An open letter to the Bianchis

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Dear Mr. and Mrs. Bianchi,

Forgive me for (once again) intruding into your lives.

Once again,  allow me to tell you that you have been examples of dignity and humanity in the face of unthinkable tragedy. While I cannot possibly understand the depth of the tragedy you have faced, as a father I can understand its immensity. And through it all, you have remained open and full of love and respect. You are marvellous people and you are forever in the minds and hearts of hundreds of thousands of Jules’ fans .

While it is not for me to judge “correctness” or propriety, I believe you are doing the right thing in seeking legal redress for the tragedy that has befallen you. It goes without saying that nothing will re-kindle the light that Jules brought us, but it goes without saying that your reasons lie elsewhere.

Most importantly, multiple components of the safety structure of current race practice must be reviewed and reformed. Your action will no doubt catalyse that long overdue process.

The issue closest to me is that of the medical and rescue services, the medical regulations, and the level of competence and experience of the Medical Delegate. Please do not misunderstand me. I have done my time in motorsports medicine. I have given what I can to improve how we take care of our boys and girls when they get into trouble. I am no longer angry about no longer being involved, and do not seek to once again travel the world in that position.

I am, however, bitter at the glaring lack of consideration for the quality, experience and competence of the person who has ultimate responsibility for medical and rescue decision making for the FIA’s flagship series.

This is not a “vanity” position. And while thankfully the need for medical and rescue services has become astonishingly rare, the weight of this responsibility is enormous. The decisions that must be made by the Medical Delegate often have dramatic consequences…as you have so horribly and painfully experienced.

As I’ve mentioned before (limiting myself to that with which I am intimately familiar) the crucial element as concerns the tragedy of Suzuka lies in the fact that meteorologic conditions precluded use of the medical helicopter. As the minutes of numerous meetings of the FIA Medical Commission will confirm, helicopter regulations are a constant subject of debate and concern.

According to the current regulations (authored by the Medical Delegate himself), under the conditions at Suzuka that day, with the medevac helicopter grounded, the only way that racing could have continued is if it had been demonstrated that ground evacuation to the designated receiving hospital took 20 minutes or less. I needn’t remind you that, in fact, this transfer actually took 45 minutes, more than double the allowable time.

I am not a lawyer but I think your legal team should, in their efforts to uncover contributory elements to your tragic loss, explore the following issues:

  • was there a simulated evacuation to the receiving hospital, and if so what was the time of the transport?
  • if there was a simulation, was it carried out under “real world” conditions of race day traffic, and what if any allowance was made for the atrocious meteorologic conditions present on Sunday?
  • if there was no simulation, how was a predicted ground transport time calculated? All experienced pre-hospital care providers know to use an average ambulance transport speed of 30 km/h AT BEST. Even this is often optimistic, especially under the conditions mentioned above.

It would be normal to ask the question as to whether this could have changed things in Jules’ case. While this is of course impossible to know with any certainty, I would encourage your legal team to speak widely to experts in the acute care of head-injured patients to ask the following question;

Could a difference between a 20 minute transport time and a 45 minute transport time to definitive care have been important in contributing to the outcome of a deeply comatose victim of a head injury?

Other facts can be raised, not directly relevant to this case, but rather to hammer home the lack of experience with modern pre-hospital trauma care. One of the most important of these would be the extrication strategy of the FIA. This strategy is so out of touch with current practice that several Chief Medical Officers of circuits of the F1 season worry that by following the FIA’s own regulations they are putting themselves at risk of malpractice because of deviations from standards of care. This is so critical that some have even gone on record with their concerns.

I fully expect a vicious response from certain elements at the FIA. After attempting to have my employment at my previous hospital terminated, and after threatening (almost comically were they not actually “serious”) legal action against me, I now expect worse. But no matter – I devoted a large part of my career to caring for our drivers, and I will continue to do everything I can to make sure that the legacy of my mentor Sid Watkins is not sullied.

I am available to you for any assistance or expert testimony I can provide to help you on your painful and courageous quest for answers, and more importantly, changes, to make sure that others do not suffer as you have.

