A win for Formula 1

No matter how you slice it, Fernando’s decision to not drive in Australia is a proof of his intelligence, maturity, and understanding of “the big picture”. My assumption is that he is suffering from concussion. Although there are curious elements in the story we’ve been told, if we “simply” put together a few relatively objective tidbits, they would appear to spell “concussion”:

  1. an impact to the head
  2. talk of loss of consciousness
  3. talk of retrograde amnesia (loss of memories of events BEFORE the trauma)

What we’re worried about is twofold. In order of importance this would be: concern about a driver whose brain was not functioning optimally at the helm of an F1 car, and concern about second impact syndrome.

(here are links to previous posts about concussion, or MTBI):

https://formerf1doc.wordpress.com/2013/10/26/we-really-need-to-have-a-word-about-baseline-concussion-testing/

https://formerf1doc.wordpress.com/2013/10/27/what-about-return-to-competition/

That’s why it’s crucial that all symptoms and signs (respectively subjective and objective) of concussion are totally resolved before resuming competition. Let’s briefly remember two things – both of them correlations. First of all, we have to remember that the correlation between the force applied to the head and the severity of the concussion is quite . . . coarse. Every ER doc has seen patients with huge hits who are only mildly concussed, as well as patients who’ve only tapped their heads mildly and are totally in outer space! This might help us understand how Fernando could have a concussion that’s enough to keep him out of action this long with an impact that was, all things considered, not that heavy (although I HAVE heard it was, in fact, high speed). The second correlation that’s notable for its weakness is between the severity of the concussion and the time it takes to get over the symptoms. My conclusion? There’s nothing suspicious here . . . yet. Statistically speaking, there’s an extremely high probability that Fernando will be fine for Sepang. What about if not? I think that if for some reason Fernando doesn’t drive in  Malaysia, we’ll certainly have more information by then – because at that point, we’d very clearly be into new territory (still conceivable, but . . .) in terms of concussion recovery in our sport. Lastly, I’m immensely proud of this sport. This is a mature decision, clearly prioritising what’s important. It indicates just how pervasive the culture of safety regarding head injury is in Formula 1 – a wonderful legacy of Prof Sid!

80 thoughts on “A win for Formula 1

  1. Autoweek, 9 March:
    “Rumors persist of shocking cause of F1 driver Fernando Alonso’s crash”
    In Spain, newly emerged amateur video of the incident was published by the broadcaster Antena 3, with the Italian publication Autosprint surmising that a “strange noise” was made by Alonso’s McLaren-Honda.
    “What bothers me,” said 1997 world champion Jacques Villeneuve, “is that we do not know the full story. The wind? Come on, it also blows at Indianapolis when you’re doing [235 mph]. Some people are talking about an electric shock but I can’t comment on that. But if there was, it would mean that you cannot race anymore with these engines. [ed: ah, so these are the stakes worth stonewalling. . .]
    “There is something hidden and we are not being told, and that is worrying.”
    http://autoweek.com/article/formula-one/rumors-persist-shocking-cause-f1-driver-fernando-alonsos-crash?utm_source=DailyDrive20150310&utm_medium=enewsletter&utm_term=image-center&utm_content=body&utm_campaign=awdailydrive

    Gosh, Jacques, this sounds like an investigative job for the Federation Internationale de l’Automobile! We don’t want Button and Magnussen frying their brains in Melbourne, do we?
    lm

    • The story has grown legs and is now resides in the realms of fantasy.
      The problem is 2 fold so it seems.
      1.The total lack of credibility that McLaren, The FIA, Flavio Briatore (For God’s sake …. who let HIM out to play!) have, which is indicative of where the sport finds itself these days.
      2. The usual scenario of the press ratcheting things up to the max and taking everything anyone says about the accident and its aftermath and reporting it as gospel.
      The only person no one seems to take much notice of is Alonso himself. A man known for being relatively straightforward, he says nothing untoward happened and not to look for conspiracy theories. He suffered a bang on the head and the doctors kept him in for a while while he regained his composure.
      Why does no one want to listen to him? Because he works for McLaren. I return you to point 1….
      But look at the video – http://youtu.be/JNVSWSzsrjQ – all 4 wheels are still on the car and not much looks bent. So exactly what did happen? We’ll probably just never know.
      Another nail in the F1 coffin.

