Extrication in 2013

I talked last time about introducing the concept of “cockpit-out design” as one of the ways I think motorsport safety can progress. It’s important to realise that this is a further application of the system put into place by Max Mosley and Sid Watkins. After acceptance and adaptation of the concept, the essential element is the research, in order to develop a consensus among experts as to exactly WHAT current best practice is.

While I’m firmly convinced that “cockpit-out design” will further reduce injuries, in terms of the actual practice of motorsport medicine (that is, after the accident has happened), I think one of the major priorities to be addressed by the coming administration is EXTRICATION. Extrication is quite simply the process by which an accident victim is removed from his vehicle.

First, a bit of background, then I’ll make some suggestions (why is this not a surprise!) as to one way forward.

After Philippe Streiff’s accident in Brazil in 1989, Sid Watkins charged one of his associates with looking at the process of extrication. (Ironically, extrication had absolutely nothing to do with the devastating injuries Philippe suffered, but that’s not the subject here). Thus were born the “KED teams” seen since 1990 at all F1 races. These are physician-led six man teams trained in the use of the KED, a device originally used for extricating accident victims from road cars. (Here’s the Wikipedia article: http://en.wikipedia.org/wiki/Kendrick_Extrication_Device). Interestingly, the first time an extrication team was used in anger was at MY first Formula 1 race, at Spa in 1990. The victim was Luca Badoer, who incidentally had just said some pretty nasty things about my mother after I placed a rather huge catheter in a rather small vein on his hand. In his defence, he was concussed. And in the interest of truth, my mother is a TEACHER, and she’s not filthy.

It rapidly became clear that while the KED was useful, it was hardly ideal. Among other difficulties, placing it in position required manipulating the driver, which is precisely what we try NOT to do. This led Sid to push for extricable seats, which are now in use in all major single-seater championships. The idea behind this is intuitively brilliant: the seat itself acts as a spinal splint and the driver is removed from the car still in his seat.

Under the influence of Sid’s associate (who also was a motorsports medicine pioneer but had zero experience with real accident victims), training in use of the KED and extricable seat became the be-all and end-all of “medical” training for FIA championships. To this day, there is an official extrication exercise on the Thursday before every race weekend; it is only recently (and totally unofficially) that the rest of the medical competencies necessary at the track are examined with an integrated accident simulation scenario . . . including extrication.

Spinal injuries are devastating, and it is clear that every measure possible must be taken in order to avoid aggravating the injury caused by the accident, notably by moving the victim inappropriately. This is the “raison d’être” of extrication teams.

The problem is, in 2013 we have no real idea of what spinal injuries are occurring, and what mechanisms of injury are causing these lesions. We know they’ve become extremely rare in motorsports (a wonderful result in itself, but one that singularly complicates our job in a statistical sense!), but beyond that, we just don’t know if what we’re doing is the best way to do it, if the tools at our disposal are the right tools for the job, and if the apportionment of training (currently 99% extrication 1% everything else!) is correct.

Obviously, we should have answers to all these questions . . . before the next spinal injury! How do we go about getting those answers?

I think the first step needs to be to convene an expert conference. This needs to look at both road accidents as well as motorsports-related accidents. The epidemiology needs to be obtained – who’s getting injured, how, and how are these injuries evolving from time-of-impact to definitive care. Then the experts need to look at this data and determine how best to take people out of cars in different situations. Are the vast majority of lesions stable in flexion but unstable in extension? Is rotation to be avoided at all costs? This kind of knowledge will place bounds on how we extricate and on what tools we can use to get that job done.

Once this is done (and this is no small job), we need to look at the tools available, both for paramedics, EMTs and docs working in the streets, as well as in the motorsports environment. And we need to remember that “the motorsports environment” means single seaters, dragsters, rally cars, GT cars, etc! If the proper tools don’t exist, we need to develop them. The full resources of the FIA, FIA Institute and FIA Foundation can and should be used for this, especially by forming ties with industry.

Who better than the FIA Institute and Foundation to organise this kind of conference? A  global commitment to arriving at an evidence-based updating of extrication procedures for both road accidents as well as those occurring in motorsports would bring potentially massive benefits. To my way of thinking, this is one of the ways to really bring home the “Action for Road Safety”, and to start to make the FIA a deservedly household word!

5 thoughts on “Extrication in 2013

  1. Gary, I am a member of the highly successful Royal Berkshire Fire & Rescue Service Vehicle Rescue Team and have just returned from the World Rescue Challenge, this year was held in Clearwater, Florida where we managed to achieve first place for the third year in a row. The challenge involves the rescue of seriously trapped and injured live casualties with a strict time limit and the requirement to ensure the gold standard of medical care throughout the extrication.
    I was fortunate enough to attend this year’s Le Mans 24 hour race and was very disappointed to witness the brutal manner in which a crashed car with driver were manually rocked back onto all four wheels after at least a dozen unsuccessful attempt by the track side rescue team!
    As an avid motorsport fan I would be delighted if I can assist this very worthwhile cause in any way.
    Keep up the good work! Regards, Adam

  2. Hi Gary. This is a timely blog (again) – the compression vertebral fractures are not only occurring in open cockpit cars. I have had personal experience with exactly the same injuries in closed cockpit cars in gravel and tarmac rallies over the last 4 years. I can count 7 of these injuries over that time period. All have been stable with no cord compromise, but the emerging pattern is glaringly obvious. Through the CAMS medical advisory committee we are now finally collating data in an organised fashion through a serious crash program. We have postulated that part of the mechanism may be related to the wider use of HANS and similar devices, with modified energy transfers to the vertebral column, particularly with sudden frontal deceleration. However, as you note, we need a dataset to analyse to allow us to advise our colleagues based on evidence wherever possible.
    Cheers from down under, Matt

  3. Another excellent, well reasoned and compelling argument. All the best with persuading the powers that be to move this forward. Nick

  4. Hi Laura. Thanks for the comment. Remember that a large number of people who spend their weekends at circuits, rallies and such spend their weekDAYS doing this on the streets. But you’re absolutely right, this is a great opportunity to influence practice in both areas.
    As for Anthony’s injury, and I assume (but can’t confirm) Dario’s, this has become BY FAR the most frequent bony vertebral injury. In the “real world” ertebral compression fractures are frequent in patients with osteoporosis, but we had an “epidemic” of them in GP2 and GP3 in 2010. We had at least 5 incidents. The good news is that these lesions do not pose a threat to the spinal cord. Of course, when you’re trackside, you’ve got a driver in a car complaining of back pain, and at that point you don’t know what the injury is. This means that you do a full, controlled extrication (I’ll probably blog about the general approach to an accident and what we think and do). This is EXCEEDINGLY difficult from a closed Le Mans car. And this difficulty is one of the things that needs to be included in a cockpit-out design.
    We’ll get the statistics, we just need to have the will and resources of the FIA behind us to do it. It’s what they’re there for.

  5. As soon as I started reading this post, i was thinking about how useful you and your colleagues knowledge would be to the wider vehicle accident and emergency response teams on the road today!
    Also I’ve heard of two high profile spinal injuries in single seater cars in the last couple of years – Anthony Davidson at Le Mans (from which he appears to be completely healed) and Dario Franchitti at a recent Indicar race (from which this and other injuries he is still in hospital). So unfortunately your stats are out there….

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