us following Bernd in the Safety Car exiting Suzuka’s Spoon Corner, one of the most thrilling moments one can have in a car, as quite significant velocity is involved. In fact, my laps around Suzuka with Alan are certainly my favourite car moments ever.)

The Medical Car is on standby for all F1, GP2 and GP3 sessions and races. The standby position varies from circuit to circuit, but is usually at the pit exit. We’ll always have scouted out any shortcuts through the circuit using secured inner roads (not all circuits have them). These can allow us to cut off up to half the length of some circuits, with a huge time gain.

There’s been an accident

When something happens on the circuit, we usually see it at the same time you folks do. Not surprising, given that we get the same TV feed you do. Obviously, race control has seen things in rather more detail, because of the coverage of the circuit by CCTV. 

If we look at how the actual decision to deploy medical resources is made, it really occurs in one of three ways. (Remember, I grew up in a medical car, not in race control!) The first would be “by sight”. It’s a big accident, there are bits everywhere, gut feeling: fair likelihood of needing some sort of medical presence. I’d include in this category a good number of the bigger incidents we see, fully aware that most of the time there are no injuries. Obviously if the driver is immediately on the radio (and they usually are) speaking appropriately about, well, just about anything, this is good evidence for the absence of significant injury, at that moment anyway. I feel pretty strongly that if it looks big, secure the circuit and deploy. Sure, the MC would be deployed a bit more often, but these types of incident are relatively rare. A practice session or qualifying  can be restarted after a red flag; admittedly a higher threshold needs to be used for the race. On the other hand, if there are time-critical injuries, if a “by sight” deployment isn’t used, then race control will have to rely on the report of marshals. Now I’m never been convinced that this kind of non-medical evaluation of the victim is any more valid than that of a first, visual, impression from the cameras by an experienced crew in race control. If the driver gets out of the car, has no complaints, walks and talks, then the medical car, deployed “by sight”, can be told that fact, and would either continue back to its standby position, or, more likely, pick up the driver. This would allow the medical team in the car to evaluate the victim for concussive symptoms and decide on the appropriate followup. Again, this should not be a common occurrence, but the 15-20 seconds saved by NOT waiting for word from the marshals WILL come in very handy some day.

As I just said, a request by marshals for medical assistance, or a report of driver complaints (other than about his colleagues) while he or she is still in the car, will elicit a medical response.

Lastly, race control can decide to send us out based on triggering of the medical warning light.

This light equips every F1 car. It’s located on the top surface of the car, just in front of the “windscreen”. Wired to the car’s data logger, it is always on, with a slowly oscillating bright-dark cycle, to show it’s operational. But when it is triggered by a force of > 15 g (front to back, side to side), or > 20 g vertical (to take into account running over curbs) for over 5 msec, it shines VERY bright blue. It’s a reliable indicator of high energy transfer, and it also activates a warning lamp in race control. Activation of the MWL will often lead to race control ordering a response.

Once the decision is made to activate the medical service, the circuit is secured. For practices and qualifying this is by a red flag. The Medical car is informed by the FIA that the red flag is coming out, and we’re either then deployed immediately or put on a brief standby. During the race, we’re put on standby with the safety car. When we’re given the “GO”, we follow Bernd out; Bernd will show us his green light and move over usually within a corner or two of deployment. In any event, when we need to go, we always know there are likely to be race cars on the circuit at least for some of the time we’re out there. More on this next in the next post.

Remember that last time we spoke about the distribution of medical cars and extrication teams around the circuit. And we talked about the CCTV screens in race control. In order to reduce response times to a maximum, race control has a chart like this for each circuit (this example is from Malaysia, 2005):

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Each cell in the table corresponds to a screen in race control. An incident on any screen, referred back to this chart, immediately indicates the local units to deploy. Because traffic NEVER goes the wrong way ’round a circuit, each car and each extrication unit, covers a sector from their respective position to that of the next downstream unit.

When we get told to go, everybody on board the Medical Car needs to be ready for just about anything. In the next post, we’ll look at what happens en route to the incident, and what happens on arrival.

 

 

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13 thoughts on ““Deploy Medical Car”: decision-making and roll-out

  1. Gary, thank you for taking the time to write these posts and explain in such detail. Very informative and interesting. You have a new subscriber to your feed!

  2. Thank you for writing about this in great detail! I find the the medical and rescue aspects of racing very interesting.

    On your comment on never driving the wrong way being the prime directive, I just could not help and think about Roger Williamson’s very sad accident in 1973 at Zandvoort. The only fire truck in the area that could have saved Williamson wasn’t allowed to drive 50 meters in the opposite direction, and had to drive a full lap of the circuit in order to reach the crash site.
    As a Dutchman I feel very ashamed of what happened there.

    I’m so happy that todays standards actually allow for this prime directive to be executed safely and I thank you and Dr. Watkins for your great efforts to make this possible.

    ps. I’ve read books by Dr. Watkins and Dr. Olvey and hope you will write a book on this topic some day as well.

  3. Dr. Gary – this is incredibly interesting and informative AND exciting! I am on pins and needles awaiting your next installment. Seriously, you are a darn good writer – I hope that you are thinking about doing something with your talent.

  4. Perhaps it was only the practice of your predecessor Sid Watkins to perform what appears to be, at least from my perspective as a fan on tv, extensive track side treatment of an injured driver. I recall one accident in Canada where it appeared that Watkins was performing a heart transplant on the guy he was over him so long. I can’t recall the driver, but I do recall the extent of his injuries being relatively minor, nothing broken, no concussion reported.
    My question to you ,fine doctor, would be why would Watkins spend so much time administering aid by the track instead of loading the driver up and speeding him off to a place where they could do a heart transplant if needed? This was not the only incident where I saw similar actions. I have been watching F1 since 1975. In the US, it appears the protocol is to stabilize the victim, ie: stop any bleeding, clear airway, stabilize the head/ neck and get the guy to the trackside hospital or helicopter if necessary. Forgive me for being crude, but it seemed to me that Watkins was embellishing the gravity of the scene for reasons I don’t know. I mean, it seemed at times that he was waiting to see if the victim was going to get up and walk on his own, he took so long to get the driver stabilized.
    Any thoughts?

