A Guide for Doctors and ParamedicsParamedics Working on the TT Mountain Course

Produced by Manx Roadracing Medical Services LLC Registered in the Company No. 985L

Supported by The Rob Vine Fund

for

MRMS 2 A Guide for Doctors and Paramedics Working on the Isle of Man TT Mountain Course

CONTENTS

SECTION 1. An Introduction to the Mountain Course - Page 3 2. The events, how they are organised and run - Page 3-4 3. The Medical Services on the Mountain Course during events - Page 4 4. Requirements for medics working on the Course - Page 5-6 5. Insurance - Page 6 6. Registering with Manx Roadracing Medical Services LLC - Page 6-7 7. Travelling to the Isle of Man - Page 7-8 8. Accommodation - Page 8 9. Signing on for the event - Page 9 10. Road Closures - Page 9-11 11. Marshalling on the Mountain Course during events - Page 11 12. Safety on the Course – Flags - Page 12-13 13. Communications during the event - Page 13-14 14. Medical equipment on the Course - Page 14-15 15. Before you set off to your location - Page 16 16. Getting to your location - Page 16-18 17. When you arrive at your location - Page 18-19 18. Managing a racing incident - Page 19-20 19. Helicopter procedures - Page 20-21 20. What to do after an incident - Page 21 21. Record keeping - Page 22 22. Professions Allied to Medicine – Physiotherapy & Psychology - Page 22 23. The Emergency Services - Page 22-23 24. Nobles Hospital - Page 23 25. Educational activities - Page 23 26. Social activities - Page 24 27. Payments to medics - Page 24

APPENDICES

1. Radio points around the course - Page 25-26 2. Course locations - Page 27-28 3. Trackside Medics SOP - Page 29 4. TT Course Incidents – Historical Data - Page 31

This guide and its appendices is intended for people directly involved in the operational delivery of the medical services for events run on the TT Mountain Course, and should not be passed to third parties or placed in the public domain. – Manx Roadracing Medical Services LLC – November 2017

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1. An Introduction to the Mountain Course

The Isle of Man TT was first run in 1907. In 1911 it moved from the St John’s course to the Mountain Course where it remains to this day. The started life in 1923 as the Manx Amateur Road Races. In 1930, it was renamed the Manx Grand Prix. The Mountain Course starts at the TT Grandstand in Douglas, and covers 37 ¾ miles, with over 200 corners. From Douglas it runs out to Crosby, past the Crosby Hotel, and on to . A sharp right hander there takes the course through , past the Glen Helen Hotel and on to Kirkmichael. It passes through the village of Kirkmichael, through Sulby and on to Ramsey. At Ramsey, the riders enter the famous mountain section of the course. Going up the mountain they reach Bungalow Station, just below the summit of , and on to the highest point of the course at Brandywell. From there it is downhill past Windy Corner, The Creg-ny Baa pub and back into Douglas.

2. The events, how they are organised and run

The TT is a 2 week event that takes place at the end of May and the beginning of June each year. It is promoted by the Isle of Man Government (Department of Economic Development) and is organised and run by ACU Events Ltd, which is the commercial arm of the ACU ( www.acu.org.uk ). It is licensed by the ACU and runs under their regulations. The Manx Grand Prix, together with The Classic TT forms the Festival of Motorcycling. This is also a 2 week event, usually spanning the end of August and the beginning of September. The Manx Motor Cycle Club promote the Manx Grand Prix and the Isle of Man Government promote The Classic TT. Both events are organised and run by the Manx Motorcycle Club. Like the TT, the event is licensed by the ACU and runs under their regulations. When practicing or racing is taking place, the whole of the Mountain Course is closed to public traffic. This means that there are large parts of the course that are not accessible once the roads close. In both events, the first week is Practice week, when there are 6 practice sessions, one run each evening for 6 days. Races are scheduled to be run on the Saturday, Monday, Wednesday and Friday of Race Week. In the event that racing is postponed due to adverse weather (or for any other reason), they can also be run on the Sunday (TT only), Tuesday, Thursday and the final Saturday of Race Week.

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Once the roads have been closed, the responsibility for them passes to Race Control which is situated at the top of the tower located at the Grandstand in Glencrutchery Road. Within Race Control there is a team of people who’s responsibility it is to run the Practice or Race session comprising The Clerk of the Course, Deputy Clerk of the Course, 3 controllers in contact with all of the Chief Sector Marshals and Deputy Sector Marshals around the course, a controller in contact with all of the course cars as well as the Travelling Marshals and the Elite Dispatcher who monitors all of the radio communications for Emergency Calls. There is a further group of people in Race Control responsible for managing any responses by the Emergency Services (Police, Ambulance and Fire) as well as the Control for the Medical Team out on the Course. Finally, because we use 2 race helicopters and a civilian helicopter, there is an Aviation Co-ordinator in Race Control