With all my respect, sympathy, and love,

-Gary Hartstein

 

65 thoughts on “An open letter to the Bianchis

  1. Thanks Gary – I just came across this letter. It’s beautifully written and I sense a genuine desire to help a family who probably have their back against the wall somehow.
    Your sense of duty is quite palpable too.Good on you as we say in Aus. You have my full support.

  2. Hi Gary,

    I am SO happy that the Bianchi family has decided to take legal action against the FIA. I hope it achieves all of their objectives. At the very least, at least Whiting and the rest of the incompetents will have to endure the stress of legal action, which is never pleasant.

    I watched the Monaco GP and surprise, surprise, that clown is STILL allowing races to continue while debris litters the track. I guess being responsible (IMO) for one needless fatality isn’t enough for him, it will take at least another before he gets it through his head that the (virtual) safety car MUST be deployed the instant there is any debris on track.

    ———-

    As I’m sure you’re aware, unfortunately, moto 2 racer Luis Salom had a fatal accident during practice for this weekend’s Grand Prix of Catalunya. I was wondering if you could shed some light on why they decided not to use the helicopter which had landed at the accident scene.

    From Autosport / Racer…
    “CPR continued at the trackside for 18 minutes, but taking into consideration Salom’s life-threatening condition, a decision was taken to transport him by road in an ambulance. Treatment continued for an additional 40 minutes during the ambulance transfer, but oxygen saturation deteriorated.”

    On the youtube videos for the crash, there is a helicopter visible at the accident site. Do you have any information as to why it wasn’t used?

    Also, 58 minutes total time before reaching a hospital seems a bit excessive, no?

  3. Hi Gary,

    I’ve already vented my spleen on this topic in 3 long winded comments (as Lola Bido), so I’ll just say here that I am SO happy that the Bianchi family has decided to take legal action against the FIA. I hope it achieves all of their objectives. At the very least, at least Whiting and the rest of the incompetents will have to endure the stress of legal action, which is never pleasant.

    I watched the Monaco GP and surprise, surprise, that clown is STILL allowing races to continue while debris litters the track. I guess being responsible (IMO) for one needless fatality isn’t enough for him, it will take at least another before he gets it through his head that the (virtual) safety car MUST be deployed the instant there is any debris on track.

    ———-

    As I’m sure you are aware, unfortunately, moto 2 racer Luis Salom had a fatal accident during practice for this weekend’s Grand Prix of Catalunya. I was wondering if you could shed some light on why they decided not to use the helicopter which had landed at the accident scene.

    From Autosport / Racer…
    “CPR continued at the trackside for 18 minutes, but taking into consideration Salom’s life-threatening condition, a decision was taken to transport him by road in an ambulance. Treatment continued for an additional 40 minutes during the ambulance transfer, but oxygen saturation deteriorated.”

    On the youtube videos for the crash, there is a helicopter visible at the accident site. Do you have any information as to why it wasn’t used?

    Also, 58 minutes total time before reaching a hospital seems a bit excessive, no?

    RIP Luis Salom.

    • Let me make one thing absolutely clear – I think that Charlie Whiting is one of the most competent, hardest working and impressive people I’ve had the privilege of meeting. Further, procedures in clearing Sutil’s accident were strictly compatible with protocol at the time, and in no way raised my eyebrows . . . and I’m somewhat familiar with that aspect of race craft.

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  5. The question you put against a grey background: impossible to answer anything but “YES”. In a court room as many specialists as possible could say that and explain why.

  6. Hello Gary,

    I’ve enjoyed your articles that have explained medical issues in F1 in an understandable fashion and your extended interview with Mario Muth.

    I don’t know why it didn’t come to me before, but the mention here about the helicopter not being able to fly reminded me about conditions in Fuji in 2007. I wonder if you would be able to answer a question about that race please.

    I remember there was some talk and speculation on TV about the conditions and the helicopter. As far as I could tell the conditions had not improved greatly when the safety car pulled in. Was this also a race run with the helicopter grounded? Or were medical facilities closer to the circuit than at Suzuka?