      • Peter,
        There’s just something about the human brain (mind) that needs to fill a vacuum. How many hard drives melted discussing the Schumacher Affair? We all understand the power/money behind blaming the wind, so why not just go with that? What real difference does it make to our lives anyway? Happily for we curious millions the season is about to begin so now we can watch and wait and wonder.
        lm

      • Maybe this is a good OMEN (or maybe pigs might fly!)
        Thursday 12th March
        1.Sauber have failed in an appeal to overturn a court ruling that says Giedo van der Garde should race for the team at Sunday’s Australian Grand Prix.
        2.Ron Dennis has admitted he was wrong and Alonso did have concussion (surprise, surprise!) He said: “It was not the best performance by me. I understand why the press beat me up for being inaccurate. I wanted to be open and honest. I failed. But it is my objective to try to be as honest as possible in future.”

  2. With the new season starting next Sunday, I’ve now seen the first trailers on BBC and I’m looking forward to a good, safe season. I’m sure Alonso will be racing in the second race. I’ve also heard rumours that Jules Bianchi has made no progress since his return to France. In any other situation (especially in the UK) Jules’ accident would have been treated as a workplace accident, as Richard Hammond’s Top Gear crash was, and the ordinary rules meant that the HSE published a report which was available to the public to read. I very much hope that Bianchi’s accident is not swept under the carpet and the FIA take responsibility as I feel they should morally if not legally.
    http://www.hse.gov.uk/foi/releases/richardhammond.pdf

    • It’s just so hearbreaking and so predictable. I’m sure that everyone who has been reading Gary’s blog since Schumacher’s accident knows that the odds are massively against him, but I would like to think that the support of the fans has been some help, and the family know that Jules is not forgotten.
      “Jules is still in a coma. As long as he does not wake up, the only thing we can do is wait,” Bianchi’s father is quoted as saying by Gazzetta dello Sport.
      “It takes patience, a lot of patience, but it is difficult to know that at any moment a terrible call could be coming from the hospital.
      “We have to be strong, like Jules and for Jules.
      “As long as he is in this state, the doctors cannot say anything. He might wake up or he might not.
      “I think he will, as he has not fought with us this long for nothing.”

  3. I’ve just bought the Sun (a paper I hate in general but now behind a paywall) because Jeremy Clarkson has written about Alonso in his column today. Clarkson is a long time F1 fan and also knows a lot about TBI – this is worth sharing I think.
    Hope for Alonso
    The news from Spain all sounds very frightening. According to sources close to Fernando Alonso, he came round from his “weird” crash during the F1 testing and thought he was a 13-year old go kart racer.
    My sources tell me he thinks he races for Ferrari and has no memory of switching last year to McLaren.
    Whatever, he is plainly concussed and that sounds very frightening.
    It IS frightening. I remember well the awfulness in the wake of Richard Hammond’s jet car crash as doctors struggled to put his head back together again.
    But, and I hope this gives Fernando’s family and friends hope, Richard did get better and soon he was back to his normal irritating self.

  4. Hi Gary, I’m interested in carotid sinus hypersensitivity. which you mention as a possible cause of Alonso’s crash in BBC item. I often feel very briefly faint if a tight strap is pushing against my neck, such as a seat belt or when carrying a laptop, and I fainted both times I was pregnant in the hairdressers when they put a tight rubber mat type thing round your neck when washing your hair. I also hate having my hair washed in a hairdressers when you have to bend back over the wash basin because I feel faint when I do this. I can imagine this could be dangerous in a racing driver and I have often wondered about it.

    • Hi Jane! The symptoms you describe could represent carotid sinus hypersensitivity. Ask your GP (or a cardiologist) to check for it. He or she should first LISTEN to your carotids, to make sure it’s safe to do the massage manuver. This is usually done under ECG monitoring.

      Carotid sinus massage is the diagnostic maneuver of choice, but the technique has not been standardized. There are no controlled studies on the subject.