3. The Medical Services on the Mountain Course during events

There are a number of challenges in delivering medical care to injured riders during the races. These include the fact that the road is closed to traffic, and in most circumstances, the racing or practicing will continue whilst the medical and marshalling teams deal with any incident, and also the fact that incidents can occur quite a number of miles away from the Island’s main hospital, Nobles. The terrain can be quite rough, and sometime communications (although improving) can be difficult The medical service comprises: • Members of the medical team on the Course providing an immediate response (anything from 20-40 and a mix of Doctors, Paramedics and Advanced First Aiders) • 2 helicopters crewed by a Doctor and a Paramedic experienced in delivering Pre-Hospital Care. (A 3rd helicopter covers the civilian population) • A Response Car crewed as the helicopters, and providing a response to those parts of the course where the helicopters cannot land. • 6 Land ambulances (supplied by Hogg Motorsport Association and St John Ambulance) and providing immediate response and transport to hospital in those parts of the course where the helicopter cannot land. • A 4 x 4 Ambulance (supplied by St John Ambulance) providing transport to the helicopter landing site at Sarah’s Cottage. • A First Aid Post (when roads are closed) in the Grandstand Complex • Paddock Based Physiotherapy service (providing free treatment for riders). • 2 members of the Medical Team in Race Control

Medical Helicopters in use during TT and FoM Hogg Motorsport Association ambulances and crew

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4. Requirements for medics working on the Course

As a doctor, paramedic or nurse, your Duty of Care requires you to be competent at dealing with the type of casualties you might expect to encounter when volunteering to work on the TT course. That means that you need to have knowledge of basic first aid and resuscitation/life support as a minimum. Although not essential, there are other skills that would be very valuable, and we would always recommend that you try to attend an appropriate course such as ATLS (Advanced Trauma Life Support), PHEC (Pre-hospital Emergency Care) or PHTLS (pre-hospital Trauma Life Support). More information about these can be found on our Educational Resources page. Currently, it is not an absolute requirement that you have any of these qualifications, although it is your responsibility to make sure that you are working within your own level of competence.

We would also recommend that you read the BMA guidance for Doctors providing medical care at sporting events. If you would like us to email you a copy of this document, please contact us.

Having said all of that, it is important to remember that you will be supported by an experienced team of Marshals, as well as by the very experienced crews in the Air Ambulances and/or Medical cars in use around the TT Course, so you will not be on your own!

If it is your first experience of road racing on the Isle of Man, we would also suggest that you try to attend one of the Incident Management Courses that are run by the TT Marshals Association (TTMA). Further details at http://www.iomttma.com Failing that, we require that you watch the TTMA video about incident management at https://www.youtube.com/watch?v=M8WwHjWYdRM

Doctors: In order to work on the TT Course a doctor needs to hold FULL registration with the General Medical Council (GMC). This also applies to UK mainland motorsport events. In addition to full registration, a doctor needs to have a licence to practice issued by the GMC. In order to get and maintain a licence to practice, a doctor has to have a Designated Body and be subject to revalidation. Doctors that work outside the UK (and therefore do not hold full GMC registration) but within the EU, should contact the GMC as there are certain circumstances where they can be permitted to work for short times within the UK.

Because FY1 doctors hold a provisional registration rather than a full registration, they are only permitted to work within approved Foundation Year 1 posts, and are therefore not permitted to work on the TT Course.

The GMC regulations concerning FY2 doctors has changed, so that even though they are required to work within an Approved Practice Setting (APS), provided that their Educational Supervisor is happy, they are allowed to work outside their Designated Body. It is quite possible that your Educational Supervisor might want further information about the nature of the work and the level of supervision before allowing you to work on the TT Course. We are happy to provide such information for

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you to pass to your Educational Supervisor. You can read more about Approved Practice Settings at www.gmc-uk.org

Paramedics: In order to work as a Paramedic on the TT Course you need to be a State Registered Paramedic with the Health & Care Professions Council (HCPC). In order to maintain your registration with them, you will need to satisfy their requirements. You can read more about this at www.hcpc-uk.org

5. Insurance

We are pleased to say that we have been able to organise Medical Malpractice cover for all of the Doctors and Paramedics that work for us during the TT and the Festival of Motorcycling as well as during the road races on the Billown Course (Pre- TT Classic races, Post-TT races and the International Southern 100 races). In order to be covered medics need to be Statutorily Regulated. For doctors this means that they have to be registered with the GMC and have a licence to practice. For Paramedics this means that they have to be registered with the HCPC (Health and Care Professions Council) and hold a current licence.

Our Medical Malpractice Insurance will only provide cover whilst you are working for us during one of the events that we provide medical services for. Should you choose to carry out other work whilst on the Isle of Man (such as working alongside the Isle of Man Police) our Medical Malpractice Insurance will not provide cover for that work, and you should make sure that alternative malpractice cover is in place for those activities.

It is essential that all Doctors and Paramedics sign on as Officials of the event in order to obtain insurance cover. Please see section 9 for further information on signing on.

6. Registering with Manx Roadracing Medical Services LLC

Manx Roadracing Medical Services LLC is responsible for the recruitment of Doctors and Paramedics to provide medical cover for both the TT and the Festival of Motorcycling (both run on the TT Mountain Course) as well as for the events run on the Billown Course in Castletown, namely The Pre-TT Classic Races, The Post-TT Races, and the Southern 100 Races. All of these are organized by the Southern 100 Club. This process is largely paperless, accomplished via the Registration section of our website WWW.MRMS.IM

Once you have filled in the Registration Form, we will contact you via email confirming that we have received your registration, and sending you links to the more detailed availability forms for the event(s) you are able to cover. If it is your first time working with us, we also ask that you submit a current CV with the Registration Form, and there is a facility on the form to allow you to do that. It is important that we have a CV for anyone working with us for the first time.

