INTERNATIONAL JOURNAL OF MOTOR SPORT MEDICINE ISSUE#7, APRIL 2016

MEDICINE'S HIGH COUNCIL Inside the latest International Council of Sciences congress P26 KEEPING SAFE AND SOUND Scientific study examines high noise levels at motor sport events P38 DANIEL DE JONG The GP2 racer looks back on a major accident and his recovery process P32

FIRST RESPONSE World Rally drivers are learning to become first-on-scene responders as part of an expanded training initiative from the FIA AUTO+MEDICAL AUTO+MEDICAL

Welcome to the new issue of AUTO+Medical, which features the latest news and reports from the world of motor sport medicine. As a member of the Editorial Board, I’m pleased to present the seventh issue of this publication as safety is the first and constant concern of the FIA. Contents LETTERS/ Training the medical and safety officials who P4 The best letters and emails received from readers around the world work throughout motor sport is extremely important and the cover story of this issue GLOBAL NEWS/ explains how these skills are being taught to P6 Nürburgring hosts extrication training event participants in the . P7 Education needed over hearing loss risks This training programme has been running for P8 returns after wrist injury 15 years and is now being expanded further with P9 Dr Amjad Obeid appointed Azerbaijan GP CMO P9 Concussion debate planned a potential partnership with the Red Cross. P9 ARC publishes response to 2015 ILCOR guidelines In the future, the FIA hopes to expand a P10 FIA President delivers 2016 Watkins lecture second phase for different participants in rally P11 IndyCar introduces Zylon tethers to reduce airborne debris events around the world. P11 Rally study aims to reduce spinal injuries Elsewhere in this issue we speak with Dr FEATURES/ Amjad Obeid, the CMO of the Bahrain Grand Prix, who will also handle the medical training P12 FIRST RESPONSE WRC entrants to receive expanded first responder training from the and services for the inaugural race International Federation of Red Cross and Red Crescent Societies in Azerbaijan. We also hear from GP2 racer P20 CMO PROFILE: DR AMJAD OBEID Daniel de Jong about his recovery from injuries Dr Amjad Obeid on his career, the challenges he faces and how he sustained in a major crash last season. wants to improve motor sport medicine Our scientific study examines one of motor P26 MEDICINE'S HIGH COUNCIL sport’s most overlooked medical topics: hearing The International Council of Motorsport Sciences held its latest annual congress in December 2015 damage amongst spectators. This is a problem P32 THE ROAD BACK: Daniel de Jong that has been addressed for team members but The GP2 racer shares his thoughts and memories about his crash at there is a need to protect fans at the same time. Spa-Francorchamps that left him with a broken back I hope you enjoy the latest issue. STUDY/ P38 KEEPING SAFE AND SOUND A team of American doctors studies the effects of engine noise on spectators and reports on attitudes to ear protection

Editorial Board: Dr Kelvin Chew, Dr Jean Duby, Dr Pedro Esteban, Dr Matthew MacPartlin, Prof Jean-Charles Piette, Dr Robert Seal, Dr Paul Trafford Dr Jean Duby Editor: Marc Cutler | Deputy Editor: Alex Kalinauckas | Designer: Cara Furman FIA Medical Delegate for the World Rally Championship We welcome your feedback: [email protected]

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AUTO+ Medical is helping doctors across the world, according to Dr Jenny Bertin, CMO of the Mexico ePrix (pictured)

In this section, we print the best letters and emails received from readers around the world. We welcome comments on articles as well as suggestions for future content or insight into an area of motor sport medicine you feel would be relevant. If you wish to send in a letter or email, please direct it to: [email protected]

Dear Editor, Keep up the good work you´re doing, and be sure that with every article, As a doctor in motor sport, I´ve every note or letter, you are making been following the AUTO+ Medical a difference all around the globe to publication since it began, it is quite a improve safety in our sport. comprehensive way to keep up to date in this challenging environment. Best regards,

In Latin America there is not a proper Jenny Bertin training program for doctors, and Chief Medical Officer all the skills and know-how have Formula E Ciudad de Mexico ePrix been through tutoring from more experienced doctors, from whatever is Editor: Thank you for your positive available from other countries and the comments. We would be very keen to FIA publications. hear more from the motor sport medical community in Latin America and across I´ve found that this specific publication the world, whether that is through further has also been of value to create letters or articles submitted for publication. networking among motorsport doctors from different countries, allowing All articles should be relevant to Motor to share experience and useful Sport Medicine and follow the accepted information. guidelines for any medical articles submitted for publication, be they an I feel very proud to be a part of this overview of a topic or original research community of professionals who share being presented. They should should the same passion and the will to lend a also include Title, Authors, Images and hand to each other. References.

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HINCHCLIFFE REVEALS HOSPITAL SCARE

IndyCar race winner GLOBAL has revealed that he was minutes away from losing his life in the aftermath of his crash in practice for the 2015 500. The suspension on Hinchcliffe’s Schmidt Peterson car failed at 223mph and when it hit the NEWS wall, part of a wishbone penetrated the cockpit and the Canadian driver’s right thigh, into his left leg, pining NÜRBURGRING HOSTS EXTRICATION TRAINING him to the car. After a difficult extrication period, Extrication teams from around the world received special safety requirements at Formula E events from The study took place Hinchcliffe was rushed straight to the rescue certification after a training event organised by the championship’s head of safety John Trigell, every at the 2013 FIA WEC Indiana University Health Methodist the DMSB Academy took place at the Nürburgring. participant was awarded extrication accreditation. The round in Austin Hospital where doctors later informed The course, which was held on 20-21 February, DMSB is a recognised FIA Institute medical regional him he arrived close to death. involved 75 participants from extrication teams training provider (RTP). The German teams were given He said: “There was a time on my stationed at the and Nürburgring the extra certification that will enable them to work at way up to the operating room from circuits in Germany, Assen in the Netherlands, Zolder in Formula E events. EDUCATION NEEDED the shock room in the emergency Belgium, as well as applicants from Finland and Canada. Scholz said: “The debut event at the Nürburgring was room where they couldn’t find my Dr Michael Scholz, the DMSB’s association medic, a total success. The circuit provided perfect conditions OVER HEARING pulse anymore.” directed the course, which involved extrication training for the training and further education of the national As he was transported to the using an LMP1 World Endurance Championship car and international extrication teams. LOSS RISKS hospital, Hinchcliffe was given 22 and a BMW DTM machine. "In the end, we presented all the teams with the pints of blood, more than twice what After the event, which also included lectures on the FIA certificate.” the human body can typically hold. The results of a study into the risk of noise-related “That’s possible because they were Extrication hearing loss at motor sport events has concluded that putting it in before they plugged the crews practiced more needs to be done to educate fans of the sport leak. They were putting fresh blood on a DTM car about the issue. in me and I was spitting it back out,” The study took place at the 2013 round of the World he said. Endurance Championship and Hinchcliffe, who returns to racing and was produced by a team of doctors working at the in 2016 after his recovery, praised Circuit of the Americas track in Austin, . everyone involved in saving his life. Of the 825 spectators surveyed for the study, 91.9 per He said: “There’s no one person cent of the total group was aware of the possibility of that had a bigger role than the other noise-related hearing injury, but only 49.5 per cent of but there were a lot of people that those who were aware of hearing injury reported it as a without, I wouldn’t be here.” concern and just 53.7 per cent of the entire group described their intention to wear hearing protection during the race. The paper concluded that efforts to educate motor sport fans about the danger of noise-induced hearing loss should be encouraged. “It is likely that many fans do not understand that hearing loss can occur at lower decibel levels than they realise,” the paper reads. “Continued efforts to educate spectators and offer options for hearing protection at venues should be supported.