      A commonly accepted massage method includes the following 4 steps:

      Place the patient in the supine position with the neck slightly extended. The patient should lie supine for a minimum of 5 minutes before carotid sinus massage is applied.
      Massage over the point of maximal carotid impulse, medial to the sternomastoid muscle at the upper border level of the thyroid cartilage.
      Massage for 5-10 seconds on each carotid sinus consecutively, with a 1-minute interval between massages.
      Carotid sinus massage is preferably applied to first the right carotid sinus, as CSH is more prevalent on the right than on the left side.
      Continuously monitor surface ECG and blood pressure. Phasic, noninvasive, beat-to-beat blood pressure monitoring is preferred over using a cuff measurement.
      A massage is considered to have a positive result if any of the following 3 criteria are met:

      Asystole exceeding 3 seconds (indicates cardioinhibitory CSH)
      Reduction in systolic blood pressure exceeding 50 mm Hg independent of heart rate slowing (indicates vasodepressor CSH)
      Combination of the above (indicates mixed CSH)
      A less frequently used method consists of carotid sinus massage performed for 5 seconds on each side in the supine and 60º positions using the head-up tilt table. Substantial evidence shows that sensitivity and diagnostic accuracy of carotid sinus massage can be enhanced by performing the test with the patient in an upright position. Furthermore, the endpoint of a 50 mm Hg reduction in systolic blood pressure may be achieved with tilt, but not when supine.

      Do not perform a carotid sinus massage if the patient is known to have transient ischemic attack, stroke, or myocardial infarction in the preceding 3 months. History of ventricular tachycardia, ventricular fibrillation, or carotid bruit on auscultation are relative contraindications to carotid sinus massage.

      Some authors describe the use of carotid Doppler ultrasonography to guide carotid sinus massage in patients who have a carotid bruit on auscultation. Carotid sinus massage is performed only in patients with a carotid bruit when there is less than 70% stenosis on Doppler examination.

      Although carotid sinus massage is usually a benign bedside procedure, a few case reports describe rare neurological deficit symptoms following the massage. Currently, the estimated incidence of neurological complications is less than 0.2%.

  5. And now for my reply with the CORRECT link!!!

    Hi Gary – a busy start to the year and nice to see you back and blogging.

    Here is an interesting article on the matter by Trent Price

    “With the FIA Institute devoting more funds to race and road safety, side impacts could well be the next big area of development.”

    http://richlandf1.com/?p=34319

  6. (For complete article: link to grandprix247 below)
    DID A 600 WATT SHOCK CAUSE ALONSO’S TESTING ACCIDENT?
    Officially, a gust of wind blew Fernando Alonso’s McLaren off the Circuit de Catalunya on 22 February, resulting in his concussion that has sidelined him for the season opening Australian Grand Prix in Melbourne.
    Unofficially, speculation and doubt are running wild with most recently Sky Italia, the F1 broadcaster, claims the Spanish driver has confided to close friends and family that he suffered a “major shock in his spine” before losing control of his McLaren-Honda and striking the Barcelona wall.
    The broadcaster made clear that Alonso did not say specifically that he was electrocuted, but the report adds weight to the theory that there is more than meets the eye to the controversial crash saga.
    Fabrizio Barbazza, an Italian who had a brief F1 career in the early 90s, is quoted by La Repubblica newspaper: “Fernando took a 600 watt hit with serious consequences. Difficulty focusing and temporary obstruction of the veins.”
    Another disparaging voice belongs to Rene Arnoux, a winner of seven grands prix.
    “The recommendation of Alonso’s doctors did not surprise me in the least,” he said at the Geneva Motor Show, “because I am convinced that Fernando had a physical problem before the accident.
    “I have driven in Formula 1, I know what I’m talking about. The impact was lateral, more of a glancing blow, and it does not explain the damage (to Alonso). I firmly believe that Alonso felt wrong at the steering wheel. That there was wind was then used as a welcome excuse,” said the former Ferrari driver.
    http://www.grandprix247.com/2015/03/04/did-a-600-watt-shock-cause-alonsos-testing-accident/

  7. In professional sports in America there is baseline testing of an athlete when healthy and after a concussion to more objectively show injury and recovery. I haven’t read anywhere about baseline testing in F1 or here in the case with Alonso. Is there such a thing as baseline testing in F1?