The registration process generally starts during November for the following year’s events. We appreciate that you may not know your exact availability at that time,

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since this will often depend upon travel arrangements, work commitments etc. However, the sooner you are able to provide that information for us the better. In order to comply with the 2016 Road Races Act on the Isle of Man, from 2018 we will be issuing photo ID Cards to all of the Doctors and Paramedics that work with us. In order to produce the ID Cards, we require a recent passport style photo. The photo can be uploaded when you fill in the Registration form on the website or can be emailed to us at [email protected] An example of the ID Card is shown here. It is a lot easier if we can produce these well in advance of the event, so again the sooner we can have a photo, the better.

Once we have received availability details for everyone coming to a particular event, we will start to draw up the Duty Rota for that event. We generally aim to have that completed approximately 10 days before the event starts, at which time we will email it to all of the medics concerned and ask them to check that what we have them down to work is what they were expecting. Any changes can be made at that stage, and once that process is completed we will post the rota in the rota section of the website. We would prefer not to make any changes after that if possible. However, if people want to swap locations during the event with another team member, we are happy for them to do so, provided that they inform us of any changes made.

When we email the rota, prior to the start of the event, we will also email other information applicable to that event. The information that we email will also be available for download from the website, and will be available in a paper form when you sign on for the event. See section 9 for more information regarding signing on.

7. Travelling to the Isle of Man

There are two ways for people visiting the Isle of Man to get here. By plane or by ferry. Either way, with the number of visitors that the TT in particular attracts, tickets to travel get booked up very early. Given that the majority of visitors are motorcyclists, the ferry is especially popular. Even though the Isle of Man Steam Packet company ( www.steam-packet.com ) puts on a lot of extra sailings during the events, we would advise that you make your travel bookings as soon as you can. The ferries sail from both Liverpool and Heysham. If you are unable to get the exact sailings that you want, we advise that you book sailings as close as possible to the actual ones. Once you have a booking, we are sometimes able to arrange with the Steam Packet to change them to the actual sailings you want. It isn’t always possible, but if you contact us we can advise further. Ferry sailings for TT are particularly popular and get booked up fast. The Steam Packet releases the sailings for TT to the general public a year in advance (i.e the tickets for TT 2018 were released on general sale during TT 2017). The Steam Packet does have an

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arrangement with the TT Marshals Association to allow Marshals access to the tickets approximately 4 weeks before they go on general sale. They have extended that offer to Medics travelling to the Island for TT, but they do require confirmation from us that anyone booking the tickets early, is genuine. We provide the Steam Packet with a list of names and contact details of people coming over to work for us, and they will then email out the form required. Of course, it does mean that you have to commit to the event 12 months in advance, but for some people it can ensure that they get the sailings they want.

Flights to the Island and generally from Manchester, Liverpool or Gatwick and the two main airlines servicing the Island are Flybe ( www.flybe.com ) and Easyjet ( www.easyjet.com ). Of course, the advantage of the ferry over flying is that you can bring your own transport, which given the size of the course is helpful. See section 16 Getting to your location for further information. If you do choose to fly, it is possible to hire a car. The two main car hire outlets on the island are Mylchreests (www.mylchreests.com/carhire) and Athol (www.athol.co.im)

8. Accommodation

There are a number of options for people wanting to stay on the Isle of Man, but be aware that there are a lot of visitors during TT and the Festival of Motorcycling. Accommodation does get booked up early, and hotel rooms can be hard to find and expensive. Try looking at the Isle of Man Official Visitor site www.visitisleofman.com which has information about where to stay, where to eat and what to see. Another option is TT Homestay which is a scheme whereby local people with rooms to spare rent them out for the duration of the event. Information about that can be found at www.iomhomestay.com

A popular choice is camping. There are a number of permanent campsites on the Isle of Man, and information about many of them is available on the Official Visitor website. There are also numerous campsites that open just for TT and the Festival of Motorcycling. We are able to offer free camping for Medics at the Blackberry Lane campsite, close to the TT Grandstand complex. It is a site that opens just for TT and the Festival. It tends to open 1 or 2 days before the events start and closes 1 or 2 days after. If you want to camp there, you would need to let us know in advance (generally when you are submitting your availability). We need to sort out the camping permits so we need to have your details in order to do that. We also have available a number of tents that people can borrow, to save you having to bring one over with you. Again, let us know in advance if you wish to borrow a tent. In the satellite picture on the left, the edge of Nobles Park and the TT Grandstand complex can just be seen to the left of the picture. Blackberry Lane is marked with the purple pin.

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9. Signing on for the event

It is essential that all Doctors and Paramedics working as a part of the medical team sign on using the ACU Officials signing on form before they undertake their first duty. Signing on takes place at The Hoggery, which is the headquarters of the Rob Vine Fund and the registered offices of Manx Roadracing Medical Services LLC. Medics can sign on from the Thursday before the event. You only need to sign on once for the event. Once you have signed on you will be covered by our Medical Malpractice Insurance as well as the Event Insurance organized through the ACU by the event organisers.

When you sign on you will be given a pack containing information relating to the event, a paper copy of the rota (should you need one), an official programme for the event, a Medical Pass and a Vehicle Pass issued by the event organisers and a photo ID Card issued by MRMS. You will also receive some ‘freebies’ from us. As well as signing the ACU Officials list, you will be asked to complete a Contact Form to make sure that we have the correct contact details and phone number for you. That will include your bank details to allow us to pay you expenses after the event. See section 27 Payments to medics for more information regarding the expenses. The picture above shows the location of The Hoggery, which is in Nobles Park behind the Grandstand.

