“Medical car on scene”: first medical contact (1)

It’s been a while (apologies, stuff kept getting in the way of me sitting down), so I thought we’d get back to our series on trackside intervention. Since we’re getting into the essence of the subject, I’ll break this into fairly small morsels, in order that each post not be too . . . boring.

We’ve arrived on-scene and informed the tower of that fact. I tell Alan I’m unplugging from the car radio and intercom, and switch to my handheld radio, tucked away in a pocket of my overalls. I’ll admit to forgetting this sometimes – being halfway out of the car, focused on the incident, only to be yanked back into the car by that damned cable from my helmet! Next item on the checklist: make sure I can egress safely. With my basic tool kit in hand, I get out. I always try (and often succeed) in making sure that both doors are closed behind us (myself and the local doctor) as we exit; Alan stays behind the wheel initially, waiting to see if we’re actually going to have to work, or if we’ll just be the world’s fastest and most viewed taxi. It’s surprising how often we need to move the medical car during an intervention, and it’s vastly preferable that the doors be shut to do so! If I give Alan a hand signal, he informs Race Control that he’s getting out of the car, and he alights also. At that point we liaise, to determine what equipment we need, and roughly how long this will take. Alan really takes care of most comms with the tower, and I pretty much concentrate on letting Alan know what’s going on and how work is progressing. He also takes care of a lot of the overall organisation of the scene, making sure that people and vehicles aren’t getting in each other’s way. He is a vital asset at interventions, and the fact that he so capably moves beyond the role of “simply” driving the Medical Car makes things run INFINITELY more smoothly and safely.

As we actually approach the car(s), I always remember the acronym “ETHANE”. This helps us to remember the information about the scene that the dispatching centre (in our case, Race Control) requires in order adapt the response appropriately. While in the context of a Formula 1 incident many or most of the elements are already known, it’s an important discipline to run through this EVERY time. Here’s what we look for:

  • E: exact location
  • T: type of incident. I’ll usually use this as a first opportunity to give race control a rough idea of how things are – very bad, bad, not so bad, not too worried. Not a very scientific system, but the goal here is just to get Charlie (Whiting) and Herbie (Blash) on the same wavelength as me as early as possible in the intervention.
  • H: hazards. This might include risk of fire, electricity, fuel or other hazmat.
  • A: access. This is where we (usually Alan) let the tower know if there are any conditions that might affect the conduct of a safety car deployment, or whether there are particularities to be communicated to oncoming rescue units.
  • N: number of victims. Although I’ll admit it must be hard to imagine, but this one is surprisingly easy to get wrong. Especially when one car is obviously damaged, or where one victim obviously needs our help, the reflex to start taking care of that person, right away is very strong. But it’s crucial, before starting care for ANYONE, to have a precise idea of exactly how many victims there are, and just how sick each of them is. This means EVERY potential victim needs to be quickly and efficiently assessed; we need to know if there’s a car we can’t see (on the other side of the guardrail?), a marshal struck by debris 100 metres upstream, etc. (By the way, we’ll talk in more detail about mass casualty incident management in a future post. This is a fascinating subject, and important to understand.) Evaluating the “N” is vital in terms of helping determine the next step:
  • E: emergency services required. Do we need an extrication unit? How many intervention cars? Ambulances? Fire suppression? This is where we tell Race Control what we’ll need to get the job done.

Although every accident is different, the overall sequence of care at an accident scene is always rigorously the same:

  1. rapid “global” assessment
  2. determination of extrication strategy
  3. extrication
  4. primary survey (find and treat immediately life-threatening injuries and manage them)
  5. transport to medical centre

We’ll look in more detail at these elements over the next few posts. Remember that under real circumstances, especially with a well organised and well-led intervention, some of these steps will ideally overlap. For clarity, however, we’ll consider them in sequence.

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24 thoughts on ““Medical car on scene”: first medical contact (1)

  1. A special thanks to Dr. Gary

    This morning on my way to work I ran into the corner of a facia board which, first: hurt like heck and second: stunned me off my feet for a couple of minutes without a loss of consciousness. Nausea, yes…slight headache, yes…off balance, yes…felt dumb/stupid/drugged, yes. Went straight to emergency room after noting time of non penetrating injury to my left temporal area. Had partner check my pupils which were alike. On the way to ER my left eyelid proceeded to fall, albeit left and right side of body felt same.

    At hospital, Dr. asked time of injury which I could report. Bed was elevated to 30%.
    I talked slower, could not write my signature well, actually hardly, but passed all preliminary verbal questions, hand squeezes, foot presses and pulls all fine; pupils remained normal. Dr. Gave me an anti nausea pill and ordered a CT scan to verify that injury was what he thought was most probably a mild concussion.