You can read the full report on p38 of this publication

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VICKERS RETURNS OBEID APPOINTED ARC PUBLISHES TO NASCAR RESPONSE TO 2015 NASCAR driver Brian AZERBAIJAN GP CMO ILCOR GUIDELINES Vickers completed the Daytona 500 after recovering from blood clots Dr Amjad Obeid has been Piette, the FIA medical The Australian Resuscitation Council that have stopped him appointed Chief Medical delegate. (ARC) is the latest major regional body from racing four times in Officer for the inaugural “Professor Piette and I to present its response to the 2015 the last six years. Azerbaijan Grand Prix, inspected the track and International Liaison Committee On The American driver which will take place later discussed the deployment Resuscitation guidelines finished 26th in NASCAR's this year. of the medical team.” The ARC, in co-operation with the New blue-ribbon opening event Dr Obeid, who is also Dr Obeid explained that Zealand Resuscitation Council, makes of the 2016 season after the CMO for the Bahrain the training for the Baku recommendations for how resuscitation substituting for Stewart- Grand Prix, will lead the safety and medical teams should be conducted based on the Haas Racing’s Tony medical team at the Baku would continue after the evidence and guidelines issued by the Stewart, who is recovering during its Bahrain Grand Prix, which central body, ILCOR. from a back injury himself. first Formula One event will take place on Dr Matthew MacPartlin, deputy CMO Vickers described his on 17-19 June 2016. 3 April. at and assistant CMO at joy at being back in a In an interview with He said: “We will have the Australian Grand Prix explained how Sprint Cup car after he had AUTO+Medical (which you another medical seminar the ARC’s response could potentially previously feared that he can read in full on page for them after the influence the work of medical motor would never be able to 18), Dr Obeid described Bahrain Grand Prix and sport personnel. take part in another race the initial training then move on to the full He said: “It would seem that the next again. sessions and track team training on time you respond to a race incident Heidfeld at He said: “For me, this is deployment plans that he medicine for the Formula with the suspicion of a neck injury, at the Buenos huge. I wasn’t sure I would had already initiated for One race.” least by mechanism, the application of Aires ePrix ever race again (after his the medical team in a semi-rigid c-spine collar is no longer most recent blood clot Azerbaijan. mandatory. issue in March 2015). The He said: “I have already “Instead we can exercise discretionary last five or six years of started my training for judgement as to whether to let the HEIDFELD RETURNS TO FORMULA E my life have been a roller the medical team. In person self-extricate, self-extricate with coaster, to say the least.” January, we trained with a collar in place or be assisted out with AFTER SURGERY ON WRIST INJURY Vickers also advised the extrication team in careful manual in-line c-spine control. other top-line drivers to Baku and with Dr. Jean- “The rigid spine board takes a hit enjoy their time in motor Jacques Issermann and too. While it still has a role in assisting Nick Heidfeld returned from a Aires] although my therapist said sport while it lasts. Professor Jean-Charles extrication or moving a person, wrist injury to finish seventh in the at first it was impossible. He said: “I think a lot of leaving them strapped to the board Buenos Aires ePrix, his first “But the test in an old GP2 car these guys get in these cars for prolonged periods is no longer Formula E race following surgery. in Valencia showed there was a and they are so caught up CONCUSSION DEBATE PLANNED acceptable.” The German driver tore the good chance. in the moment and the The issue of resuscitation will scapho-lunate ligament on his left “I didn’t have any pain, I did a future, they don’t stop to be covered in a future issue of The FIA’s Medicine in Motor Sport condition were proposed. wrist during the Putrajaya ePrix couple of laps without major think that it may be their AUTO+Medical. Summit will discuss the sport’s Speaking about the meeting Dr and subsequently missed the next problems. I didn’t push it to the last time and they should treatment of concussion at its next Paul Trafford said: “An agreement round at Punta del Este. limit, but it was enough to decide enjoy it.” meeting in December. was reached to make concussion a Heidfeld had two pins inserted to come [to Argentina].” A panel of experts recently met subject for the conference with a into his hand and although these Heidfeld also explained that the in Geneva to examine the results view to issuing guidelines on were removed prior to the nature of Formula E’s steering of a survey on concussion in a diagnosis, treatment and when to Argentinean event, he only made system meant he had to wait until previous edition of this publication. allow concussed participants a last minute decision to take part after the Buenos Aires shakedown Discussions regarding rotation, return to motor sport.” in the race following a successful to decide if he could take part in the mechanisms responsible for Future research projects test of his movements in an old the full event. concussion and how they could be including measuring angular GP2 car and then the ePrix’s He said: “In the Formula E measured also took place, and rotation, high- cameras shakedown session. car you can turn the steering ideas on how to use motor sport’s and new imaging methods for He said: “I thought there might wheel a lot [and] it’s a lot close relationship with engineering examining concussion were be a chance to drive [in Buenos more bumpy.” to further study and treat the also agreed.

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Aiden Moffat RALLY STUDY AIMS TO FIA PRESIDENT DELIVERS 2016 missed three BTCC races REDUCE SPINAL INJURIES WATKINS LECTURE ON SAFETY with concussion in 2015 A scientific study to assess the threat of spinal injuries among cross-country FIA President Jean Todt delivered safety standards during his time as rally participants took place at the the annual Watkins Lecture for the boss of the Ferrari Formula One recent Abu Dhabi Desert Challenge. Motorsport Safety Fund at the team and it then became a top The rally’s organisers, the Autosport International Show. priority when he took charge of the MSA ADOPTS Automobile and Touring Club of the Todt addressed a range of issues FIA. CONCUSSION RULES UAE (ATCUAE), conducted the research that motor sport faces. He He said: “When I was team in conjunction with the FIA and the FIA identified ’s high-speed principal at Ferrari I always Britain’s Motor Sport Institute’s research partner, the Global accident during the 1985 Rally encouraged Michael [Schumacher] Association has implemented Institute for Motor Sport Safety. Argentina as a pivotal moment in to promote global safety, and when new rules regarding The study assessed what causes his drive to improve safety as he I was elected president of the FIA it concussion among motor Zylon tethers spinal injuries among cross-country followed the aftermath of the was only natural that I would put aim to reduce sport competitors ahead of rally competitors using accident data Finnish driver’s crash. road safety on the top of my list. flying debris the 2016 season. recorders fitted into each car to assess “For many days we thought he “We have made progress in Under the new rules, G-force loadings. That information would not survive. So that becomes safety in racing, in certain countries concussion will be diagnosed will now be correlated with the priority, and you follow your on the road, [and] on circuits. [But] by the Chief Medical Officer INDYCAR INTRODUCES reconstructions made using the latest people in the crucial hours after the every weekend it reminds you that following an accident if there virtual crash simulator technology. accident. [Vatanen’s accident] was there is more to do, to protect the ZYLON TETHERS TO REDUCE is any momentary loss of “The aim is to lessen the threat of probably the turning point of my drivers, the marshals, and the consciousness, confusion, AIRBORNE DEBRIS spinal injuries in cross-country rallies interest in safety. Then you reach spectators. We have created disorientation, amnesia, by creating a driver cockpit safety some success in your life and you specific safety commissions - like headache, dizziness or nausea package using crash simulations think it is time to give something the closed road commission displayed by a participant IndyCar has introduced Zylon tethers to major with virtual reproduction of injury back." headed by Vatanen - so for me involved in a crash. aerodynamic components for the 2016 season in a bid to mechanisms,” said ATCUAE President The President explained that he [safety] really is the biggest No concussed competitor prevent them detaching and causing injuries to drivers. Mohammed Ben Sulayem. continued his quest to improve priority.” will be allowed to return to The sport was rocked last August when Justin Wilson “We want to know exactly what action. They will have their was killed in an accident at where a amount of G-force can result in a President Todt licence withdrawn by the piece of bodywork flew off ’s crashed car and competitor’s spine being broken,” in conversation MSA, who will then outline the struck the British driver on his helmet. added Dr. Sean Petherbridge, the with F1 presenter requirements for its return. Since the start of the new season, IndyCar rear beam ATCUAE’s Chief Medical Officer. James Allen In professional wings and rear wheel guards are tethered for all races, The final outcome of the study aims championships where a while the cars' noses will be secured on superspeedways to produce a new that can further driver wants to return sooner that are one-and-a-half miles or longer. protect drivers from spinal injuries. there will be the possibility Will Phillips, IndyCar’s vice president of technology, “The objective is to design cross of competitors being directly explained how the series would use the tethers to country rally which do not break referred to specialists who will improve its safety standards and reduce flying debris under normal operation but which be able to use a range of tests without affecting the racing. compress to absorb the energy in high to deem if a competitor may He said: “It is a continual goal to improve safety for all impact situations in order to protect be allowed to return sooner. the participants, fans and drivers alike. We also need to the spine,” said Petherbridge. Any competitors who do this in a fashion that does not create more yellow-flag experience a second racing and try to prevent as much debris as possible. concussion within three “We have great support from our partners to improve months will be required to safety and wish to thank , and Dallara for see an expert before they are their participation and efforts in working together to allowed to return again. implement change.” Speaking about the new IndyCar machines have featured tethered wheel rules, Dr Paul Trafford said: restraints for the last 17 years and also secure the rear “This is a major step for motor wing to the transmission in a bid to reduce airborne debris. sport to regulate concussion Another safety change included for 2016 is the use of a and other ASNs are considering domed skid plate on the underside of the chassis to help how to implement concussion yaw and spin characteristics, which is designed to work with regulations.” rear wing flaps to reduce the chances of a car taking off.