10. Road Closures

In order for racing to take place on the Mountain Course, the roads have to be closed to any other traffic. Given that the roads concerned are several of the main routes around the island, there is an inevitable degree of inconvenience to the general public, with many properties and areas being inaccessible whilst the racing takes place. The timing of road closures is published in the official Road Closing handbill published for each event by the Department of Infrastructure. An example of that (from TT 2017) is shown on the next page, and you will be emailed a copy of the relevant handbill before the event. In effect, for both events the roads close each evening of practice week from 6pm until 9.30pm (TT) or 9pm (FoM) at the latest. During race week the exact timing of the roads closing depends upon a number of things including whether it is a working day, a weekend day or a bank holiday. The timing also changes slightly if it is one of the Reserve days, being used because of a postponement from the previous day. The exact times are published on the handbill.

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A key difference between the TT and the Festival of Motorcycling is that during TT the mountain section of the course, from through to the Creg-ny- Baa is one-way (from Ramsey to Douglas) for the whole of the 2 week period. That is not the case during the Festival of Motocycling when that section of the road remains two-way when the roads are not closed. During TT, this requires a lot of signage, cones etc. to manage the public traffic on that section of the road. All of that has to be removed before racing can take place and has to be re-instated before the road opens again to the public. As a result, during TT (but not during the Festival of Motorcycling), the mountain section of the course closes earlier than the rest of the course to allow that work to take place. Typically, during Practice Week, the mountain section closes 1hr 15mins before the main road closure from Ramsey through to Bungalow, and 1hr before the main road closure from Bungalow through to the Creg-ny-Baa. The equivalent timings for Race Days are 45mins before the main road closure from Ramsey to Bungalow, and 30mins before the main road closure from Bungalow to the Creg- ny-Baa. The fact that during TT the mountain road is one-way, and that it closes before the rest of the course obviously has an effect on the ability of Marshals and Medics to get to their positons on the mountain in order to be ready for the racing. Please see section 16 Getting to your location for more information on this.

Access road: In order to allow public traffic to get from the outside of the course to the inside of the course (or vice versa) whilst the roads are closed, there is an access road. This starts from the outside of the course by Quarterbridge, runs under the Course at Bridge, and ends on the inside of the Course. It is only open when the roads are closed, and it is quite narrow (single track in places), so at busy times it does get quite congested.

Crossing points: During race days, typically between races, the Clerk of the Course may open up crossing points at various places around the course (which are listed on the Road Closing Handbill) to allow members of the public to get across the Course form the outside to the inside or vice versa without having to go through the access road. When this happens, a Course Inspection car will travel around the course and the crossing points will be opened after the car has passed through that particular location. This means that the crossing points open in order around the course as the car proceeds, with the effect that the crossing points towards the end

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of the course will open some 25 or 30 minutes later that the crossing points at the start of the course. When the crossing points close, they do so simultaneously.

11. Marshalling on the Mountain Course during events

Providing and organising the marshals on the TT Course for both the TT and the Festival of Motorcycling is the responsibility of the TT Marshals association. Their website is www.iomttma.com . Without the Marshals there would be no racing and the TTMA do a great job in recruiting around 1500 volunteers for each event. For any Practice or Race session there are over 500 of them out on the course. In overall charge is the Chairman of the TTMA, who is also Chief Marshal for the events, Robert Crane. The course is split up into 12 sectors, and there is a Chief Sector Picture courtesy of www.iomttpics.com Marshal (CSM) who has responsibility for each sector. Within each sector there are a number of individual marshalling points, and in charge of each point is a Deputy Sector Marshal (DSM). When on duty, the marshals at any given point will be allocated specific roles by the DSM such as responsibility for clearing the bike, responsibility for flagging etc. One of the marshals will be allocated the role of caring for a casualty, and when you are on duty that person will assist you. See section 17 for more information about what you should do When you get to your location.

The DSM is responsible for all activities at his/her particular location as well as for the safety of the marshals/medics and the spectators there. If he/she gives you instructions in this regard you should follow them.

Travelling Marshals: Road racing in the Isle of Man is unique insofar as it makes use of Travelling Marshals. These are generally experienced ex racers who also have experience of managing incidents on the course. During practicing and racing they are located at specific points around the course (generally 7 points in total), and they are the ‘eyes’ of the Clerk of the Course. They are in radio contact with Race Control, and in the event of an incident, the Travelling Marshal at the point immediately before the incident will be dispatched to attend. When he arrives at an incident he will assume overall control. Amongst other things, he is responsible for ensuring that someone is sent to secure the helicopter landing site (if a helicopter is required), and he is also responsible for making sure that the road surface and the incident scene is suitable to allow racing to continue. They carry some First Aid equipment with them, and have had some additional training with regard to things such as airway management.