    Results of CT Scan: Mild concussion confirmed. Be attentive to how you feel for 24 to 72 hours. If you notice a this or a that return immediately. Prognosis: “Your brain looks normal for a person your age and I think you will be just fine.”

    I would not have been able to be the patient I was today without all the posts from Dr. Hartstein, plus so much research that I have done on my own, as well as some of the wonderful comments and questions this blog has had. One other thing. While they were doing the CT scan I thought about Michael Schumacher and said a prayer for him as either I or the machine moved because my eyes were closed.

    God Bless you Gary for all that you have given to us and God Bless Michael and his family as well.

      • Thanks Peter. You words mean a lot to me. Still feeling a bit stupid though and slight headache remains. This has given me a very tiny microscopic view into TBI’s as the medical field refers to a concussion as such here. What stands out the most is how SLOW things are, how long it takes, getting back to MY normal and I just cleared 24 hours. Doc said up to two weeks, maye longer.

        With what Michael has been through, if he survives his survival, the odds are he will have many very difficult and complex years before him that are beyond my understanding and yet, now, I have this very very very teeny tiny insight. And it ain’t easy on the family.

        One day at a time and thank you again.

      • Thank you so much. What is so interesting is that I kept thinking about Michael and what he is going through and I wasn’t scared at all. Let’s pray and hope that Michael comes round soon.

    • Yes, this was nice to read. Hope you are completely well now.

      Had a mild concussion myself a few years ago, after being thrown off a horse, but I did not realize this fully, until after I read this blog. Did not know the symtoms then. So this blog is good, raising awareness. Thank you for this, Dr Gary.

  2. Thought this was so funny ….. (posted from Dr. Gary’s twitter) especially since Maldonado had yet another crash in Spain. His damaged car was swinging so much while being lifted; it looked like it was going to knock over all 5 guys trying to hold it steady.

    Maldonado dropping by the hospital to check up on Gutierrez

    pic.twitter.com/6aG1tAlQY2

    (a.k.a. Liza)

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  4. Having been involved in CART/Champ Car for many years (from 1999-2006), I was always impressed with their safety team. I got to know quite a few of them personally, and they took great pride in how they were pushing driver safety forward. I would love to read your thoughts on that team vs. the F1 philosophy of the same era. It was always my opinion that the CART Safety Team was world class, and seemingly on the forefront of safety technology and technique.

    • Forgot to finish my post (watching the Rangers and Penguins in Game 7!!)

      I also want to thank you for your excellent blog. Please feel free to write as much as you want, it isn’t boring, and I’m hanging on every word!

      Moorestown, NJ

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  6. Thanks Gary for your new post.

    I have a few comments, which I shall present below.

    Does any of the F1 tracks have an ISO 9000/1 or 14000/1 certification regarding organization, maintenance, evacuation, health care, security, sanitation, emergency, safety etc. If I remember correctly, you mentioned in your previous posting that Malaysian track operations are ISO certified with regard to health care. Why are not all the other tracks? Why are they not ISO certified in all fields of operation?

    When will standardized procedure (an ISO 9000/14000 certification) be an integral part of acceptance procedure for a new and existing F1 race track? Is this an issue at all within the inner circles of FIA, Formula One Group, Allsport Management? FOTA, FOA, FOCA are extint organizations who could have had something to say. Soon also GPDA. Monopolistic situation, almost: Delta Tepco is dictating everything: Jean Todt can enjoy good meals ending with the best of Armagnags and Cognags in three Michelin star restaurants.

    I know that Ferrari has been keen to get ISO certifications earlier: quote from Wikipedia: “DNV has certified Ferrari according to the ISO 9001 and 14001 standards, recognising the companys environmental concerns and decision to reduce any negative impact from its operations.” end of quote.

    Has Ferrari shown same enthusiasm within the motor-sport division and operations? I would expect that Mercedes (Daimler Group) would be the forerunner in the safety issues, but have they been active in this field field at all? Well, VW will probably join F1 in 2018, maybe there will be more competition within the safety issue.

    F1 is close to two billion dollar-industry annually. Why not get it certified? In all aspects? Has this been a subject at all within the inner circles? Or, maybe the answer is so simple, that the present owners (Delta Tepco: CVC Capital, Waddel and Reed, remains of Lehman Brothers, Bernie Ecclestone trust, Bernie himself and some other investors) just want to sell the business to the highest bidder as soon as possible, and therefore development measures into the safety will not be taken? Just a wild quess. Which is actually not so wild, if you start to think… Bernie is not that young anymore, and the others are investment funds (one of them are just remainings of a bankrupt bank).

    PS Gary, sorry if I got a bit carried away from the original subject in one previous theme.

  7. Gary – What a great start, almost like an verbal aerial view… . Your commentaries, posts, have most definitely increased my interest in F1 racing as well as an understanding of the medical side. I am really looking forward to the next installment. Very exciting!!!

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