“Medical car rolling”: en route and approach to the accident

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So there’s been an incident, and race control has red flagged the session (or activated the Safety Car, if this is a race), and asked us to deploy. We’ve instantly switched from being the spectators with the coolest seats around to being the people to whom everyone turns when the bad stuff happens. How exactly do we roll up our sleeves and get to work?

We usually, but not always, have a good idea of where the incident has occurred. This is either from having seen the accident and understood where it is on the screens in the car, or because we’ve been told by race control. In any event, the tower quickly lets us know where we need to go – and when it’s important, where the car has come to rest, whether at the entrance to, mid corner of, or at the exit of a corner, left side or right side of the circuit, etc.

A parenthetic anecdote to lighten the atmosphere

(When Olivier Panis had his accident in Montreal, race control cleared us to deploy. Sid and I had gloves on and were ready to go when we realised the car hadn’t budged. Sid assumed there was a linguistic problem with our French-speaking driver. He told the driver, in an appropriately assertive way “We need to go!”. A quizzical look came over the driver’s face. “Now?”, he asked, “in the middle of the race?” Sid hid his frustration well. “Yes old boy, there’s been an accident we need to attend.” Our driver, a lovely fellow named Pierre, stated the obvious – “But we don’t know where the accident is!” At this point I heard the reassuring tones of Sid’s angry voice “LET’S JUST DRIVE AROUND THE FUCKING CIRCUIT AND WE’LL PROBABLY FIND IT SOMEWHERE!”)

Back to the serious stuff

The second we see an incident that might require a response, Alan puts the car in gear (the motor is running through all sessions), and we start putting on our medical gloves. Alan has already verified that we can exit our standby position safely, and this verification is repeated until we get clearance to roll.

As you can imagine, this is a fairly active moment for us all. Our first order of business is to get to the accident scene safely. That’s a tall order. There will almost always be racing cars on the circuit and even when they’ve slowed dramatically for a red flag (and are therefore heading back to the pit lane) or safety car, they’re still going VERY VERY fast.

To the extent possible ALL of us (meaning Alan, myself, and the doc-in-back) have our eyes on the circuit. Ideally Alan is freed up to drive, but obviously he’s also in the mirrors. When a race car approaches us (I wish you could appreciate the closure rates; we’ve usually got some speed going, but the racing cars make us look, and feel, like we’re standing still), Alan will tell me when to activate our green light. This is the same as on the light bar of the Safety Car, and signals to the oncoming racing car that we’ve seen him, and that it’s ok to pass us.

The racing cars pose some hazard to us; much more dangerous still are the local medical intervention cars, ambulances, and extrication units. These can be expected to join the circuit from their respective standby positions without looking, to immediately take to the racing line, and also to drive two or three abreast. Often no attention is paid by our colleagues to those low, loud and fast cars covered with advertising stickers and big rear wings. The ones driven by helmeted people. You only need search for YouTube videos of Safety- and Medical Car accidents to see the kind of stuff that we just CANNOT let happen. Coordination of this deployment is one of the important reasons behind my insistence in the first post of this series that the FIA team and the local resources be in real communication with each other.

As we head to the accident, Alan is pushing quite hard. I’d say (my impression) that he’s somewhere around 80 -85% of the car’s possibilites. This depends on a lot of things, among which are the situation and how “chaotic” things seem (higher chances of a marshal randomly losing focus and stepping in front of us), the weather, etc. Race control will be giving us information (status at the site, info relayed from the marshals, etc). 

This is also the time for a final quick review of the sequence of our intervention with my colleague in back. Scene survey, driver survey, determine the extrication strategy and need for care on-site. Who will do what. I always insist, en routethat my colleague will manage the scene and I’ll assist as necessary . . . if he or she is comfortable with that. If not, I have no problem assuming that role. There can’t be ambiguity about any of that once we start working.

On approaching the scene, we are thinking about three things: vehicle placement, scene safety, and indicators of mechanisms and severity of injury.

Vehicle placement

When arriving at the scene of an accident, it’s important to think about where each vehicle should be stopped. The accident scene, although covered by flag marshals, can be more clearly delineated using the intervention vehicles, especially as they are almost always equipped with flashers. The scene also needs to be protected from any oncoming traffic. Finally, vehicle placement should facilitate, rather than hamper, the functioning of the intervention.

Of course, every accident is different, and for most situations there’s no one right way to do this. The point is to take into consideration the following factors:

  • has the race been stopped, and if so is the circuit already clear, or are we under yellows and the Safety Car?
  • how far off or on the circuit is the accident?
  • visibility on approach
  • relation of the accident scene to the racing line
  • the width of the track

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In general, the first intervention car on site (MIC in the diagram) should park upstream of the accident, off the racing line, and in a “fend-off” position. This means the car is slightly angled away from the circuit with the wheels also turned towards the edge of the track. This way, if the car is struck, it will move further from the circuit. This will often, but not always, be the FIA Medical Car.