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12. Safety on the Course – Flags

As mentioned above, the DSM at your location will be responsible for ensuring the safety of marshals at his/her location, but it is up to all the people at a location to make sure that everything they do is done in a safe manner. With that in mind there are a few things that you should do • Make sure that you always wear a yellow hi-viz tabard indicating your role as doctor or paramedic. These are available from The Hoggery when you sign on • Use your common sense to make sure that you do not stand in any obviously dangerous positions • Always move if asked to do so by the DSM • If you have to go onto the course to attend to a casualty, make sure that the appropriate flags are being displayed before you move. • The instinct to rush to help someone is very strong but always ‘Look before you leap’ • When you are on the course, keep your wits about you. The bikes travel very fast. Even when the riders have slowed down for a yellow flag they may well still be doing over 100mph! • If you feel that the position that you and a casualty are in is at all unsafe, let the DSM know and make arrangements to move the casualty to a safe place to assess and treat them.

Flags: There are various flags that you may see displayed at different times. Some of these flags are intended to provide information for riders, whilst others are intended to give them an instruction.

Information flags: Instruction flags:

Yellow flag. Lack of Adhesion flag Stationary - Danger, slow Used when grip on the down, no overtaking. road surface is reduced Waved - Imminent danger, (usually oil) be prepared to stop

Sun flag. Green flag. Used when low sun in Normal racing can resume. parts of the course Used after a yellow flag, causes dazzle once riders are past an incident.

Visibility flag Red flag. Used when visibility is All riders must stop at that poor (usually mist) location when they see a red flag.

Rain flag. Used when rain is Black flag. wetting the road surface Used in conjunction with a number to tell a specific rider to stop.

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Flag procedures:

The most commonly used flag is a Yellow Flag. When shown stationary it warns riders of a potential danger ahead, such as a bike that has pulled in ahead. Riders must slow down and cannot overtake. A stationary yellow is also used immediately before a Waved Yellow Flag being shown at an incident. Finally, Stationary Yellow Flags will be shown in all the sectors after the sector in which a Red Flag incident has occurred. The purpose of this is to allow riders who have already passed through the location of the Red Flag incident to make their way back to the Start/Finish, but to do so without racing, since the race has been stopped. Doing this allows a race to be restarted more quickly than it otherwise might. A waved Yellow Flag is shown at an incident, and riders must slow down and be prepared to stop. Generally, riders will sit up on their machines and raise one hand to acknowledge the flag. Do not go onto the course to attend an incident until there are Waved Yellow Flags being shown. A waved Yellow Flag will also be shown if a Marshal is on the course (or making his/her way up the pavement). Riders, judged by the marshals, that ignore yellow flags, and do not slow down are reported to the Clerk of the Course, who can then take any action necessary.

A Green Flag is displayed immediately after an incident that is being managed under Waved Yellow flags to allow the riders to resume normal racing speeds, and to start overtaking again.

When the course is blocked by debris following an incident, or when there is oil on the track making it unsuitable for racing, the Marshals may ask Race Control for a Red Flag, which stops racing. In that event a Red Flag is displayed at the Start line and at all the Red Flag points in the sectors up to and including the sector where the incident has occurred. Riders must stop at the first Red Flag they see. Not all flag points are Red Flag points. When they have stopped, they may be given further instructions by a Marshal to proceed to a holding area, signified by a further Red Flag. Once the Red Flag incident has been dealt with, all the riders who have been stopped on the course (i.e. the riders that were on the part of the course before the incident when it occurred) need to be brought back to the Start/Finish. Depending on where the incident was, they will sometimes be escorted back by Travelling Marshals in the opposite direction to normal racing.

A Black Flag is used in conjunction with a race number when the marshals judge that there may be a mechanical problem with a particular machine. The Black Flag points are also the points where the Travelling Marshals are stationed. A bike that has been stopped by a Black Flag will be examined by the Travelling Marshal at that location and a decision will then be taken whether to allow the rider to resume.

13. Communications during the event

As mentioned above, before the event starts we will generally communicate with you via email. During the event we will normally contact members of the medical team by text message. We will send information out regarding delays to road closures, cancelled sessions etc. via our Group Text system. Please make sure that we have the correct phone number for you when you sign on. See Appendix 4 for Useful numbers during the events.

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During the actual racing sessions, most communication around the course is via the Tetra radio system, but most of the medical team out on the course do not have a Tetra radio (we do not have enough radios for that). Consequently, if we need to contact any of the medics during the racing we will usually do that by phone.

Tetra radios: There are approximately 266 radio points around the course (see Appendix 1 below for details). In addition to that, all the ambulances, helicopters, response cars, course cars and Travelling Marshals have Tetra radios, and there are quite a number of separate talk groups to handle all the radio traffic. The course is split into 12 Sectors and each sector has its own talk group, allowing the marshals in that sector to communicate with each other. They can also contact Race Control where there are 3 controllers, each of whom is in contact with 4 Sectors of the course. There are separate talk groups for the ambulances (ambmotorsport) and for the helicopters and the medical response car (dtlairmed3). The Travelling Marshals, and the Course Cars are on another talk group (dtlairmed1).

In the event of an incident, the DSM at that location will press the orange button on the top of his/her handset (which you can see in the picture on the left). This will alert Race Control to the fact that there has been an incident, and also where the incident is, since the location of each radio is known. It will also give that handset 30 seconds of priority over all of the other handsets in that group to allow them to pass any information to Race Control without being blocked by other callers in that talk group.

14. Medical equipment on the Course

The medical equipment that is around the course is provided by The Rob Vine Fund, www.robvinefund.im Equipment is placed in over 100 locations around the course, and when you are on duty this equipment will always be available to you.