    Thanks,

    Matt

    • I was the Delegate at Fuji, and I delayed the start PRECISELY because the helicopter couldn’t fly. And once he could take off from Fuji, the conditions at the destination hospital had degraded . . . so we had to wait more. Bernie was quite impatient, but I told him the same thing Sid did under those conditions. That I’d be glad to let them race if he’d sign a release absolving me of all responsibility for the consequences of that decision. He smiled, said “You can fuck off” and accepted the delay. And when we finally did get going (more than half the race under safety car) the helicopter could fly. And I was in direct contact with the pilots minute to minute in case conditions worsened. And in fact, the hospital was (as I remember) about 45 minutes by ground UNDER GOOD CONDITIONS.

      • Thanks for your reply, Gary. I remember watching that race expecting a massive accident and given that the cameras understandably were focused on the cars, I was worried about the chances of that happening with no helicopter. At least it wasn’t as bad as that, even if the hospital was at least 45 minutes away.

      • I was one of the very wet spectators at Fuji that year, and I can confirm the conditions were definitely not good. One of the three access was actually cut by a mud slide, so the helicopter was the only way out not to get stuck behind a line of ‘limousine’ coaches. It only took us 7 hours to go back to Tokyo!

  7. Hi Gary and everyone!

    Calculating time for ground transfer might be interesting, but futile as well. The ambulance has its own timing. Nobody can assure some “timing” since this is absolutely subject to many circumstances….

    I explain….in the ambulance the average speed is…It depends on the patient condition mostly, but also the traffic. There are always exceptions, but I do not know any rational team able to undergo CPR or intubation in movement. Wonder how a mechanical ventilation -exquisite sensitive for pressure and volume changes- behaves in an weared asphalt.

    Somebody wrote 150kph in an ambulance?? In my enviroment I have to disagree. Most modern ambulances have factory speed limit up to 120-130kph. Plus, total team for the transfer should include at least 3 people (paramedic-driver, trauma doctor and nurse). The equipment carried in this kind of vehicle is huge. So it weights a lot. Literally over 4 tons. I have travelled up to 160kph in old ambulances but only highway downhill. The reality is that aerodinamics become a factor at that speed. The shape of the ambulance (no matter how new they are) is far from slim, so in the event of high speed you will notice there is a clear limit. Based on my experience this limit is about 140kph downhill. Going elsewhere feels tremendously unsafe.

    Next weak point of ground transfer, the brakes. Retrofitting ambulances with propper brakes is something just unreal, so you have a 4 ton bullet to stop with brakes engineered to do so with half the weight. In the event of having an emergency braking (quite common while driving on blue lights), all the crew and the patient are at tremendous risk. And not to forget, the prehospital on route mantra is “safer, shorter, quicker”, to be followed exactly in this order.

    The only aproach it seems logical to me is to carry on a simulation as you mentioned. But even in that case, the simulation does not guarantee any exact time. Only gives you an estimation. You could get blocked (literally) on a traffic jam, spoiling all the magnificent calculated time. It is more predictable the timing towards the incident (which in case of motorsport doesnt matter since you have the ambulance on the circuit), because we took off the patient factor.

    Bottomline, in the world of dreams, If I were running a GP, I would really demand HEMS ready all the time, since it is generally quicker and much more predictable.

    Letting this technical details apart, please allow me to close the post and paraphrase-modify one of my favourite films:

    There are three types of balls. There are Gary´s enormous balls, big brave balls, and there are little useless christmas balls😉

    With the utmost respect, I wish you the best in this. Drivers deserve it. Prof Watkins memory too….

    Peace and Love for All!

    • Thanks for this. Took the liberty to edit a bit, just to avoid a storm of comments, but tried to keep the meaning.

      The “calculation” of an average speed is simply to “ballpark” things. While I was Med Rescue Coordinator, if the CMO of a circuit thought he could evac in the regulation timeframe, we insisted he demonstrate it . . . and then added some fudge time to the actual transport to compensate for the fact that it was done on Thursday not Sunday. Furthermore, if the outriding policemen were not actually STATIONED at the med centre during the race, all promises of an escort were ignored, as the time to organise it would obviate any time gained in transport.