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FEATURES FIRST RESPONSE The FIA is expanding its medical training programme for competitors in the World Rally Championship and beyond

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At one point during Rallye , three- events, in contrast with circuits, where an WRC Medical Delegate Dr Jean time world rally champion Sébastien Ogier extrication team is obligatory.” Duby in conversation with WRC had his hands around co-driver Julien Often, in the case of a serious accident, one champion Sébatien Ogier Ingrassia’s throat. But this wasn’t a dispute person in the vehicle is more injured than the between teammates over a costly mistake on other, giving the second person a chance to the road; the pair were practicing a technique act. In addition, within the space of ten that could save the life of a rally competitor minutes, three or four other competitors who is trapped in the wreckage of a car would have arrived on the scene, all in a following a major crash. position to provide medical assistance. The ‘Rautek’ manoeuvre for safely removing “In this scenario, we are moving from ‘First a trapped person is just one of the practical aid’ to ‘First-on-scene training, based on the first aid skills that were taught to the WRC P1 principle that if you know what to do and class drivers as part of an introductory what not to do you are able to improve workshop between the FIA and the the situation and maybe save a life,” International Federation of Red Cross and explains Duby. Red Crescent Societies (IFRC) at the opening The first training session of this type took round of the 2016 WRC season. The potential place at the in Greece in 2001. partnership could lead to all drivers receiving It was given to all drivers taking part in regular training sessions throughout the year the event together and was entirely that will enable them to provide first-on- theory-based. scene assistance if they come across a “It proved far from ideal,” admits Duby. “It serious accident during a competitive was inefficient due to the absence of a rally stage or when they are driving on practical element and also because the group public roads. size was too large.” It could then be rolled out across other It became clear to him that the training PARTNERSHIP PLAN championships around the world with sessions needed to be organised in small IF THE DRIVERS KNOW WHAT Now the FIA is planning to take this training support from local IFRC offices. groups and include practical workshops in TO“ DO AND ALSO WHAT NOT TO to the next level through a global partnership addition to the theory. It was also evident DO THEY MAY BE ABLE TO SAVE A with the IFRC. STRONG FOUNDATIONS that the training needed to take place in the LIFE IN AN ACCIDENT “Pooling the expertise and, above all, the If approved, this IFRC partnership would build days preceding an event and then repeated resources of the FIA and the IFRC is on the regular first-aid training the drivers during the season to ensure that all drivers ” indispensable and vital for the development have been receiving from WRC Medical entered into the championship received and co-drivers entered in the World Rally of the current training sessions, not only for Delegate Dr Jean Duby since 2001. the training. Championship have been trained throughout the benefit of WRC competitors, but for all “Some 15 years ago it occurred to me that it “I developed a PowerPoint training module, the year and been given regular refresher drivers and co-drivers taking part in rallies was necessary for rally drivers and co-drivers which was significantly improved and courses, working closely with the relevant worldwide,” says Duby. to have first aid training,” says Duby. “Why regularly updated in collaboration with two Chief Medical Officer in the host country of This training would not be limited to drivers might that be? Drivers and co-drivers in these Turkish associates, Professor Cem Boneval, a each event where they take place. but also available to those present at events types of competitions can play an essential surgeon in Antalya, and Dr Erdem Yilmaz, The training evolved over the course of the who could find themselves on the scene of an role as they are often the first to arrive on the founding director of an established company years and was taught to groups of 10 to 16 accident: the stewards, officials, and even scene of an accident. Furthermore, there is in specialising in first aid training.” drivers using the latest medical and safety the spectators. no experienced extrication team at rally As such, over the past ten years, all drivers theories, as well as practical demonstrations. “If fans were interested in receiving the

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then takes the hand of the competitor’s arm collaboration. Since 2014 they have been training, on a voluntary basis of course, they behind their back so they are holding the working together on the implementation of would act as ambassadors for such training THE FIRST-ON-SCENE injured driver in their own arms and under projects dedicated to improving first-aid which, if tailored to motor sports, would the armpit of the opposite hand. The rescuer awareness and have developed over ten TRAINING SKILLS WOULD also apply in any type of road accident,” “ then uses their other hand to support the initiatives on first aid training for road safety says Duby. ALSO APPLY IN ANY TYPE OF casualty’s head, takes hold of their neck and and post-crash recovery globally. The potential importance of this type of ACCIDENT OUT ON THE then levers themselves backwards and out of training was underlined by the experience of PUBLIC ROADS the car. DRIVER SAFETY WRC driver . He recently found The drivers also learnt how to deal with The value of this training was not lost on the himself on the site of a traffic accident in ” unconscious patients, as well as how to treat drivers, all of whom engaged enthusiastically which the driver had died, but he had been there had been a serious crash. This involves severe bleeding and burns. with the session. able to extricate an unconscious elderly activating the FIA emergency dashboard “But it’s not just for the WRC drivers to help “It is very important for us,” says person from the accident vehicle and place transmitter in each car and trying to raise each other in a rally car,” explains Trafford. ’s Ogier. “We have done first aid them in the recovery position, using methods the alarm via radios, mobile phones and “It’s also for if they come across an accident training before, but now it will become more he had learnt in Duby’s training sessions. The speaking to nearby marshals. “It is important on the road because they are travelling regular. Like everything in life, unless you driver was congratulated by firefighters to cover this because people will panic a thousands of miles and if they come across keep doing these things often, it is all too arriving later on the scene, who confirmed little bit if they are involved in an accident accidents, it’s useful for them to be able to easy to forget so it is so important for us, that he had saved that person’s life. and they forget what is useful,” explains offer assistance because they have skills that even though we hope we will never have to This FIA–IFRC partnership began last year, Trafford. could save a life.” use it.” from a practical standpoint, with the creation After raising the initial alarm, the drivers This ties in with the FIA and IFRC road safety If the programme is taken forward then of a Survival Kit, which will be developed by are instructed to tell the authorities the the FIA and then placed in race cars. The exact location of the accident using their partnership was further cemented at the on-board road book and explain where the beginning of this year with a joint training car has stopped if it is away from the road. before the . They then need to put out the warning triangle and SOS board that will inform the RED CROSS TRAINING next competitor about the crash. On the Thursday of the Monte Carlo Rally, the The next car on the scene is instructed to P1 drivers, and their co-drivers and team stop and give assistance, and the car after representatives gathered together to receive that then slowly carries on to the following training from members of the Red Cross, FIA, radio post to make sure the message gets and FIA Institute. back to the rally’s headquarters. “It’s a belts “At first, we reinforced the fact that and braces approach that ensures everyone whatever they do, the main priority is their knows there’s been an accident and the own safety,” says Dr Paul Trafford, the FIA’s emergency services are mobilised,” medical advisor who led the session. “So if says Trafford. somebody is injured and another driver stops Utilising the FIA’s Medical Extrication at an accident, they must not put themselves Vehicle, all the drivers then practiced the in a position where they are going to end up ‘Rautek’ technique. This involves putting one Dr Paul Trafford as a casualty.’ arm behind the back of a casualty, taking instructs the WRC The drivers were then taught the correct their nearest arm and putting it across their participants in procedure for alerting rally organisers that chest. The person performing the technique

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All participants knowledge and can act appropriately if they practiced the lateral MEDICAL EXTRICATION VEHICLE come across a serious accident. safety position “The idea is that, eventually, every The medical extrication vehicle competitor in the world who wants to do a was developed on behalf of the FIA rally and hold a rally licence will, through their Medical Commission and designed ASN, have to do a first-on-scene course,” to be a portable and reusable explains Trafford. “The ASNs would then liaise model of a closed-cockpit racing or with their local Red Cross officials who will rally car to train safety personnel. know the standard that course needs to be The vehicle, which includes a because it will have already been steering wheel, tunnel, console, pedal established.” box, footrest, gear stick, handbrake A good example of this took place recently and optional seats and bodywork, can during the Formula E event in Mexico, where be packed into a square box, weighing drivers were instructed by Red Cross just 95kg. Volunteers on what to do in emergency The car also uses replaceable situations. steel tubes that can be cut away during extrication drills. These can FAN FOCUS be refitted at very low cost, which The IFRC is also working on a first aid course means that extrication teams and for the fans stood at the side of a road so they fire forces can practice real-life can assist if a major accident occurs or if they rescue simulations. come across one on the public highways. This is a one-and-a-half hour session for training spectators and as part of the agreement with each group of drivers will receive further first the FIA it will be promoted during WRC events. On remote stages it is aid training from the FIA and IFRC on three TO BE ABLE TO HELP EACH essential that drivers Dr Pascal Cassan, Head of the IFRC Global more occasions throughout 2016 using local OTHER IS REALLY IMPORTANT have medical knowledge First Aid Reference Centre, believes that the medics and trainers at those events, before “ WRC training, even before it is extended, has completing the course at the end of the year. AND IT MEANS YOU CAN the potential to save lives. At the end of the season the drivers will be POTENTIALLY SAVE THE LIFE “We believe that this programme will help to tested in a practical scenario where they will be OF ANY COMPETITOR save lives in the event of a serious accident as able to demonstrate their knowledge. If they well as improve first aid knowledge and pass this test they will receive an official award ” understanding throughout the sport,” he said. from the IFRC and be recognised as having potentially save the life of a driver, co-driver The nature of means it covers achieved a certain standard in first aid training. or any competitor. It’s nice to learn the basics remote roads and medical assistance can “This adds big value,” says M-Sport driver and have training about what to do and help.” sometimes take a long time to arrive at the Mads Østberg. “If there is an accident in our In the future, the FIA and IFRC hope to scene of an accident. But thanks to the sport there is no guarantee to be with make the first aid training sessions available techniques taught in first-on-scene sessions, medical people, because we compete over to National Sporting Authorities (ASNs) drivers with the skills and knowledge to help such large areas. To be able to help each around the world so that national-level rally their fellow competitors will be just moments other is really important and it means you can competitors will possess the same amount of away to offer help in life-threatening situations.