Immediate Care Case: Usually referred to as the ‘Orange Box’ the Immediate Care Cases provide equipment required to manage minor injuries and also to manage the first 5 minutes or so of a more major incident, before a helicopter or response car gets to your location. The boxes are sealed but we would encourage people to open them to check the contents, and to familiarise themselves with the layout. They can be re-sealed with one of the spare yellow seals in the box. The top layer contains dressings and bandages, eye care products, Paracetamol and an Antihistamine. The layer contains a selection of IV Cannulae (including paediatric sizes), IV giving set and fluid, fixings for an IV cannula and also a large burns dressing. The lower compartment contains a bag,

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valve and mask, a hand operated suction unit, a selection of NP and OP airways (including paediatric OP airways), sharps container, a SAM splint, straps for securing the casualty onto the scoop stretcher, and patient report cards & pen.

Pictures: Top left – The top tray of the Orange Box. Top right – The middle drawer of the Orange Box Bottom left – The lower compartment in the Orange Box. Bottom right – Head block for use with scoop.

Scoop stretcher: Along with the Immediate Care Case, at each location there is a scoop stretcher, and a red head block. The purpose of the head block is to keep the cervical spine in a neutral position, given that the vast majority of riders wear leathers with an aerodynamic ‘hump’. Without the use of the head block this would put the cervical spine into hyperextension. If you are dealing with a rider with a suspected Cervical Spine injury and leathers without a ‘hump’, the head block should not be used. It can be used in any rider not suspected of having a Cervical Spine injury, for comfort.

For 2018, we have introduced some Medics Backpacks, in order to provide members of the medical team with some further options when dealing with major haemorrages, and also to provide some enhanced airway management options. The backpacks contain a cervical collar (previously available in the Orang Boxes, but now removed from there), 2 x iGel airways (Sizes 3 & 4) plus lubricant, and a major haemorrhage pack which contains 2 x 4” Olaes haemorrhage control bandages, a large blast bandage, a haemostatic ChitoGauze dressing, a Russell Chest seal and a tactical tourniquet. We can also add Penthrox for those that want it, and have had appropriate training in it’s use, to allow an analgesic option in the first few minutes. These backpacks can be signed out from The Hoggery when you sign on for the event, and should be returned at the end of the event.

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15. Before you set off to your location

There are a few things to bear in mind before you set off to your location on the TT Course. Firstly, make sure you know the time that the roads close. If there is any alteration to this (for instance due to adverse weather, or any incidents that might have occurred on the roads delaying their closing), we will alert you via our Group Text system. The information is also given out on local Radio Stations – Manx Radio, Energy FM and 3FM.

You will want to make sure that you have a number of things with you when you go on duty: • Hi-viz tabard (available from The Hoggery when you sign on) • Photo ID Card (issued when you sign on) • Medical Pass and Vehicle Pass (issued when you sign on) • Mobile Phone (charged!) • Any medical equipment you want to take (see section 14 above) • Clothing for all weathers (it is the Isle of Man after all!) • Appropriate footwear (the ground can be quite rough underfoot) • Enough food and drink (you will most likely be stuck at your location until the roads open again) • Insect repellant, sun block etc.

If you have any specific location requests, or if you have travelled with another medic and want to be positioned close together, please let us know by email when you send in your availability and we will do our best to meet your requests.

16. Getting to your location

This sounds straightforward enough, but if you are new to the Mountain Course there are a few things to bear in mind. The traffic on the course in the run up to the road closing can be very heavy, so be sure to allow yourself enough time to travel to your location. If you are travelling course direction you will pass the various mile markers so, provided that you know how far in to the course your location is, you will know when you are getting close. See the table below or Appendix 2 at the end for more information on this. There are also signs giving the names of many (but not all) of the locations. Bear in mind, if you are travelling in the opposite direction to racing (‘Wrong Direction’ or ‘WD’) these signs will not be visible to you. Examples of these signs are shown on the left here. During TT, the Mountain Section of the course is one way and you have to go onto it from Ramsey, so you need to travel to Ramsey, either along the course, through Kirkmichael and Sulby, or along the coast road from Douglas, through , to Ramsey. Remember that during TT the Mountain section closes earlier than the rest of the course (see Section 10 on Road Closures) so if you want to travel to a location on the Mountain on open roads you will need to aim to get there early. In order to avoid Marshals and Medics having to get to

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locations on the Mountain too early, the TT Marshals Association operates a Marshals Convoy during TT. There are two convoys, one from the Ramsey end of the Mountain Road travelling course direction and one from The Creg-ny-Baa travelling wrong direction. These convoys leave from both locations approximately 15 minutes after the Mountain Road has closed (i.e. before the main road closure). If you want to go in the convoy, decide which location you want to go from and get there in plenty of time. The vehicles in Ramsey gather at Lheanney Rd and the vehicles at the Creg-ny-Baa gather on the grass verge opposite the pub. There is a lead car which is clearly marked and has an orange flashing light. The convoys will proceed along the Mountain Road and you just pull in when you get to your location. There are convoys that bring the Marshals and Medics off the mountain at the end of the session, before the road is opened again to the public. In the convoy there is a minibus, and if you want to park up at either end and get a lift in the minibus you can.

During the Festival of Motorcycling, the convoy is not in operation since the Mountain Road is not one way, and it closes at the same time as the rest of the course, so you can make your way to a location on the mountain in the normal way.