  8. Hello Dr Hartstein
    I have been reading through your blogs over a period of time and I sense your frustration and if I may put it in a simplistic way like too many chiefs and not enough Indians?? So if this is the case then surely any driver could be at serious risk at any circuit with these regulations in place?

    Thank you for sharing your thoughts .
    Kind Regards
    Andrew

  9. Dear Gary,
    Thank you for such a thoughtful, caring, tender and understanding open letter, to Jules family, your sympathy is beautifully appropriate for their Jules.

    I continue to support you after educating me on the sheer incompetence of the FIA following the crash and their clandestine ways during which they have hounded you and tried to take away your income for expressing the truth of the rules. This truly still angers me, I cannot begin to believe how this makes you feel.

    I’ve never wavered in support of your analysis of the terrible accident and the extraction to the hospital or the questionable politicalisation of F1 Safety since Todt took over.

    I can find nothing of the Suzuka Medical Delegate Matteo Bonacini although I notice that virtually anybody these days can call themselves a “Medical Delegate” which is truly disturbing. Of course, Matteo Bonacini may be highly qualified for this position although I can’t find his qualifications or himself the Internet.

    Gary, if you need any support on the crowd funding please just say.

    I can’t say all the truth will be finally exposed on all matters for this Court case as money, media coverups and simple media deflections will be used which is a sad reflection of today’s society. Thank you Gary for providing real insights to the truth before it is further clouded by Media muddiness.

    Kindest Regards
    Rick

  10. Hi Gary, very brave as usual. I couldn’t help noticing that in the article Sir Jackie Stewart is quoted in saying the following: “It is very sad for his family – and one can only feel great sympathy for them. But I do not think taking legal action is the right path to go down. This can only extend their grief. It will not make the pain go away.

    “Looking at the incident, the most important consideration is that double yellow flags were being waved. That means, under the regulations, the driver must slow down to such a speed that he can stop immediately should that be necessary. But he was travelling very much faster than that, and that is what caused him to go off the road.”

    Stewart added: “All drivers know there are risks. This is not ping-pong. Motor racing is dangerous. There is always the chance of a freak accident, and that has to be accepted.”

    It is entirely understandable that you are focused on the undoubted errors which occurred after the accident but I fear that in this case, as in so many others, prevention would have been so much better than anything which happened afterwards. If prevention includes preventing totally unqualified medical delegates from having for too much responsibility for situations they should never have been in in the first place I’m with you all the way.

    • As you remember from my posts around the time of the accident, I was quite vociferous about lack of flag discipline. It is obvious that the proximate cause of this crash was excessive speed into the corner, given the conditions, and given the double waved yellows.

      That said, there were in my opinion other contributory factors; the fact that under the no-fly conditions that prevailed, the regulations themselves clearly state that racing should have been stopped being the most significant.

      It might also be said that a failure to consistently IMPOSE flag discipline (timing sheets can easily be produced that show speeds totally incompatible with being able to stop under double yellows . . . with no ensuing sanctions applied). The fact that there existed a climate of near impunity for lack of flag discipline would then also be related to causation.

      Just my opinion. The legal system will need to make sense of all this. And most importantly, the Bianchis will hopefully find what they are looking for.

  11. I’d even go as far as including the calendar planning in the list of accused parties. Everyone knows that BCE likes to schedule races in the local “monsoon” season. Everyone likes an entertaining race, but I’ve seen lots of completely rainsoaked races that shouldn’t even have been planned as they were, because it was foreseeable that there would very likely be too much rain.

    It’s a difficult topic, because for a lot of the races, rain is possible at any time of the year, especially Belgium, Britain, Germany etc. – but if you’re staging a race in Brazil, Malaysia, or Japan, then there are seasons I’d avoid..

  12. You’re a class act Gary. F1 and motorsport in general needs crusaders like you – if you don’t mind me calling you that.

    • A culturally and politically charged word here in the Middle East, but in the context it’s accepted and much appreciated. I’ve been called a lot of things, but this might be the first time I’ve been labelled a class act. While not at all sure, I do thank you sincerely!

