Time To Standardize At-track Emergency Treatment
Dr. James R. Adams, Jr., M.D., Tachyon Sports Injury Research Foundation
Published: March 01, 2002
It is time to begin to standardize systems to improve the consistency of care for athletes who race motorcycles. This does not require new thinking. The lessons are known; effective systems have been developed already. Alex Zanardiís recent accident during the CART race in Europe showed how the CART system of medical care works when the clock is running after a serious accident. German physicians stated that had care been delayed (and we are talking about minutes) that there would have been a fatal outcome.
We have no illusions that such a program is possible for all road racing. There are not sufficient means to provide such medical systems at all locations for all levels of racing despite the fact that the laws of physics are the same for the amateur in a Saturday night dirt track event or the professional rider in an international series. But there is plenty of room for improving what we do have. The principles of good care are also the same. Our group thinks that each racing venue can apply the principles that are needed as best as they can, and improve the prehospital phase of medical care where ever racers come together for competition. The basic elements needed are trained individuals (ambulance personnel/paramedics) and pre-existing arrangements with area medical care systems (hospitals and trauma centers). Letís examine the basics and learn from what we have seen over the past two-three seasons here in America.
You canít open a track for practice without at least one ambulance ready to roll. Most places have two or more ambulance crews. In America, each ambulance runs under the local rules of the Emergency Medical System (EMS) that has firm guidelines and standards of care. These are basic rules formed over the past 20 years to provide ambulance systems with operating standards based on direct medical control. In general they are sufficient. We all know specific stories where the system was sub-optimal for the racing situation, but EMS systems were designed for sick people being transported to the hospital. By applying lessons we learn at the racetrack to specific additional training for the workers who by their presence let us get on the track, we can not only improve our ambulance coverage, but we will gain friends for the sport. During our first years of examining paramedic function at racecourses we met many men and women who had worked many racing events. Their on-the-job experiences and stories focused our work and helped us to learn more as we made progress.
Last season at Road Atlanta I observed a helicopter approach the medical center less than 20 minutes after the estimated time of impact out on the course. These sorts of situations can only happen when rules and directions are known in advance. In settings where the road course already has set arrangements, the potential for good care increases.
All competitors need to support such programs by personal effort and 0through the sanctioning body. Shared goals have a better chance of becoming reality. We need the reality of experienced ambulance systems transporting to established trauma centers if we are to reduce bad outcomes after sports injuries. Let us begin by planning for the following:
Trained Paramedics: We must help to establish specific continuing education programs for Paramedic work in the road racing environment. Offer these programs to EMS systems as part of their training programs. Establish onsite training at road courses already served by experienced paramedics as a sign of support of this important work. Recognize the workers for their contribution to our sport. They must not only be quickly accessible to the accident scene, but they must be empowered to make decisions regarding contacting the trauma center from the accident site for prompt transfers. This must be possible both in amateur and professional settings. Time dependent injuries can be recognized. The ambulance professionals must be ready to act and their actions should be supported by the system.
Coordination of Track Management/Sanctioning Bodies in Safety Programs: This is a natural alliance. Tracks and Sanctioning bodies will benefit by forming shared goals in the area of safety. Contractual agreements that include this also demonstrate the proper recognition of both sides to the idea of making the sport safer for the competitors by active steps. The insurance industry should be encouraged to recognize this activity in ways that are reflected in real-world terms (either a lowered cost for coverage, or in a negative way, no coverage if basic provisions are not met). The prospective program with correct goals shows the dedication of the track and the sanctioning body to the goal of improved safety.
Pre-arranged contacts with local trauma care systems: It is essential that local hospitals and trauma centers (sometimes different hospitals) need to be part of this coordinated system. The fastest ambulance or helicopter transport possible is no help if there is not a surgeon and anesthesiologist ready to operate. The time to set up these agreements is now, not at 4:00 p.m. on a Saturday afternoon. The inclusion of the receiving hospital in the planning will do a lot to improve the time frame from accident impact to the definitive control of bleeding (review the Alex Zanardi reports).
Analysis of system performance for improvement: There is always something to learn. If we do the first steps and review the workings of the system, we will not only improve our work, but we will be able to see concrete evidence of its effectiveness. The more we learn, the more we can improve the system. The most important fact is that we have access to the kinds of people who can make this happen. I am sure that every racing group, every track ownership group and every sanctioning body has individuals who can take on this project and succeed. We should start today.
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