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remember when I was on track and have a full A+M: Have you had any experience from DR AMJAD OBEID understanding and appreciation of those any other position in motor sport safety? situations and how to respond. AO: I joined as an emergency physician at the Chief Medical Officer, Bahrain Grand Prix and FIA Medical Commission member I also figured out how to improve our beginning, but as we work as a team we Dr Amjad Obeid has worked at the Bahrain Grand Prix since it first appeared on the performance based on that experience and I consider ourselves to be marshals. Whenever developed and tailored the training programme there is a big event in Bahrain we have a Formula One calendar back in 2004. After gaining experience in various positions for the medical team as a result. This was committee where all the marshals sit together on the Bahrain medical team, he was made the event’s CMO in 2007 and has since always my concern and my passion – how to and we all gain experience. fulfilled the same role in the Indian Grand Prix and will do so again for the inaugural train my team to be the best. I always want to When you are in this field you try to search Azerbaijan Formula One event later this year. be the best so I work to help them to provide for what marshalling means and how you co- the best medical services on track. operate between the other on-track teams, As a doctor, I’m very comfortable in my whether that’s marshals, fire marshals, AUTO+Medical: How did you become hospital, and in my resuscitation room as I’m an recovery marshals or whoever to make any involved in motorsport? emergency physician and I have my nursing event that we are covering successful. Dr Amjad Obeid: Back in 2004 I was a member staff there, but I have to provide this medical of the team at the first Bahrain Grand Prix. I care on track in a very high adrenaline A+M: What does your work as CMO at the participated with the medical team and that environment within motor sport. This care Bahrain Grand Prix involve in the period developed my high interest and passion for needs to be on standby and fortunately we leading up to the race? motor sport and I have continued to provide don’t have lots of accidents, but if that were to AO: We have several weekends for local the medical services for the race. happen we should be ready for it. We should championships and while I don’t go to them I approached the organisers from within the also do it in the best possible way with the very frequently, the doctors and the medical medical team after I had worked in a couple of limited resources you have out on the track. team covering them are members of the other positions: I worked in an ambulance, I So my work with the team from the very medical team that covers all the international worked in the extrication team and then I beginning in Bahrain gave me an idea of how I events in Bahrain. became the deputy chief medical officer after a could provide the training they need to convert I also produce safety designs and discuss with year. From 2007 I took over as the chief medical them from acting as clinical doctors, nurses and the organisers of the Grand Prix about where officer for the Bahrain Grand Prix. paramedics, and bring their medical expertise we need to put the medical team and what the and knowledge of how to take care of people in medical requirements are for those events as A+M: What did you learn from your a hospital and put them on the track. That was a they do not do an event without having a prior experience in those different positions? good thing that I gained and I learned from that discussion or agreement in place. So if they say AO: I think that was actually a good start for time. Every year we try to improve and we try to they want to use the small circuit or the long me, as a medical officer, that I worked in most upgrade our team with extra training provided. circuit and whether that means they need a of the positions in the medical team. It gave me certain size of medical team, a certain supply of a better understanding of how it really feels to ambulances or extrication equipment, or if be part of the team, as sometimes there might there is any problem or emergency, they can of be people who are assigned to be a chief MY CONCERN AND MY course immediately call me at any time. medical officer without really working on track. PASSION IS WORKING OUT I don't work full-time at the Bahrain I did my part and worked to see how we “ International Circuit as the Bahrain Motor really need to improve on the track and saw HOW TO TRAIN MY TEAM TO Federation (BMF) assigns me and I don’t work how I could take care of my medical team when BE THE BEST AND PROVIDE THE for the circuit, I only give advice as a BMF they are out there. For example, if they told me, BEST MEDICAL SERVICES official. I just give them what we advise as an “one doctor is not comfortable with this,” I can ” ASN, what we require as a minimum and 20 21 AUTO+MEDICAL FEATURES AUTO+MEDICAL FEATURES

The 37,000 spectators at would be able to handle this person. Also part the Bahrain Grand Prix of the medical centre is the air-medical can visit clinics if they are unwell or injured evacuation, the medical helicopter, which is available for all four days of the race. Before the race we do several drills and simulations on how to load a patient and fly them to the local hospitals. We even do this drill with the standby hospital, whether that is the Ministry of Health or the military hospital in Bahrain. Finally, we have a fascinating vendor area at the Bahrain International Circuit and more than 37,000 people who attend the Grand Prix. This is indeed a very large area that has its own proper medical services and spectator clinics EVERY YEAR WE UPGRADE should any of them get sick or injured. There are clinics in every stand where a spectator can OURSELVES, AS MEDICINE IN “ go and there will be medical help provided to MOTOR SPORT IS NOT SOME- them. THING THAT YOU CAN JUST READ IN A BOOK A+M: Have there been many changes to the medical facilities and services since the ” Bahrain Grand Prix began in 2004? discuss what we need. Then it is up to the Endurance Championship, or any series. Even teams who work on foot in the pitlane. Those AO: Every year we always upgrade ourselves, circuit and they should comply with those before it was mandatory to do the simulation people are only concerned with the track and as medicine in motor sport is not something safety regulations. on track we did it to give a sense of co- taking care of any injuries that may occur with that you can just read in a book, it is an ordination to the medical teams and show the competitors or marshals. experience. I’ve got members of my medical A+M: What is your role during an actual them how to practice and prepare for an The second part of the team is stationed in team who have been with me since 2004; so race weekend? accident that might occur during the weekend. the track medical centre, which is a permanent they are experts and not only that, they enjoy AO: During the Formula One event I am medical facility and is fully equipped and ready their work. Part of creating your work is to deeply involved. I do training for the medical A+M: What medical and safety facilities do to receive any trauma patients. We always enjoy it and I’m very proud of them. The more teams before the race as we do drills and you use during the Bahrain Grand Prix? maintain this medical centre and it has four experience and expertise you develop as a simulations. In Bahrain, we were one of the AO: We have one of the best medical services trauma beds, a minor surgery procedures medic, the better and more confident you are very first countries to practice full simulations that can be provided and we divide that service room, anti-doping facilities, a small pharmacy, in providing medical service. Of course every before Formula One events. into three parts. The first part is for the track X-rays and Radiology. It is all part of the FIA year if we find there is an area of improvement In 2007 we trained for an accident on the medical team – the people who are all around requirements and the strict rules that we that we need to make in terms of training or track with an extrication simulation and since the track. Then we have the track’s permanent always comply with. Inside the track medical documentation or planning our sessions and then the FIA has made that a mandatory medical centre and the third part is for the centre we have doctors and surgeons, seminars, then we will do it. exercise for its medical delegates and the spectators who attend the races. emergency physicians who are able to provide For the last seven years we have organised a medical rescue teams. So we had this idea The track medical team is made up of the 11 any needed medical services whether it’s for a Bahrain motor sport seminar, which is a one and we developed it and we use it in every ambulances we use, the three extrication and driver, mechanic, marshal or any of the day medical course where I gather the whole event, whether it’s Formula One or the World six medical intervention teams, as well as six organisers. So if someone got injured or sick we medical team in a big hall and we give a full

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refreshment on medical updates on topics that We will also plan where they will park their to always keep them tuned. include extrication, trauma management, vehicles and I have done an extensive study for For example, someone on my team may say medical theory and how to apply that on the the track. As we walked the track we stopped at “come on, we took the same training last year,” track. I also get speakers to come from my every point to say where we could park our and my reply would be “no, it’s not a matter of hospital and from different hospitals in medical cars and approach the track in the that, we always need to be ready, updated and Bahrain; sometimes I get speakers to come event of an accident. I did my proposal and properly tuned up.” So the challenge is from outside the country as well. then this was all discussed with Professor Piette continuity and providing the necessary support. We have also been made a regional training and he approved that. You hear that in some parts of the world provider (RTP) by the FIA Institute as we were there are some races, challenges and recognised as a training centre here in Bahrain A+M: What is the most rewarding part of championships that are not FIA sanctioned for all the medical teams in the region. Bahrain your work in motor sport medicine? events. There are motor sports and people and Germany were the first two countries to AO: The most rewarding thing is that as I’m an racing on track without having proper medical receive this RTP award, from a medical emergency physician I deal with trauma care, coverage and you feel very sorry because those perspective, and we got it in December 2014. YOU DON’T JUST TRAIN A critical patients and pre-hospital care, so I feel athletes and drivers deserve proper medical Based on our experience, the Bahrain Motor that being in motor sport combines my care. So the challenge is the continuity of motor Federation and myself were also involved in the PERSON“ ONE TIME AND THAT specialty and my passion. I love motor sport sport medicine, and also the support and the training for medical team at the Grand Prix of IS IT, YOU ALWAYS CONTINUE and I love the very beautiful organisation of the distribution via an exchange of knowledge India. I was the CMO for the Indian Grand Prix TRAINING THEM TO ALWAYS sporting teams. For example, I love how they between all the medical teams around for two years and in the third year I supported KEEP THEM TUNED. co-ordinate things, how they do teamwork and the world. them, so in total we prepared, trained, and as a result I always try to implement that in my maintained the medical team in India for three ” own team. A+M: In what ways would you improve consecutive years. started our first training sessions, mostly for Every member of the team is as important as motor sport medicine? This year the BMF will be providing support to the extrication team. We will have another the other ones. I have learned that as you do AO: That’s a very critical question, but there are Baku for the first Azerbaijan Grand Prix, and medical seminar for them after the Bahrain your work and you enjoy it, the rewarding races that are sanctioned by the FIA, so all of training has already started with the team Grand Prix and then move onto the full team feeling comes from covering big events and big those events have, at least, a proper medical there. We went over recently to prepare the training on medicine. races in Bahrain. I am proud that I am serving a plan as part of the governing body’s rules and team and the standby hospital, as well doing big event in my country and I am proud that I regulations. Without those rules the FIA will not the safety and medical applications with the A+M: Does the street circuit layout in Baku am part of the medical team. But not only are accept a race. So the challenge is for other FIA. This has all developed the experience the affect the protocols for the medical team? we providing the services, we have been non-FIA championships to improve. Any race BMF has, as well as my own, over the years. AO: It will be challenging but the basic recognised as one of the best medical teams that is not an FIA championship and does not principals are the same and I’m also expecting thanks to the RTP. That makes you enjoy it even have the rules and regulations and proper A+M: So will you also be the CMO for the it to be a really nice race. It’s very challenging as more and it’s rewarding to give even more of safety guidelines needs to be improved. 2016 Azerbaijan Grand Prix? the Baku circuit layout is going to go from the your time to it. The most critical ones for example might be AO: Yes, I was appointed and I have already old city to the new city. We will need to provide some races, especially if it is not an FIA started my training for the medical team. In the proper medical coverage for the sharp and A+M: Can you describe the biggest challenge one, and of course open track days. If people January, we trained with the extrication team in critical turns along the course and we need to you have faced as a motor sport doctor? go and they are not experienced and just want Baku and with Dr. Jean-Jacques Issermann and plan the rescue procedures, how do the teams AO: The biggest challenge for medicine in to race, that would be a challenge. But I would Professor Jean-Charles Piette, the FIA medical actually go into the track and then how they motor sport is the continuity. You need lots of like to improve all non-FIA sanctioned events delegate. Professor Piette and I inspected the leave. We also need to make sure that they are medical equipment and training for a medical that are taking place because they may not track and discussed the deployment of the properly equipped and that the medical team team and it is challenging to provide them all have implemented these strict rules and medical team, as well as the need to prepare fulfils the requirements and regulations set by the time. You don’t just train a person one time regulations and there is no one to the medical team ahead of Baku 2016. We have the FIA. and that is it, you always continue training them monitor them.