  8. Jane A,
    Alonso’s post-crash mind returned to 1995? So interesting.
    Perhaps he received an unintended dose of ECT (electroconvulsive therapy)? According to the National Institute of Mental Health in therapy the electricity passing through the brain causes a seizure of less than a minute. (enough time to run into a wall) with a side effect of memory loss around the time of the ECT, though the effect usually fades after days or weeks. Of course, this article is about the ECT protocol followed under modern, controlled conditions. It does state that earlier methods of ECT via “constant, high dose” charge did cause memory problems.
    On the bright side, if Alonso had been suffering from depression (‘Why oh why did I sign on with McLaren?’) or even a touch of schizophrenia (I.E., experiencing false beliefs such as ‘I know I can win a third WC under my old bête noire Ron and in a car with an untested engine!’) a dose of electricity might have been just what he needed.
    http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

    • Hi Lulu, I do know a bit about ECT having studied Psychology at university during the dark days of ‘One flew over the Cuckoo’s Nest’ in the 70s. Lobotomy was the great evil in those days and Walter Freeman was the Ice Pick Lobotomist who was presented as the ultimate Dr Evil to us all. He used ECT to render people briefly unconscious so he could insert his ice pick into their brains through their eye sockets to destroy connections in the prefrontal lobes, which was meant to cure depression.
      I know people who have had ECT (still used to this day for depression) and they always say it has destroyed their memories. Mind you, we were all half mad in those days and several people went on to suffer from schizophrenia or bipolar disorder later on.
      I would not like to think that poor Alonso suffered something like this, although I have to say that I was surprised to hear how confused he was and I think we can all agree that McLaren’s PR have been somewhat economical with the truth.
      Actually, now I come to think of it, I have read a few accounts of people who have been struck by lightning and showed symptoms just like this. It’s all rather peculiar.

      • Jane A,
        The “Ice Pick Lobotomist”? (I hope he wasn’t granted tenure.)
        And your “. . .somewhat economical with the truth” is a delicious circumlocution. As though using just a little, or perhaps no truth at all, is a positive. It has a kindly ring to it that I intend to use as my own. . .
        Thank you,
        lm

  9. Well it looks like Andrew Benson (Chief F1 writer for the BBC) and Gary have come together to produce what looks to be a great article: http://www.bbc.co.uk/sport/0/formula1/31732315

    It also seems that McLaren have shown Benson all the data they have on the matter. Before the crash (a side impact with the wall), Alonso was breaking hard – what was pointed out was the breaking seemed perhaps a little too hard & a little too suddenly applied – although there was conflicting information as Alonso was changing gear and still steering while breaking – but there remained a small suggestion that Alonso could have been a little more controlled in the breaking which might have led to a better steering away from the wall.

    It was also revealed that for a short while Alonso didn’t know who he was or where he was – and that came back “slowly” – suggesting a significant impact. McLaren say they have data to show Alonso hit the side of his head against one side of the cockpit and then the other. Presumably that is what caused the concussion – a bang on one side of the head followed by a bang on the other – while wearing his helmet.

    • The BBC open up the article to comment so that the “general public” can comment – and the “general public” either moan that the information is not interesting and far too detailed to bother about or they moan that the article is witch hunting for someone to blame.

      It seems the average Joe gets angry if they are disturbed from their blissful ignorance. Another example perhaps of the public getting comfortable in their dumbed down nursery environment – or am I being too harsh and overgeneralising?

      • Pyotr,
        You’re not “being too harsh and overgeneralizing”, but it’s not that we’re ignorant, it’s more like we know too much and we’re inclined to be suspicious of given truth, no matter the source. Everything we read, hear, see is filtered through our personal histories so we focus on a different facet of the event. Have public figures ever lied to us? Have we experienced dissembling from trusted sources? Have our personal assessments been denounced as junk thinking only to be found accurate at a later time?
        Are we paranoid? Delusional? Sometimes.
        Bear with us.
        lm

  10. I see from reports today that are starting to surface that Fernando woke in hospital thinking it was 1995.

    If this report is true then it is indicative of significant retrograde amnesia and explains the caution that Fernando is displaying about returning to driving on the track.

      • Hi Gary is it possible to conclude anything from how far back the temporary retrograde amnesia extends, for example:

        Wake up thinking it is last week: slight damage (bruising) to brain
        Wake up thinking it is 2005: moderate bruising
        Wake up thinking it is 1995: moderate to severe bruising

      • Intriguing but unfortunately not the case. It just might be true depending on how affected the areas or circuits that are responsible for our sense of time are, but we don’t know where or what those centers/circuits are . . . yet.