The amount of parking and facilities that are present at each location varies quite a lot around the course, and is quite restricted in some areas. There is information about specific locations from the map on our website at www.mrms.im/course-map

See the table below for the medical locations and their distance from the start. LOCATION Miles LOCATION Miles LOCATION Miles Sector 1 Sector 6 Sector 9 (cont) Top of 0.4 Westwood 13.7 Black Hut 29.5 Bottom of Bray Hill 0.7 Douglas Rd Corner 14.3 Sector 10 Quarterbridge 1.3 Birkins/ 15.3 Verandah 29.7 Braddan (Oak) 1.7 Alpine 16.5 30.4 Braddan Church 1.8 Sector 7 Bungalow 30.8 Railway 2.6 Bridge 17.2 Brandywell 31.6 nd Strang Rd Union Mills 2.7 Ballacrye 17.7 32 /Dukes 32 Sector 2 18.6 Sector 11 Ballagarey 3.8 Sulby Crossroads 19.3 Windy Corner 32.5 Crosby Hotel 4.8 Sulby Bridge 20 33rd 33 5.9 Hotel 20.3 Keppel Gate 33.7 Sector 3 Sector 8 Kate’s Cottage 34 6.7 Kerrowmoar 20.6 Creg-ny-Baa 34.5 Gorse Lea 7.1 Glentramman 21.8 Sector 12 Ballacraine 7.7 Pinfold/Milntown 22.8 Sunny Orchard 35 7.9 Parliament Square 23.8 Brandish 35.4 Bridge 8.2 May Hill 24.1 Hillberry 36 Sector 4 Whitegates 24.2 Cronk-ny-Mona 36.4 Laurel Bank 8.6 Ramsey Hairpin 24.5 Signpost Corner 36.6 Black Dub 9.2 Sector 9 Bedstead 36.8 Glen Helen Hotel 9.8 Waterworks 24.8 The Nook 37 Sarah’s Cottage 9.9 Gooseneck 25.5 Governor’s Bridge 37.4 Cronk-y-Voddy 10.6 26th/Joey’s 26 Start - Finish 37.75 Sector 5 Guthries 26.7 Handley’s 11.9 Mountain Box 28.7 For a more complete list of locations, and their various names, see Appendix 2 – Course Locations

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Clearly, because of the distances involved, it is a lot easier to get around the course if you have transport. If you are travelling from the UK and don’t have transport, let us know when you send in your availability. We will do what we can to position you within walking distance, or somewhere that you can get a lift to.

Another option for getting to a location without transport, is to take the Marshals’ minibus that is organized by the TTMA. It leaves the Grandstand (Glencrutchery Rd) approximately an hour before the roads close and travels course direction as far as Ballaugh (where the driver is a marshal!). Seats are limited and you need to get a ticket to get on it. You can get the tickets from the TTMA office which is situated at the top of the paddock behind the Grandstand. The tickets are only valid for that particular day. If you know you want to travel on the minibus it is a good idea to get a ticket sooner rather than later, by calling in to the office the day before. During the Festival of Motorcycling, there is another minibus that leaves the Grandstand at the same time and travels the opposite direction over the mountain to Ramsey. This doesn’t operate during TT because of the different arrangements for closing the Mountain Road that apply during that event. After a session, the minibuses(s) take the reverse route back to Douglas so you can get a lift back.

17. When you arrive at your location – see also, Appendix 3 (Trackside Medics SOP)

It is important to let Race Control know that you have arrived at your location. You can do this by text to 07624 420085, or by phoning the medical desk in control on 01624 644607. It is slightly easier for us if you text because it allows us to handle the multiple calls we will be getting at that time more efficiently, but either way is fine. If you are unable to text or call (for instance due to lack of mobile phone signal), then speak to the DSM at your location and ask him/her to let Race Control know that you are there. They will do that over the Tetra radio system, and the relevant controller in Race Control will pass the message to the medical desk.

You should introduce yourself to the DSM and the other marshals, and in particular you will want to introduce yourself to the marshal responsible for looking after a casualty. It is a good idea to find out from them what they are comfortable doing.

The DSM at the location should be able to give you a good idea what the ‘typical’ incident at that location might be like and where the rider is likely to end up. You can then start to think about safe areas to treat a casualty, and discuss with the marshals the best way of moving a casualty, and the medical equipment to those areas. It might be helpful to run through a few simple scenarios with the marshals.

For 2018, for the first time, we have removed the Stiffneck collars from the Immediate Care Cases, mainly because the current evidence suggests that they are of dubious value, and in many instances may compromise care. We would recommend discussing that with the marshals, and reinforce the idea that Cervical Spine control should be by manual in line stabilisation until such time as you or the aircrew are happy to decide otherwise. The Incident Management courses run by the TTMA for marshals will be changed to reflect this change in practice, but for now, the majority of marshals who have been on one of the courses will have been trained to apply a collar.

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We would recommend that you check through the Immediate Care Case (‘Orange Box’) in order to familiarise yourself with it, and to check that there aren’t any issues with the contents. The boxes are sealed, but there are spare yellow seals in the box to re-seal it. If you do discover any problems with any of the equipment, let us know in Race Control. You can do this by phone, or by text, but we are also working on an electronic solution for passing that information by using your smart phone, which will hopefully be in place by 2018.

