“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.