  11. Every day Fernando accident seems more strange. Is there some kind of regulation in F1 racing that prevents to race a driver after he has had a concussion? Is it a matter of his doctors, or of some kind of medical board? why do you think that after Montmeló accident his entourage said that he may or may not be in Australia, and now they say that he may not be in Sepang? I agree with you that an official statement provided by independent doctors will close the door to speculations. Michael accident was not on a racetrack, then the decision of communication policy must be left to his family, but this is not the case in Bianchi nor Alonso accidents.

    By the way, probably race cars must have an “official black box” which stores information about speed, pedal position, skidding, steering wheel and wheel position, G – forces, etc. I am not asking for confidential telemetry data, but for some short term memory (< 2 minutes) that stores vital security information before the crash that will be handled to an official and independent security board short after the crash. It would be very helpful in vehicle development

  12. I’ve always been interested in individual variability. I know in law there is the ‘eggshell skull’ rule or thin skull rule which means that if you injure someone and they have an unexpected vulnerability leading to more severe consequences than you intended you are still liable for the consequences. I’m sure that people’s skulls really do vary in thickness (I remember when Blair Peach was killed by the police in the UK they used this as a defence, saying that he had an unusually thin skull.) There must be numerous other physical reasons why some people are more vulnerable to concussions than others. That’s before we even get onto psychological reasons. For all these reasons I’m convinced that Alonso just had a concussion but was more vulnerable for some reason than other drivers might have been.

  13. Could the effects of Fernando’s crash be exacerbated by his previous high g crashes? I’m thinking especially of Brazil 2003, but he has had others. I’m wondering if these can have a cumulative effect, where structures are weakened in earlier crashes, leaving the brain more susceptible to damage, even under relatively light forces?
    Keep up the good work doc. I don’t believe a lot of what is written on t’interweb, but your little page is a gleaming exception! I’ve been checking back to see your opinion on this, because a right load of twaddle has been written by others!😉

  14. Gary, I was very interested in your previous article on head trauma from all sports related issues (even soccer players heading the football) and just wondered if you ever had the time to progress anything concerning a less intrusive head / neck protection system which could be worn but affords some degree of superior cushioning for the brain. Lets face it, even some athletes are at risk just by the very nature of falling over, and if their sport means they fall fairly frequently, then I suppose a properly designed head / neck system could save injury. Any progress ???

  15. Thinking about Alonso and wondering if this crash is an OMEN. I’m reminded of my uncle Willis who was seeing a woman everyone in the family KNEW was exactly wrong for him. One night, while engaged in a sleepover with her, he left his new Porsche in front of her building. The next morning the only thing in his parking spot was broken green glass. We warned him it was an OMEN, but he didn’t listen and married her anyway. They were miserable together and eventually divorced. (At least he wasn’t electrocuted nor did he suffer a concussion. . .that we know of.)
    lm

    • Well the Ides of March is on the 15th March, the day of the first Grand Prix and so I look forward to a very dramatic race! If a car is struck by lightening we can all cower in front of the gods.

    • Oh come on! You can’t just leave us in suspenders!
      What happened to Uncle Willis … did he ever find his Porsche with green grass? Did she sue? How much did she get? Did he marry again? Does he still drive a Porsche … or did he buy a McLaren instead?

      • Hello Peter,
        It is always fun when F1 drama or brain trauma brings the old MS Debate crowd bubbling back to the surface.
        Uncle Willis was quite a sad case and frequently used as an object lesson for choices the next generation should avoid. The Porsche was lost forever. The police concluded it was taken for resale in foreign markets. Willis stayed with Madame (as she was referred to by the family) for about twenty years, during which he lost most of his money. Their divorce was not amicable. He died of heart attack in Chicago in 1998.
        None of this is particularly interesting except the incident was drummed into our brains that when a particular piece of bad luck occurs one must pay attention to the why, where, and how of it – because it is an OMEN.
        So now we will all pay extra attention to how the 2015 season plays out for Mr. Alonso. Thus far? Not so good.
        lm