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The 2015 ICMS annual congress was held in MEDICINE'S Indianapolis HIGH COUNCIL AUTO+Medical takes a look at the various medical and safety topics that were presented at the 2015 International Council for Motorsport Sciences annual congress The International Council for Motorsport Sciences held its annual three-day congress on 9-11 December 2015, where a number of medical and safety topics were covered in presentations given by officials from within the field. Several research studies were presented and discussions took place on how to implement new theories into future practices. Amongst the topics that were presented on day one was an explanation of how to download meaningful information from Accident Data Recorders by IndyCar director of engineering Jeff Horton, and Dr Mark Bayley’s Dan Marisi Memorial Lecture on the best rehabilitation practices for post- concussion syndrome. On Day two, Formula One race director described all the safety preparations necessary to host a world championship Grand Prix, before Dr Claude Meistelmann, Chief Medical Officer for , reviewed motion sickness in rally co-drivers and navigators. Among the techniques that were presented on the final day of the congress were safety director Carson Wilkinson’s talk on fire suppression and IndyCar safety team manager Mike Yates’ explanation of the mechanics of a response to a crash.

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Practical safety problems in the shoulders, to wrist and ankle regime were measured against a control group demonstrations took place on sprains, across a season. of development pit team members. Both each day of the “Around 20 per cent of active pit crew parties travelled together and ate the same congress members experience one of these injuries food, and were evaluated at the start and end during the season,” he added. “They undergo of the season. These tests consisted of DEXA physical therapy during the season and if X-rays to measure bone mineral density, a necessary have surgery in the off-season.” vertical jump to assess power and a Wingate Ferguson explained how a study he had anaerobic power test. designed, which was published in the Journal Ferguson explained how the results of the of Strength and Conditioning Research in fitness programme showed that the trained pit September 2014, sought to identify the crew members had a higher body mass than physiological stressors that are placed on the control group by the end of the season pit crew mechanics, as well as the physical and had less of a decrease in lean body mass requirements needed to be a successful pit percentage. The trained crew members also crew operator, and proposed a training regime demonstrated a significantly improved vertical to maximise those attributes and limit injuries. jump at the end of the season versus the The research looked at the change in body control group, which performed slightly worse. composition of ten pit crew operators across a Following the end-of-year Wingate test, NASCAR season from the Stewart-Haas Racing the trained group had improved their mean team – four tyre carriers, four tyre changers power by around 200w, and their peak power and two jackmen. by approximately 700w, whereas the control The training programme aspect of the study group demonstrated less mean power and a focussed on preventing injuries and over- lower peak power compared to the start of the training during the course of the season, with season. performances peaks throughout the year, by “This would translate to a 22 per cent The congress was concluded with a crews and reduce the number of injuries they implementing a new exercise regime for the reduction in pit crew injuries across a season,” demonstration of racetrack safety team drills suffer over the course of a season. pitstop mechanics. concluded Ferguson. and techniques, which was moderated by Dr In a race, the ideal time a NASCAR crew The pit crew members on the new training Rob Seal, CMO of the Canadian round of the aims for at each stop is between 12.5 and 14 DR STEVE OLVEY: SENSING PROGRESS FIA World championship. seconds, according to Ferguson, but despite Dr Steve Olvey, Associate Professor of Clinical Here, AUTO+Medical takes a closer look the high priority placed on perfecting pitstops, Neurology/Neurosurgery at the University of at three of the presentations, which covered few scientific studies have focused on the Miami-Miller School of Medicine, explained injury prevention in pit crews, the history of performance of the mechanics. the history of in-ear accelerometers and in-ear accelerometer technology and safety He said: “Only two medical studies have been concussion studies in US motor sport. organisation at motor sport events. conducted on NASCAR pit crews, which were Olvey, who is also a founding Fellow of the published in 2011 and 2014, and just one has FIA Institute, and CMO for Formula E in the DR DAVID FERGUSON: PIT CREW been conducted during elite level competition.” United States, described how the background PERFORMANCE Ferguson also described how the fast- for using in-ear accelerometers to signal Dr David Ferguson, Assistant Professor at paced nature of a NASCAR pitstop meant concussion dates back to a meeting between Michigan State University, presented the crew members often suffer from different representatives of US motor sport stakeholders findings of his study on training programmes physiological issues, which range from in Sebring, Florida, in 1999. that improve performance among NASCAR pit meniscus tears in their knees and rotator cuff He said: “The project was initially met with

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much scepticism. But after a second meeting could be established. But he believes the Presentations covered various one month later, Endevco, an instrument low number of concussions means that they aspects of measuring company, took the initiative and are not overly beneficial when it comes to motor sport designed the first accelerometers.” designing some safety products. safety Olvey also explained how Delphi, an He said: “There are too few concussions to automotive solutions business, modified the be useful in equipment design. Setting a trigger in-ear accelerometer models before the initial threshold of greater than 80G for mandatory tests on the project were carried out in 2001 testing makes sense as ear accelerometers and 2002. detect high-G impulse loading.” He said: “The use of the technology in an actual race car was delayed due to arguments TIM MAYER: BEHIND THE CURTAIN over its validity and accuracy, but those Tim Mayer, Independent Director of the arguments were eventually dispelled.” Automobile Competition Committee of the Several IndyCar drivers trialled the in-ear United States (ACCUS), used his presentation to accelerometer system in 2004 and by 2012 the outline all the safety elements he believes are technology was being used by the entire field. necessary for a successful motor sport event at Olvey then described how he began a circuit in the US. a new study regarding the use of in-ear Mayer, who explained that there is no accelerometers in IndyCar racing between 2012 single solution that would suit every situation, and 2015 that only examined crashes with a described how he splits race safety systems maximum resultant value of greater than 50G. into two groups: ‘inside the race fence’ “This is because concussion is not felt to ever organisation, for participants, and ‘outside the occur below a head acceleration of 50G,” race fence’ structures, for spectators. he explained. “The main difference in regulation,” said The new study looked at 43 crashes from Mayer, “is that inside the fence is principally ideally via a landline or a backup radio, is vital.” of fans who might show up to watch any motor three IndyCar seasons: 16 in 2012, 13 in 2013 controlled by the sanctioning bodies and After detailing the required equipment list, sport event and that officials remain in contact and 14 in 2014. In each accident the in-ear the FIA. While outside the fence is generally including vehicles for rescue teams and specific with local authorities and designated medical accelerometers recorded the forces exerted on regulated by state or local rules, by insurance technology for specialist series such as Formula centres at all times. a driver’s head, which ranged from 50 to 250G, requirements, or in the best-case scenario, self- E, Mayer explained that some kits need to “The basic rule of thumb is the ‘reasonable with crashes of 50-60G recorded the most developed procedures.” be stored in the pitlane to maintain safety man' test,” said Mayer. “This means, given times, at 16. During his discussion on inside the fence standards in one of the more active areas of the size and scope of your event, what Olvey explained how a total of five organisation, Mayer described the dimensions the track due to the number of personnel, cars understanding may reasonably be expected concussions were reported in that period, but of openings for marshals and drivers to enter and hazardous materials in the vicinity. to happen regularly or occasionally, and if you said that three were recorded without data and exit the track, which are 1000mm by Mayer also recommended that a circuit’s have the resources to deal with them in time.” due to wiring issues and so only two concussed 600mm and are situated 1000mm above the race control is situated with a full view of the Mayer also endorsed using a clear and drivers had the complete data set from the top of the barriers, as well as the need for clear track, that event organisers have a strategy confident command chain to avoid mistakes in-ear accelerometers. communication with marshals. for dealing with extreme weather conditions, and maintain order at any motor sport event. In his conclusion, Olvey stated that the He said: “The three most important things and put a plan to help the families of injured He said: “I highly recommend establishing information from these two crashes and the to remember with marshals is that they are competitors in place beforehand. an ‘Event Control'. For very large events this is development of the in-ear accelerometer volunteers and should therefore be treated As part of his discussion on outside the fence split into two parts: ‘Public Safety’ and ‘Event technology showed that the data from the with respect. They need to be fully trained safety systems for spectators, Mayer advocated Operations’. This is to keep life safety issues devices is reproducible and injury thresholds and keeping good communication with them, forward planning with regards to the number separate from entertainment issues."