  13. Thanks for sharing, Gary.
    I admire your stance and courage to stand against the FIA… amongst others, and I hope that the litigation does indeed identify the shortcomings of both the current practice and the incumbent officers… it would be a real tragedy if it didn’t…
    Sincerely
    Stephen

  14. Good luck Doc.
    Do not forget the crowd-funding idea.
    I am sure there will be a lot of support from fans who want to see things put right in F1.
    It is fairly obvious that the F1 governance structure is seriously compromised.
    Perhaps the rest of the incident report, which did not appear in the two page summary, will finally come to light. (ie the other 95% of it)

  15. While your assessment of the medical delegate is not misdirected, it seems that the family’s suit focuses on the situation leading up to the incident. They appear to feel that the running of the race in typhoon conditions and having the tractor on track without a red flag were the main contributors to the accident and ultimate horrific outcome. While 15 or 20 minutes of delay transfer time may have contributed to a lesser outcome, it seems that their focus is certainly on the main contributory element leading to the accident itself,.

    • Would that be the fact that there was heavy machinery on an active track under a waved yellow and that the general rule was not so much slow and be ready to stop but just lift off a bit…? Of course the race should never have been run at that time. All sorts of shit will explode from this action and I hope that motor racing as a whole opens their collective eyes to knowing when safe is safe and unsafe is opening themselves to legal action. I hope the Bianchi’s get answers, and if they get dollars or lira or euro’s or whatever as compensation that they put it towards Jules’ protege and that he never ever has to be at risk of serious injury or death because an F1 race must suit a TV window. Pressure is only pressure if you aren’t willing to say get fucked. RIP Jules, taken far too soon.

  16. Reading this breaks my heart. With the long list of problems F1 already has, it’s as if this sport is in terminal self-destruct mode. Thank you for sharing your thoughts Gary.

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  18. Hi Doc

    Been waiting for a while for the family of Jules to announce legal action and I’m really pleased that you have offered your services to them. In fact, I wouldn’t expect any different from you as I know how passionately you feel with regards to safety in F1 and the lack of experience the current Medical Delegate exhibits.

    Whilst all F1 drivers take part in the sport we fans love, knowing there is always a risk of death or serious injury, no driver should ever undertake these risks taking part in a sport with lax safety standards.

    I truly hope that the family of Jules get the answers they need.

  19. The MotoGP world could teach F1 some things on the medical front. Interesting that for the Brit F1 the 20 min rule wouldn’t get you to the nearest MTC (Coventry), be lucky to get to Northampton General in that time. Sid did an excellent job and so did you

    • As I said, it is usual to assume a best-world ambulance transport speed as 30 km/h. Then you add in race day traffic (Suzuka is a nightmare on race day), and typhoon like conditions. 20 minutes? Delusional.

      • I’m surprised by 30 km/h.
        In the Netherlands the advice is to drive 20 km/h faster than the allowed speed. In an urban area this translates to 70 km/h and on the highway up to 150 km/h.

        However this is at the discretion of the driver, speeds of 180 km/h were not uncommon in the past, but I think the current vans won’t get there.

        Is your number including putting someone in the ambulance and getting them out?

      • Try doing the math a few times, just out of curiosity. Start timing when you close the doors to the passenger compartment, and stop when you open the at the destination. Divide the distance by the time. You might be surprised. No matter the speed when rolling, traffic, traffic lights, etc simply destroy the average speed (distance/time).

      • I’ll ask a question to the follow up reply about closing doors and opening doors to the ambulance in a later answer… Wouldn’t you also take into account the time it took to load and unload the patient? I’ve been on the end of a reasonably serious accident and being wheeled from the bus to the A&E with all of the stuffing around as to what to do etc, there was minutes involved there too. My next stop was an MRI and I had been in the hospital an amount of time by then (internal bleeding via lacerated kidney). Admittedly I bypassed the queue and Jules would have too but still its not just the traveling time alone. That race should never have even started that day.