  16. “AFTER CRASHING ALONSO THOUGHT HE WAS STILL A FERRARI DRIVER”
    Definitely one of the better titles. Interesting article on Grandprix 247 site. http://www.grandprix247.com/2015/03/03/after-crashing-alonso-thought-he-was-still-a-ferrari-driver/
    Partial quote:
    “McLaren argues that a strong gust of wind blew the Spaniard off the track, but strong paddock rumours continue to suggest that Alonso fell unconscious before he hit the wall.
    Certainly, the impact data suggests Alonso – whose helmet was reportedly not at all damaged – did not hit the wall overly hard.
    The car recorded a significant 30G hit, but the accelerometer in the driver’s ear showed a value about half of that.
    Indeed, Sergio Perez says Alonso’s crash was “not comparable” to his similarly-lateral hit in Monaco 2011, as “mine had an impact of approximately 60G”.
    The lack of a widely-accepted official version of Alonso’s testing crash means speculation continues to prosper.”
    +++
    (Lying is always an attempt to protect something. . . in this instance, what’s being protected?)
    lm

    • Hi Lulu, Reports today that Alonso woke up in 1995 immediately after his crash. Sounds like a pretty bad concussion if this is true. Spanish daily El País has reported that while in a Barcelona hospital after the crash, Alonso was asked who he was, what he did for a living and what he wanted to be in the future.He reportedly replied: “I’m Fernando, I drive go karts and I want to be a Formula 1 driver.”
      In 1995 Alonso would have been 13 and attending the Holy Guardian Angel school in his hometown of Oviedo. Alonso’s father José Luis was an amateur kart racer and had built a kart for Fernando when he was just three years old.

  17. Hi Gary, nice to read you.
    May be we can consider that the accidents of Michael Schumacher and Jules Bianchi made the doctors more careful about head injuries?

    • No. We have always been super focused on head trauma, as it is one of the domains where the quality and rapidity of intervention can make a dramatic difference. This is one of the reasons that the FIA’s glossing over the reasons regulations were not followed for Jules Bianchi’s transport to the hospital is so outrageous. And no doubt one of the reasons they are so touchy about this.

  18. I read a comment from a Finnish neurologist who was also glad he is not participating in the first GP. He said that the term “concussion” is dated and not used anymore. Concussion makes people think it’s no big deal and you can just shake it off. He said that the correct terms that are used today are “mild brain injury” or “very mild brain injury”. Those terms apparently tell more what really has happened, because every time the head (and the brain) takes a hit like that, there is always some damage. Can you confirm this about the terminology?

  19. Without Gary we would be left to examining tea leaves at the bottom of teacups and chicken’s entrails in order to unspin the material that is excreted into the public sphere by FIA and Co.

  20. 1) Welcome back doc, nice to hear from you sir. I hope the mishegas of last autumn has passed.
    2) Medically I can’t question anything you’ve said but the situation also takes some level of control away from Ron, which can’t help but make him wince and ‘Nando smirk just a little bit, despite the headache😉

  21. I’m so pleased about this. It’s just probability and such good news for Formula 1 and everyone else after last year’s terrible season.. I was taught about the significance of events – 5%, just unlucky and could easily happen by chance, 1% very unlikely, 0.1% very, very, unlikely. To prove anything is significant and beat the null hypothesis you have to be absolutely sure it couldn’t just be a random chance effect. Much, much more likely that this is just bad luck and a bad concussion than anything else.

  22. This might be somewhat cynical of me, but at this stage Alonso has nothing to lose – it’s hit and miss whether the McLaren will be able to get any points in the first race.
    Do you think he would have followed his Doctors advice if he’d had the same crash/injury a week before the last race of the season, and he was within 25 points of the championship?

    • Since that would have been the actual championship, and not private testing, he’d have had no choice. If the Medical Delegate and CMO of the given circuit (they decide this, not HIS doctors) advised the Stewards he was not to drive, he’d not drive . . . regardless of his desires! We wrote the regs to make that impossible.

  23. “Lastly, I’m immensely proud of this sport. This is a mature decision, clearly prioritizing what’s important. It indicates just how pervasive the culture of safety regarding head injury is in Formula 1 – a wonderful legacy of Prof Sid!”
    Gary,
    You are far too generous and too modest. Obviously the M.O.F. (Minions of FIA) are not going to subject themselves to another GH critique of what they have been passing off as leadership. You’ve made a difference. A toast is appropriate.
    lm

  24. I’m very interested and learn so much about head injury from your blog after suffering concussion myself in a bicycle accident just over a year ago. I was KO’d for 1.5 hours but after a CT was discharged the same day. Evidently I was not thinking straight because I cycled home! Afterwards this has caused me to question the effectiveness of the hospitals discharge procedure.