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consciousness again, because I couldn’t THE ROAD BACK: De Jong collides with breathe very well. Then I awoke again when Pierre Gasly they put me in the ambulance, so I missed a big part. Anyway I am still alive and I didn’t DANIEL DE JONG get paralysed as they pulled me out of the car, so I think that everybody did a fantastic GP2 racer Daniel de Jong reflects on his accident during the 2015 feature race job. at Spa-Francorchamps and offers his thoughts on medical care and recovery techniques for racing drivers A+M: Do you remember anything else He hits the about the extrication process? AUTO+Medical: Can you describe what barriers at DDJ: I only remember that I awoke when I happened in the accident? Blanchimont was still under the tyre wall and then I awoke Daniel de Jong: I was behind two cars going again in the ambulance and then again in the through the Stavelot corner and Pierre Gasly medical centre of the circuit. But overall I was was the driver in the front of me. He and the really calm in my mind as I wasn’t scared and other driver were fighting with each other, so I didn’t care about the crash. I was expecting that they would make a Everything was working fine and I asked worse exit from Stavelot, because of the With an how the race finished and if the car would be fight. I prepared for the corner, so that I impact at ready for the next day. I even wanted to walk would make a better exit out than both of 300km/h to the toilet, as I only felt pain in my chest, them. My exit was better, as I had more which I thought was because of the crash and momentum out of the corner, but halfway would be over soon. But I had to stay on the down the next section of track I started to bed because they told me that I had broken lose momentum, possibly because of my back. I wasn’t expecting that. turbulence coming from Gasly’s car. This forced me to take the outside line. A+M: How would you describe the care I wasn’t overtaking as fast as I was remember that I put my hand in front of my given by the medical and safety crews who expecting, but in the meantime Gasly was head, as automatic self-protection, I think. attended the scene of the crash? steering to the outside of the Blanchimont But I only remembered that a few hours later, DDJ: Well I couldn’t imagine better people corner to prepare for the following Turn 18, because one hour after the crash I couldn’t around me than I had that day. It might On lap seven of the 2015 GP2 feature race at which you can do flat out in GP2. even remember the start of the race. sound weird, but you could see some kind of Spa-Francorchamps, Daniel de Jong suffered I don’t think Gasly noticed me because he passion in those people who wanted to help a huge accident. His MP Motorsport car was concentrating on the guy in the front and A+M: How was your treatment by the me. They just asked me simple questions; no hurtled off the track at the Blanchimont we hit each other. My front tyres jumped off marshals immediately after the crash? difficult conversations and they told me corner following contact with DAMS’ Pierre the ground, so I didn’t have any grip to turn. I DDJ: Well I lost consciousness three times everything that would happen next in the Gasly and slammed into the tyre barrier at also didn’t have time to react because the after the crash, so unfortunately I don’t know process. They even joked with me, so that 300 km/h. After a lengthy extrication process, speed was high, around 300km/h, and the all the good stuff that the marshals did. But made it all less dramatic. de Jong was transferred to hospital where he distance to the wall was short. for some seconds under the tyres in the wall I They only thing I didn’t like afterwards, but was diagnosed with a fractured vertebra. The awoke and I saw some light coming through it must be said this was not the fault of the Dutchman missed the next two GP2 rounds, A+M: Do you remember anything about the the tyre wall and some shadows moving from medical and safety crew, was that my father but he returned to complete the final two impact itself? a marshal who asked me if everything was saw the crash with the team in the pit lane events of the season. DDJ: I don’t remember anything. I only ok. But before I could reply I lost and it took really a long time to get

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information about my situation to him and he allowed, but I realised that when I tried to walk couldn’t get any transport to the medical a bit and move my body I started to recover centre. After some discussions somebody faster. Mentally it was just a great feeling to finally brought him to the medical centre and walk and I have never been so happy that I I think that was the one point that could be could. You start to realise how proud you have more professional as it was really important to be in your own body and how special we that my family knew I was ok. humans are. A week after the crash I went on holiday with A+M: What happened when you were my family to Italy. We had thought about transferred to hospital? cancelling it because of my back, but I said we DDJ: The people there gave me all kinds of should go as it’s the only time in the year that medical checks to see if my arms and legs we all get to be together. As the next round of could move, as well as blood pressure and GP2 was in Monza, which was the reason we heart rate measurements. I think that was a went on holiday in Italy, MP Motorsport standard process, a checklist they go through, brought a camper to our holiday house, because they did the same in the medical so that I could lie down in a bed when I centre. Then we took an X-ray to see if I had was travelling. broken anything, and I had. Finally, when we were on holiday there I could really start to feel how my body was A+M: What surgery was performed at the starting to recover. This was mainly through De Jong missed hospital? two GP2 rounds sleeping a lot, but also because I was with my DDJ: Well basically they turned me around after his crash family and we had a lot of fun together. Then, and opened my back. The sixth vertebra at after the five days of relaxing, I went to the top of my back was broken, so they put Formula Medicine to continue my recovery a plate on the fifth and seventh vertebra race on the Sunday. Then, on Monday, a with all kind of training. to disable the sixth vertebra. Basically physio came and he gave me a brace. We they made those three vertebrae into started to walk around a bit, but sometimes I A+M: What advice did the doctors give you one vertebra. got really dizzy. The next day we tried to aid your recovery? They put a total of four screws into my fifth walking on stairs and when that was going DDJ: The doctors already knew that we were and seventh vertebrae, but they did it very well they said that I could go home, because going to work with Doctor Ceccarelli from carefully. Every time the screw went deeper they couldn’t do much more for me. Formula Medicine, and they really said I would in, they stopped and took pictures to make It sounds really easy, but I was in a lot of be fine in that case. For the first week they said sure they were not hitting my nerves. Then pain because my whole back was really stiff that I just need to lie down, rest a lot and when they closed my back up really nicely with and I could not turn in bed during the night, I was going to walk I should always use the stitches on the inside and they glued the top so they had to give me a lot of painkillers brace. Then they told me to ask Dr Ceccarelli of my skin back together. otherwise I couldn’t fall asleep. Then, after I for further recovery advice. was taken home by ambulance, as I wasn’t Dr Ceccarelli asked me: “Do you want to be A+M: Can you describe your recovery allowed to sit straight for long, I stayed in bed back in the car fast or do you want to recover process? most of the time. This was because sitting well?” I said I wanted to recover well, because I DDJ: I think my recovery process was really straight or walking made me really tired but De Jong had don’t want to have issues when I am 35 years fast. I had to stay in bed for one day in the my back started to heal really quickly. to train with old. He agreed, so we started to do simple a back brace hospital, where I watched the second GP2 I was walking more than was probably exercises and treatments.