      • Thanks for your reply, I will try that. It just seems slow. Can ambulances ‘ignore’ trafficlights everywhere? I know how these are a major slow down. If I’m in a hurry, I know faster driving doesn’t do as much as avoiding trafficlights. And yes, I’m aware that an ambulance should slow down at intersections – although some times they run police bikes with them who close intersections.

        It still feels counter intuïtive
        But after Googling on “which speed is used to calculate ambulances?” I found a comparison between helicopters and cars. For the cars they went with 16 km /h!

        You already convinced me, but I think I’m slowly convincing my intuïtion🙂

  20. It’s a crude analysis, but Google maps makes it 16 km/ 29 minutes from the gates of the Suzuka circuit to the hospital. If their algorithms factor in traffic it’s 5am local time so presumably pretty quiet, certainly in comparison to a race day.

    It certainly raises questions as to how any kind of analysis of that route could conclude that a 20 min ambulance transfer was possible.

  21. Well said Doc. Any organisations run in the apparent manner of the FIA need to be seriously questioned. What happened to Jules could surely have been avoided & it’s high time the correct people were held to task for their actions & inactions leading to the tragedy & not just that particular weekend but all contributing factors in the manner of management leading up to these events which one feels appeared to be only a matter of time.

  22. Thank you for being courageous enough to stand up for the things you believe in, and to risk the wrath of certain elements of the FIA.

  23. Thank You, Doc Gary
    for not giving up your caring efforts for the wellbeing of the the men and women in their racing cars!
    I send my moral support, especially against the evil, to you.

  24. Hi Dr. Hartstein, are you able to give us a wink-wink nudge-nudge in the direction of where we may find best extrication practices?

    • Look at the Holmatro team stuff. Actually the field is boiling with revisions to extrication and spinal immobilisation practices. Keep an eye on the pre-hospital literature.

      • Would you say with the current F1 medical team, that James Hinchcliffe would of been saved by any team other than the Halmatro safety team? I personally think not.

      • First of all, if you ran the same case 10 times with the Holmatro team, you’d likely not get a save every time. That said, they are superb.

        I would say that of 20 circuits of the season, 5 would have a good shot of a good result. Another 3 or so, led and orchestrated by Ian Roberts, might do ok. The rest? Nahhhh. This is one of the reasons I tried to place so much emphasis on simulation training. But even this was largely marginalised by the Medical Delegate, who favoured using most of the runup to the race with practicing extrication. Which of course is only one (and far from the most important) element of medical rescue.

        Oh and the 5 might not be the ones you think, but I will not of course provide any more details on that.

    • I’ll land on my feet. Good thing is the UAE federation are not at all on good terms with Todt. But i expect to get knee capped. Literally or figuratively. Doesn’t matter – this is the beginning of the end for these clowns.

  25. Dr Gary,

    An open letter, that shows that the family have support during this difficult time.

    RE: “I am available to you for any assistance or expert testimony I can provide to help you on your painful and courageous quest for answers, and more importantly, changes, to make sure that others do not suffer as you have.”

    IMHO, it takes both confidence and true grit by you, to stand up and be counted and raise your head above the parapet, when it would be so easy to stay silent.

    Well done to you, Dr Gary. You are not short of courage, that is for sure.

    • Thanks Mark. Perhaps short on survival instinct! But you know, when you name your friends to highly responsible positions despite knowing they have absolutely no qualifications, you need to be ready to deal with the consequences. As I told Todt, it’s not because you WANT your friend to be the delegate that he CAN be the delegate. Now they’ll get raked over the coals for what is either Todt’s lack of concern with the reality of the Delegate’s responsibilities, or his utter lack of understanding.

      • Dr Gary,

        RE: “Thanks Mark. Perhaps short on survival instinct!”

        You have written a VERY powerful open letter, one that will undoubtedly be quoted in the news media. As you have so eloquently written;

        “I devoted a large part of my career to caring for our drivers, and I will continue to do everything I can to make sure that the legacy of my mentor Sid Watkins is not sullied.”

        Sid Watkins instilled in you Dr Gary, a survival instinct and that was, SPEAKING THE TRUTH.

        Best Wishes,
        Mark H.

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