    • As somebody who has had the privilege of working alongside Prof. Sid Watkins in the OR in his main role as a neurosurgeon I am both outraged and astonished that you, as a mere observer, can accuse him of exaggerating his response for some spurious purpose. His skill, expertise and judgement were beyond question.

      • Well, I am not a doctor, and I don’t play one on TV, but for the life of me, I cannot understand why you would not get an injured driver to a medical facility as soon as you got him clear of the wreckage. I don’t mean to offend, but leaving the driver lying on the track looks like “grandstanding” to me. But what do I know.

    • It’s because F1 has almost all the medical facilities on site, due to Sid Watkins. Helicopters are a last resort. In the US, they don’t have nearly such extensive medical facilities, so for anything beyond a relatively simple treatment, they have to be airlifted.

      Often injuries are not immediately apparent, especially to the one who’s injured. Drivers can have so much adrenalin flowing through them at the time of a crash that they won’t even notice a broken leg or worse. Sid Watkins’ method was/is to treat the driver on site as much as possible because the minutes after a crash can be the most vital time for treatment. The time taken to airlift a driver to a hospital or medical facility can often be a factor in their death. Several drivers have died in the US during the journey to the hospital.

      It isn’t grandstanding or unnecessary delay.

      • My point exactly. With extensive medical facilities “on site” I contend that the side of the racetrack does not represent a site with extensive medical facilities. Combat rescue helicopters in the US military are very well equipped and staffed with highly experienced combat trauma veterans and that protocol requires stabilizing the patient and transporting hopefully within “the golden hour”. With the extensive medical facilities available in F-1 at the track, ostensibly 5-10 minutes away, I still cannot understand Watkins treatment techniques. Remember I am NOT a doctor and I don’t play one on TV.

      • You keep saying you’re not a doctor, which one might expect would preclude you from holding opinions on emergency medical procedures, but apparently not.

        Combat rescue helicopters aren’t dealing with anything like the same thing. They’re pulling people out of combat. There aren’t sophisticated trauma units there, so they need to take them away to treat their gunshot and explosive-caused injuries.

        I’m trying to think of the incidents in which you think Sid Watkins might have been grandstanding. Something in Canada, eh. The 1982 Canadian Grand Prix maybe? Riccardo Paletti crashed on the first lap. Sid Watkins was there 16 seconds (none of this five or ten minutes stuff) after the impact and immediately began treatment. The car caught fire and Watkins remained, putting the fire out and tending to his patient. He managed to insert an airway into Paletti’s throat despite his own hands being burned in the fire. Yeah, so it’s probably not that one.

        What you’re maybe thinking of is Mika Häkkinen’s big crash during practice at the 1995 Australian Grand Prix. Two local volunteer doctors were on the scene within 15 seconds with Sid Watkins arriving seconds later. They treated him at the trackside for 15 minutes, during which Sid Watkins restarted Häkkinen’s heart twice and carried out a cricothyrotomy (like a tracheotomy but faster and safer in accidents because you don’t have to manipulate the spine). All that in fifteen minutes. If they’d taken Häkkinen to a helicopter he would have died.

        Professor Sid Watkins never did anything that was unnecessary. He never took any longer than was needed. He never showed off. He never partook in any grandstanding. If you still disagree the techniques of the neurosurgeon who did more than anyone to advance medical treatment in motor racing, then why not try reading on of his books? “Life At The Limit”, “Beyond the Limit” and “The Science of Safety: The Battle Against Unacceptable Risks in Motor Racing” are all available on Amazon for just a couple of bucks and there are Kindle versions too. I particularly recommend “The Science of Safety” as it goes into detail about his techniques and the process through which he arrived at them.

    • Be patient for a few more blog posts – we’ll get to the core of what you’re asking. Quick (and totally exonerating) answer is as follows:

      - the incidents you probably have in mind were a series of accidents in the aluminium tube-frame cars of the late 70s and early 80s. 99% of the time on scene here was attempting to extricate the victim, whose legs were usually rather grievously interwoven with the various space frame bits (think Lafitte, Surer, etc). And what Sid did was basically get these things made safer so that kind of thing was no longer necessary. So the pedal box was brought behind the front axle, etc. And then the space frame car was gone.
      - starting with Viet Nam, the dogma for management of severe trauma was early “stabilisation”, usually implying aggressive fluid infusion for shock. This led to longer and longer scene times. The situation began to change in the early 90s (in the civilian world), and is now being driven by the experience in Afghanistan and Iraq. Emphasis NOW is to reduce scene time to a strict minimum, to limit fluid infusion, etc.

      We’ll get more into some of these aspects of care in subsequent blog posts.

      • Yes, I remember those accidents and that was surely an awful time to hit something hard in an F-1 car. I had the sad experience of witnessing Cevert’s crash at Watkins Glen. I am really glad those days are over. Thanks Sid!
        You are absolutely right about current military evac procedures. I am a former helicopter crew chief for the 106th Rescue Wing of the NYANG (USAF Pararescue) and the deal is for our guys to get the casualties out of the battlespace immediately for reasons that sometimes include getting shot at.
        I will be looking forward always to your thoughts on this and other things of interest.

  5. Dr. Hartstein,

    Thank you for your time and willingness to share your knowledge and experience with us (F1 punters).

    Sincerely,

    Bob G Smith

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