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A+M: When did you decide that you were I realised that the mind is the best medicine ready to return to racing? that you can get. Try to laugh, try to be with DDJ: We set a mental goal and that was for your family. If you can be optimistic and me to be back in the car for the last race of proud of yourself then you will recover even the GP2 season, but I felt I could do Sochi, the faster. The days when I felt down mentally third to last race of the season. However, were the days that I didn’t feel any then I realised that while my back was all fine improvements in my body. I’d lost a bit of strength and conditioning. I did all the recovery exercises but I hadn’t reached A+M: Do you have any advice for doctors my old training level and so we didn’t do who have to deal with racing drivers who Sochi. But we decided to do the last two races are recovering from big accidents? because I had some extra weeks to work on DDJ: Be fair and honest and tell them the best my condition. steps that they can make to be fully recovered. Keep them up-to-date with the A+M: What did you feel when you drove the latest information and improvements that car again for the first time? they are making because if a sportsman DDJ: We decided that I should drive a World doesn’t hear any information or Series 3.5 car before I stepped back in the encouragement they will mentally suffer and GP2 car. This was because we wanted to be start to ignore the injury because you just sure everything was fine with me as it would want to be back on track. be a waste of time and money if we were at a De Jong racing GP2 event and after practice I realised that I A+M: How would you rate the care you in Monaco before wasn’t strong enough to race. were given throughout your recovery his accident But to be fair, when you drive out of the pit process? lane in a World Series car and give it a bit too DDJ: I don’t see any reason why I cannot give A+M: What physical training did you start to notice that my body was recovering much throttle and feel like the rear of the car it a ten. I can do everything again and undertake during your recovery process? really fast. is going the break out, that’s when you think sometimes for days at a time I don’t even DDJ: We started with really basic exercise, a After two weeks I went back to Italy and we to yourself ‘ah, this is how it was’. Then think about having a plate in my back. lot of elastics and cardio. Not running of started to upgrade the exercise. We also took everything starts to be normal again and I Even if the care was a six but the people course, but walking and cycling. We also did new body and brain scans as well, because Dr didn’t have any issues with my back, so it was successfully put me back to how I am now a lot of mental training, because that is one of Ceccarelli wanted to check my brain functions all fine. then it would still be a ten. The end result, the training parts that they do in Formula because as I’d lost consciousness three times which is the most important, is that I can do Medicine. Initially, because I couldn’t do a lot, he wanted to be sure that I hadn’t damaged A+M: What advice would you give to any everything happily again. being so fresh from the operation we started my brain. other drivers if they go through a similar I’d like to say a massive thank to all the with a lot of mental training. I had to use the brace for six weeks, but experience? people involved in my recovery process. Then, after a long week, I went home with after four weeks I felt like I didn’t need it DDJ: Always choose the proper recovery That’s all the marshals and people at the all the training exercises and I started to train anymore. I still used it because you have to process and don’t just go for the quick one, medical centre at Spa, Liege Hospital, FIA on my own in my local gym. I did everything listen to the doctors. After two months we because I think that a slow-but-thorough doctor Jean-Charles Piette, as well as Dr that they told me to do and every day I could took X-rays again and they said that my back recovery will be better in time compared to Ceccarelli and his Formula Medicine team. feel improvements. If I did an exercise one was fine and I could do everything I wanted. rushing back. If you want to get back too fast Also thank you to everyone who showed day and it hurt a bit, then the next day it We upgraded the training so I started to run you end up over-using your weaker body interest in my recovery process and the didn’t hurt at all anymore, so I could really and lift weights again. parts and then you start from zero again. whole GP2 family.

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CORRESPONDING AUTHOR SCIENCE John P. Sabra, MD CO-AUTHORS:

John Bedolla MD, Jaron Santelli MD, KEEPING SAFE AND SOUND Jacob Falcon MD, Taylor Alloway BA, Chris Ziebell MD, Craig Dolder PhD A team of American doctors has studied the risk of hearing loss at motor Department of Motorsports sport events and produced recommendations to help drivers, crews, and Medicine, Circuit of the Americas spectators avoid potential permanent hearing damage. Austin, Texas, USA

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Team personnel already use hearing protection

BACKGROUND/AIM protection. Peak decibel levels during the Direct observation of 1,024 spectators in the education, as well as novel methods for The team set out to investigate spectator event were recorded around the track using grandstands at the circuit revealed an actual the effective distribution and use of awareness around the issue of noise-induced a decibel meter and hearing protection being hearing protection usage rate of 43.4 per hearing protection. hearing loss at a motor sport event. As well used by spectators was directly observed cent. Peak decibel levels (dB) at spectator as attitudes toward the use of hearing and documented. areas around the track ranged from 89dB INTRODUCTION protection, noise levels and the actual use of to 128dB. Noise-induced hearing loss is a cumulative hearing defence during this same meeting RESULTS process occurring through years of repetitive were documented. Of the 825 spectators surveyed, 82.2 per cent CONCLUSION and prolonged exposure to noise levels had previously attended a major motor sport There appears to be significant awareness of between 90dB and 140dB. It is a metabolic METHODS event. While 91.9 per cent of the total group the possibility of noise-induced hearing injury process that damages sensory hair cells in During the three days of the World was aware of the possibility of noise related in spectators at a major motor sport event, the ear, which may ultimately die and do not Endurance Championship and American Le hearing injury, 49.5 per cent of those who but only 50 per cent of those who are aware regrow, leading to hearing loss at multiple Mans Series rounds at the Circuit of the were aware of hearing injury reported it as a reported it as a personal concern. frequency levels. It is distinctly different from Americas in Austin, Texas, in 2013, surveys concern and 53.7 per cent of the entire group Less than half of the observed spectators at direct acoustic trauma, which occurs at were conducted on 825 spectators who described their intention to wear hearing this event used hearing protection. In order decibel levels that are greater than 140dB, attended the race. protection during the race. to achieve greater use of hearing defence at which causes immediate hearing loss from The survey asked if fans had been to a Of the survey participants, 77.8 per cent motor sport events and help prevent noise- mechanical damage to inner ear tissues. previous motor sport event, and examined said that they would use hearing protection if induced hearing loss amongst spectators, Exposure to potentially dangerous levels of their attitude towards, and use of, hearing it were given to them for free at the track. there is a continued need for ongoing noise at motor sport events is a common

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occurrence for drivers and pit crew, and would already be aware of the possibility of noise-induced hearing loss has been noise-induced hearing injury, and that there addressed as an occupational hazard for may be other factors present that affected these individuals. Occupational exposure to their choice to wear hearing protection or noise is a well-known problem that has been not. We also set out to document the peak addressed, in the United States, by the US decibel levels occurring in spectator areas Department of Labor in the past, with around the track during this event to confirm resulting regulations. the presence of high noise levels. In addition These rules and standards limit prolonged we directly observed and documented the exposure to potentially dangerous noise actual use of hearing protection by spectators levels, with a maximum acceptable exposure during this event. of eight hours to 90dB at a time, as the weighted average. For every five dB of higher- MATERIALS AND METHODS level exposure, the maximum acceptable Data was collected in September 2013 during exposure time drops in half. For exposure a three-day race weekend, which included levels of 110dB, the maximum acceptable two major race series: the FIA World exposure time would be 30 minutes. More recent government recommendations, set by the National Institute for Occupational Safety THE USE OF HEARING and Health (NIOSH), are more strict and PROTECTION AMONGST suggest only eight hours of exposure at 85dB “ and cutting that time in half for each SPECTATORS IS LESS WELL additional three dB. UNDERSTOOD Occupational hazards such as hearing damage have been addressed in motor sport ” through educational programmes and the Endurance Championship and the American placement of team requirements mandating Le Mans Series. Throughout the event, three the use of hearing protection in the pit and research assistants surveyed spectators who crew areas. However, recreational exposure had already entered the racetrack gates and to high noise levels at motor sport events and agreed to participate in the study. All the use of hearing protection amongst questions and answers were performed in a spectators is less well understood and verbal manner and the results were recorded studied. The risk of hearing loss among using an established survey software spectators is not as significant as that for program called SurveyGizmo and run on drivers and crew given the lower noise levels iPads. The authors independently created the and brief, intermittent exposure levels they survey questions (Table 1). experience. There have been A single researcher collected noise level recommendations in prior reports and the data from around the track and they used an The Audi media that an increase in fan awareness Omega HHSL402SD decibel meter, which was LMP1 car was around the topic of noise injury is needed. calibrated each day using an Amprobe SM- the quietest machine on We had hypothesised that the majority of Cal1 calibration tool. Peak levels were the grid spectators at a major motor sport event recorded after testing over three laps where