Next to arrive will be the extraction team (EXT) (when requested) and/or the local MIC. This vehicle covers the rear of the scene, Fire teams stop ahead of the intervention cars, abeam of the accident, and the ambulance in front of the scene. Remember, the ambulance is rear-loading, so this position facilitates expeditious access to the cabin.

Scene safety

This step is usually not apparent when viewed from the outside. On arrival at an accident scene, all our instincts are screaming “GET OUT OF THE CAR AND GO HELP THIS GUY!!!”. This is the wrong thing to do. All medical rescue personnel need to always have in mind how dangerous a circuit is, and that their overriding priority is actually TO AVOID SECONDARY ACCIDENTS. This means verifying implicitly (most incidents), or explicitly (special situations) with the chief incident marshal at an accident scene that it’s safe to approach. Our reflex to help must never trump the order of safety priorities: first protect one’s team, then scene personnel, and only then the victim.

Scene analysis

I don’t think most people realise how important anticipation is when taking care of trauma victims. Trauma is caused by the application of FORCE to the body. So as we approach the patient, and in fact all through that initial management phase, we’re constantly asking ourselves –  what was the DIRECTION of the forces involved, and what was their MAGNITUDE. We’ll talk more about this next time, but for now one of the key things we’ll be doing as we get close to the accident scene is closely looking at signs of exactly what happened. 

Early clues to it being big are things like a long debris trail, the stress audible in radio communications, the vigour and intensity of flag waving on approach, and crowd movement towards the scene.

If we’ve not seen the accident on our in-car screens, as we get to work I try to find out from the incident marshals exactly what they saw.

Well we’re out of the car, heading to the accident itself. Time to take a breather.

Next time: initial assessment and management

 

8 thoughts on ““Medical car rolling”: en route and approach to the accident

  1. A motivating discussion is definitely worth comment.

    I do think that you should write more about this subject matter, it may not be a taboo subject but generally people do not discuss such topics.
    To the next! All the best!!

  2. I’m a metallurgist and often involved in failure analysis of broken metal things (mostly power generation equipment). You wrote:

    “[A]s we approach the patient, and in fact all through that initial management phase, we’re constantly asking ourselves – what was the DIRECTION of the forces involved, and what was their MAGNITUDE.”

    Substitute “part” for “patient,” and that is exactly the same thing I do for my inanimate failure analyses. I’d bet historians, economists, and a lot of other professions also take a metaphorically parallel approach to their work.

    Vectors are important and universal.

    Thank you for this series.

    &y

  3. Gary, thank you for being willing to write this. I was an EMT in the US Coast Guard. We would approach every scene using much the same process. Safety was not always guaranteed…

  4. Fascinating article, thank you!

    Regarding your engine running throughout, this may seem like a trivial question but I assure you it is genuine: is this not bad for people waiting or working in the areas near where you wait? I have walked past cars in my street where people decided to sleep with the engine running rather than drive home in the small hours, and I coughed as I walked through the cloud of fumes surrounding the vehicle. I understand you must be ready for action, but is there not a moment between news of the accident and being told to deploy, when the ignition can be turned?

    Looking forwar to further installments of these posts, thanks so much for your insight. I always appreciate your honesty.

  5. Gary,

    I have been a “reader” for a while now but this recent series of articles has prompted me to comment.

    I have been an observer/communicator at flag points for 13 Grands Prix (both in Australia and at a very, very wet South Korea), as well as at V8 Supercar races where I have witnessed medical staff working in the most severe (and tragic) of circumstances. I have always been impressed at how they handle themselves and undertake their work – and have always found them both professional and approachable on the point.

    These articles have given me a deeper understanding of processes that I believed I already knew, but now realise I only had more superficial awareness of. My understanding of the processes come from my work as a Steward at club events and I see how everything steps up a few notches at major international event level.

    ‘I will be encouraging my fellow marshals to read these (and your other) articles as it also gives some insight into the role we, on the flagpoint, play in the management of critical incidents. We don’t always get that in the feedback after such an event has occurred and has been “handled” – understandably as those who could provide that feedback are usually still dealing with the details of the incident long after we have gone back to our usual duties and the event has resumed.

    Thank you for these articles and for your past work in motorsport at its highest level.

    Eric

    • Thanks for the very kind words Eric. This series has been great for me so far, as it’s forced me to organise my thoughts after a while away, and keep things fresh. Glad you’ll find a practical use for it!

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