  25. Having suffered multiple concussions as a young man, this decision is the best for all concerned. Thankfully we are now realizing that getting one’s “bell rung” has serious long term consequences.

  26. Gary,
    I missed your post last week but I’m so pleased you are still continuing your highly informative F1 Medical blog – without yourself then it comes down “The Media” to provide information and we know that their only objective is mostly to keep the headlines coming, and the real truth is always blurred and becomes less of a consequence. We all are aware of good health be it in F1 or in ourselves and the Political power of the Medical and Pharma Industries, and to find a voice of the real truth makes it special (although it means more to yourself, especially when your Boss gets visits from the Nazi Police) …. so thanks for being one of the few flowers of trust in the world.

    On Fernando ……. after seeing serious concussion on a friend when he fell through a lean-to roof, to hit a concrete floor with his forehead and seeing him still have “memory” problems 6 months later, plus also to experience concussion for myself and truthfully I didn’t even begin to feel right for 2 months. All I can say is ….. at some point in the future, Fernando, will look back and say “You know, I wasn’t right after that crash but it took a fair while to come right and then, realise it” – Get well soon, Fernando, and thanks again Gary.
    Rick

  27. I am so glad that the sport is taking concussion so seriously. It is really about time that the “only” concussion mentality in sports was thrown out and I’m pleased to see F1 making a step forward. I’m also glad to see that a doctors recommendation was made and followed. Too often (imo) a sports person who is determined to win is allowed to play the “I’m fine” card. I personally know a rugby player with no memory at all of 35 minutes of play after a head knock. The doctor wanted him off, he wanted to play on and despite the fact he clearly didn’t have a clue what day it was the club/boss shrugged his shoulders and said ‘he wanted to play on’. It’s about time the decisions were put in the hands of the people who actually know. We wouldn’t argue with a doctor if he told us our leg was broken so we shouldn’t with “only” a concussion.

    • Sid tasked me with putting together an organised approach to concussion management in 1997. We started baseline testing the next year, and formalised return to competition criteria around 2005. Steve Olvey and Terry Trammell were also WAY ahead of the curve on this, and their advice and counsel were incredibly useful (and the first real transAtlantic collaboration in motorsports medicine!) in getting us set up.

  28. Thank you and completely agree re “other sports” and the International Rugby Union. I get to see rugby actually at the matches both at club and international level (sadly not at F1) but I also follow the NFL and hope people take guidance from the universal best practice…. I’ve seen some absolute shockers at rugby where the player insists on staying on the pitch. Best wishes Alonso and thank you Doc

  29. I’m glad to hear your explanations and experience weigh in here. Before this, I’d even considered… well, I won’t add anything to that side of things. Given a medical all-clear, and what you’ve imparted of the frequent discrepancies between severity of impact and resulting condition, all the ronspeak seems a lot more plausible.

  30. It’s good that you share these insights. Most of the media coverage appears only to give superficial information and totally fails to mention the increased risks from a subsequent concussive injury. This is not just a F1, nor Motorsports issue, but could affect anyone who is involved in sports where there is a possibility of head impact.

  31. In nascar and football (I think) we see a baseline test and then comparisons to that baseline to see if a competitor is eligible to compete. Does that mean that Fernando is unable to pass those tests? Or is this a different system of treating?

    Thanks!

    • I don’t think Fernando has even asked the FIA for permission. I suspect this is HIS decision, with the participation of his trainers, doctors, and team. When he does present himself to drive, he’ll be examined and run through the ImPACT test (see earlier blog posts) by the Chief Medical Officer of the circuit in question and the FIA Medical Delegate.

    • Like I say, if ‘Nando doesn’t drive in Malaysia, THAT might be associated with some surprising news. But again, I don’t think that’ll happen. And anyway, when it’s good news, it’s good news!

  32. Definitely a positive move forward, in line with the latest response to concussions in International Rugby Union. And an improvement since just as recently as 2010 when I recall a F1 driver who, it seems retrospectively, had concussion after a big hit and raced just two weeks later (although he did win, not that that’s the point).

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