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TABLE 1: there were multiple vehicles in groups, as (53.7 per cent) who had planned to wear Yes % No % TOTAL well as single vehicles of different classes and hearing protection at the event prior to their Have you ever been to a major 678 82.2% 147 17.8% 825 makes. These noise levels were recorded in arrival. This increased to 639 (77.8 per cent) motor sport event before? spectator areas at 21 different locations when asked if they would use free earplugs if Are you aware of the possibility of 758 91.9% 67 8.1% 825 around the track, and distances to the track they were provided at the track. Of the 754 noise related hearing injury? edge were measured and recorded using a survey participants who said they were aware Is hearing injury at motor sport 388 47.0% 437 53.0% 825 events a concern of yours? Leupold Rx1000i rangefinder. of the possibility of noise-related hearing injury, 601 (79.7 per cent) stated that they Were you planning to wear ear 443 53.7% 382 46.3% 825 Separately, another researcher recorded plugs today? data on the actual use of earplugs by would use hearing protection if it were given Would you wear ear plugs today 639 77.8% 182 22.2% 821 spectators during on-track action. This to them. Only 187 (22.7 per cent) of the if they were given to you? observation was performed in the main respondents felt that the noise level at this Is the noise level at today's race 187 22.7% 636 77.3% 823 grandstand area of the track using row-to- particular event was louder than expected. louder than you expected? row, close visual confirmation and counts This dropped to 132 (19.5 per cent) for those were recorded using an Easton dual pitch who had been to a prior event. TABLE 2 Day 1 % Day 2 % TOTAL % counter. This study was performed on two Direct observation of 1,024 spectators USING EAR DEFENCE 136 37.6% 308 46.5% 444 43.4% separate days and in different grandstand sitting in the main grandstands over two areas to avoid the potential for duplicate separate days revealed that 444 (43.4 per NOT USING EAR DEFENCE 226 62.4% 354 53.5% 580 56.6% observation of the same spectators. cent) were using ear protection during the TOTAL 362 662 1,024 100.0% on-track running (Table 2). The use of RESULTS hearing protection was higher on the second There were 825 spectators who participated day (46.5 per cent versus 37.6 per cent). TABLE 3 Turn Distance (M) Peak level 1 Peak level 2 Peak level 3 Average MG= main grandstand area in the voluntary survey and answered the six Noise levels recorded in spectator areas at (dB) (dB) (dB) peak 1 18 122 121 120 121.0 questions. There were also 170 spectators 21 separate locations around the 3.4mile 2 45 120 100 100 106.7 who refused to participate in the survey, track, and the recording distance from the 3 48 112 115 116 114.3 citing reasons that ranged from a lack of time track at these locations, were documented 4 34 117 115 110 114.0 and interest, to concerns that data would be (Table 3). These levels were logged as peak 5 27 122 117 110 116.3 used in a lawsuit of some sort. decibel levels and not sustained averages and 6 45 110 118 124 117.3 The majority of respondents had been to a were measured over three separate laps 7 48 123 120 116 119.7 prior major motor sport event, totalling 678 during the mid-point of racing. The range of 11.5 16 128 126 118 124.0 of 825 (82.2 per cent). Of the group, there peak noise levels for groups of vehicles went 12 28 128 128 124 126.7 were 758 (91.9 per cent) who were aware of from 89dB to 128dB, with measurements also 13 23 100 108 99 102.3 the possibility of noise related hearing injury recorded from lapping vehicles on their own. 14 46 95 90 92 92.3 at a motor sport event. For those who had Peak noise levels were also recorded for 15 18 126 122 122 123.3 previously attended a motor sport event this individual cars during the World Endurance 16 35 121 117 125 121.0 17 53 89 95 91 91.7 awareness slightly increased to 632 out of Championship race on day three (Table 4). 18 48 91 94 93 92.7 678, or 93.2 per cent. This peak level was recorded at one location, 19 39 112 123 110 115.0 There were 388 participants (47 per cent) 21m from the edge of the track just before 20 18 123 124 125 124.0 who said that hearing injury was a concern to Turn 1. Data was collected over a ten-lap MG 1 18 120 120 125 121.7 them, and this frequency did not increase period to assure that single vehicle peaks MG 2 18 127 120 124 123.7 significantly for those who had been to a were obtained with adequate distances in MG 3 27 124 118 120 120.7 prior event, at 320 out of 678 (47.2 per cent). front of and behind each vehicle to exclude MG 4 27 124 124 126 124.7 Of the total group surveyed, there were 443 supplemental noise interference. The highest Average 32.3 115.9 115.0 113.8 114.9

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TABLE 4 As a result of this study, a question arises cause significant hearing loss and they should REFERENCES Car type Peak dB around problems that may exist amongst strongly consider the using of hearing 1. Rose AS, Ebert CS, et al, Audi etron LMP1 86.6 spectators regarding their appreciation of protection during the majority of their time at “Noise exposure levels noise injury, and therefore, whether steps a motor sport event. GT3 111.4 in stock car ”, should be taken to help educate and protect Beyond educating spectators on the Corvette 119.7 entjournal.com, Volume these fans when the majority already appear inherent risks of noise injury, promoters and 87, Number 12, 2008 LMP2 121.0 aware of the issue and yet deliberately circuits should explore ways to facilitate the 2. McCombe AW, Binnington LMP1 121.7 choose to not use hearing protection. It is an use of hearing protection by fans that desire J, “Hearing loss in Grand Aston Martin Vantage 122.1 interesting question especially in light of the it when entering the venue. One option is to Prix motorcyclists: Ferrari 458 Italia 122.6 fact that many fans have voiced their desire have a widespread availability of earplugs at occupational hazard or for higher noise levels in other series, such as every entrance for purchase (or given freely), Average 115.0 sports injury?”, British Formula One, where the recent addition of V6 as well as at merchandise sites. If spectators Journal of Sports Medicine, turbo engines has resulted in muted noise see hearing protection offered widely at an 28(1), 1994 peak level for a single vehicle was the Ferrari levels versus the previously used naturally event and view its use as a part of the sport, 3. Clark, William W., “Hearing: 458 Italia, at 122.6dB, and the lowest came aspirated engines. These attitudes have been they may be more likely to use it. from the eventual overall race winner, the acknowledged and validated by some in the effects of noise”, Otolaryngal Head Neck Audi eTron quattro, at 86.6dB. motor sport leadership who have actually CONCLUSION Surgery; 106(6): 1992 called for teams to investigate making louder Noise-induced hearing loss is a possibility 4. Campen, et al, “Ototoxic DISCUSSION engines to satisfy fan desires. for spectators who choose not to use hearing occupational exposures Noise-induced hearing injury and hearing loss A lack of knowledge may still exist among protection at typical motor sport venues. It is for a stock car racing team: for racing teams at motor sport events is a the very fans who responded that they were likely that many fans do not understand that Noise surveys”, 2005 known occupational risk, and over the years aware of the issue of noise injury and its hearing loss can occur at lower decibel levels 5. Lindemann J, Brusis T, this hazard has been addressed with the dangers. They are not likely aware of the fact than they realise. Continued efforts to “Is there a risk of noise- implementation of mandatory hearing that hearing loss and damage can occur well educate spectators and offer options for induced hearing loss in protection for team members. below the threshold that people will generally hearing protection at venues should automobile drivers and in The hazard of noise injury does also exist perceive as painful or even uncomfortable. be supported. automobile sport racing?” for spectators attending motor sport events, The results of long-term noise exposure Laryngol Rhinol Otol 1985; but to a lesser extent. Our survey data shows below the level of concern expressed by 64(9): 476-480 that the vast majority of motor sport viewers these spectators can still cause chronic and 6. Kardous CA, Morata T, at a single event were well aware of the irreversible hearing loss, which will only be “High Speeds, Higher possibility of such noise injury, but only about noted long after the damage has been done. Decibels”, NIOSH Science half of them expressed concern about this It is therefore advisable, from a medical and Blog, 2010 topic. Less than half of those fans who were safety standpoint, to dismiss the notion that 7. Hood, J. D., Poole, J. observed actually chose to use hearing most spectators are aware of noise injury and P. “Tolerable Limit of protection during this event, as was directly choose not to use hearing protection, which Loudness: Its Clinical and spotted by watching spectators in the means there is no need to do more. It Physiological Significance”, grandstands. Some of the cars taking part in appears that spectators may not truly be Journal of Acoustics. Soc. the event did indeed produce documented aware of the potential for injury and further Am. 1966; 40 (1) 47-53 high peak decibel levels, capable of causing education is still needed. This is because they noise-induced hearing loss. may not realise that lower decibel levels still

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SOUND PROFILES OF THE 2013 AND 2014 F1 POWER PLANTS: ACOUSTICS, PSYCHOACOUSTICS AND SPECTATOR PREFERENCES

John Bedolla MD, John Sabra MD, Craig Dolder PhD, Steve Olvey MD

In 2014 the Formula One engine regulations at or above 110dB, and a harmonic spectrum were changed from naturally aspirated V8 from 20 hertz (Hz) to 18 kilohertz (kHz). The engines to turbocharged V6 power units. 2014 power unit produced an average 93.8dB, Additionally, energy recovery systems were with only 2 per cent of the measurements at enhanced, and the maximum RPM was or above 110dB, and a harmonic spectrum lowered from 18,000 to 15,000. This move from 20 Hz to 14kHz with a steep drop off changed the noise profile of Formula One cars after that. Of the spectators polled, 66 per cent and many fans and commentators found that preferred the 2013 sound profile, while 16 per new sound less favorable. cent had no preference, and 18 per cent in The Circuit of the Americas Medical Group favour of the 2014 sound profile. conducted live sound measurements at Sounds are known to elicit strong emotions Formula One races in 2013 and 2014 to better in human beings. Other than the storied understand why the new sound profile was “NOVI” engine of the 1950s and 1960s, few The new power units received unfavourably. We measured and engines sounds are as distinctive as the were brought in for analysed thousands of decibel (dB) level data naturally aspirated models from Formula 1 the 2014 F1 season points and the sound spectra of the Formula between 1989-2013. The characteristic shriek One cars, and surveyed spectators on their and the dB of 110 augmented the sense of preferences. speed and power of the cars. By contrast, the The 2013 V8 engine produced an average quieted and harmonically compressed 2014 98.8 dB, with 17 per cent of the measurements sound is controlled and clinical.

The V6 turbo power units are around 5dB quiter than the previous engines

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CALL FOR SUBMISSIONS Every issue of AUTO+Medical contains a scientific research paper that looks at the various medical issues that surround motor sport.

All submissions are welcome For each submission please AUTO+ MEDICAL so if you have a study that include a summary of the EDITORIAL BOARD you feel would be suitable research and all necessary for publication in the future contact information. Dr Paul Trafford issues of AUTO+Medical, (Chairman) please send it to: The editorial board will medical@fiainstitute evaluate each submission Dr Robert Seal before it is accepted for use (Medical Director, in the magazine. Canadian Motorsports Response Team)

Dr Matthew MacPartlin (Assistant Chief Medical Officer, Australian GP)

Dr Pedro Esteban (FIA Medical Delegate, World Rallycross Championship)

Dr Jean Duby (FIA Medical Delegate, World Rally Championship)

Dr Kelvin Chew (Chief Medical Officer, Singapore GP)

Prof Jean-Charles Piette (FIA Medical Delegate, Formula One)

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