18. Managing a racing incident – see also, Appendix 3 (Trackside Medics SOP)

During each of the events (TT and FoM) we expect to deal with 40-50 incidents. Given that these can occur anywhere on the course, it follows that the chances of an individual medic having an incident on any given day are actually quite low, but it is a case of “Hope for the best but prepare for the worst”. For more details on where incidents have occurred, see Appendix 3 below.

When an incident does occur, there is a natural reaction to want to get there as quickly as you can, but always be sure to LOOK BEFORE YOU LEAP! Make sure that waved yellow flags are out before you go onto the course. In many instances, a rider will regain his/her feet straight away. In that situation you can get the rider back to the Marshals’ Shelter and take your time to assess them for any injuries. Bear in mind that in the immediate aftermath of an incident, due to high levels of Adrenaline, injuries are not always immediately apparent. Be sure to keep a close eye on any such riders for 10-15 minutes.

In a situation where a rider doesn’t regain his/her feet, the first thing to assess is whether the situation is a safe one. You want to be assessing and treating any riders in a safe place off the course. If there is any doubt, get the marshals to help you move the rider. This may involve quickly log rolling the rider onto the scoop stretcher and carrying them off the course, with the help of the marshals, or in certain circumstances it may involve simply dragging them off the racing line to a safe location under vigorously waved yellow flags!

Once in a safe location you can assess the rider. Any marshal that has been to one of the TTMA’s Incident Management Courses will have been trained in safe helmet removal and should be comfortable doing that with your supervision. You can then assess Airway, Breathing and Circulation as well as any major haemorrhage, and take any appropriate actions. In this situation, a helicopter will be heading towards you. If there are no immediate ABC concerns, you can consider starting to package the rider ready for transfer to the helicopter landing site. However, depending upon the situation, that may not be appropriate if there are significant injuries that need to be dealt with. Having carried out your Primary Survey, and taken any steps necessary, if there are significant injuries the next things to consider are analgesia and IV access. In general, given the short response times of the helicopter, it is quite likely that the air crew will be with you before you get to this stage. We are gradually introducing Methoxyflurane (Penthrox ™) as an inhaled analgesic as it can be used quickly and effectively before IV access has been established. There are some training issues surrounding it’s use which we are able to address. Remember that

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during this time, if you have not been able to exclude a Cervical Sine injury, one of the marshals will need to be instructed to maintain manual in line stabilisation.

If the casualty is stable, and is packaged on the scoop stretcher before the helicopter arrives, you can consider starting to transfer him/her towards the landing site. See section 19 for helicopter procedures.

Once the helicopter arrives, you should give a hand over to them, describing the mechanism of injury and your medical report. There are yellow report cards in the Orange Box (see section 21 for information on record keeping).

19. Helicopter procedures

There are 2 helicopters on duty for all practice and race sessions during TT and the Festival of Motorcycling. During Race week, for both events, there is a third helicopter that is available to attend the civilian population, who might otherwise be out of reach of the Isle of Man Ambulance Service due to the closure of the roads. The race helicopters are based at and Keppel Gate whilst the roads are closed. In the event of an incident (as notified to Race Control by the DSM on scene pressing the orange button on his Tetra handset), the nearest available helicopter will be brought to standby. This means that the crew return to the aircraft and prepare everything ready for flight short of starting the engines. This generally takes approximately 45 – 60secs, at which point they will report that they are standing by. In the meantime, Race Control hopes to hear from the scene whether a helicopter is required. If it is not, they will be stood down. If it is required, or in the event that nothing further is heard from the scene, the helicopter will be scrambled. Depending upon the location, it takes from 3 – 5mins from that point for the helicopter to be on scene.

It is the responsibility of the Travelling Marshal to identify and secure the landing site and to make it clear to the helicopter where that site is. In practice, that responsibility is frequently delegated to one of the marshals on scene.

When the crew disembark from the aircraft, one of them will be carrying the Response Bag, and the other will bring a scoop stretcher and head block to replace the ones at your location.

Historically, casualties were generally loaded in to the helicopter with the rotors running, in order to save time. Due to the changing nature of Pre-Hospital Care, and with an eye on safety, it is as likely now that the helicopter will shut down when on scene to allow for loading to take place without the rotors running. There are times when the Captain of the aircraft will not want to shut down for operational reasons (difficult terrain etc).

When transporting a casualty to the helicopter, you should stop just outside the rotor disc to await instructions. At this point, one of the helicopter crew will be responsible for the casualty, and the second crew member will be ‘eyes up’ with responsibility for the overall loading procedure. He or she will wait for an all clear from the pilot and will then instruct the marshals and medics to approach the aircraft. This will nearly

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always be done from the front of the aircraft between ‘10 o’clock and 2 o’clock’. Safety is paramount at this point, and it is important to proceed slowly and safely. Make sure any caps or loose items of clothing are removed, and take care with your footing. NEVER approach the rear of the aircraft when the engines are running.

Before the helicopter leaves, the crew will replace any equipment that has been used in managing the incident. Sometimes this might only be a couple of straps which they will give you if you ask, other times it might mean replacing a whole Orange Box, which they will also do. It is easy in the heat of the moment to overlook this, so if you realise after they have left that you are short of a piece of equipment, contact Race Control either by text (07624 420085) or by phone (01624 644607) and we will make arrangements to replace it at the end of the session.

There are parts of the course that the helicopter is not able to access. Mainly these are the areas from Cronk-ny-Mona down to the Grandstand and on as far as Union Mills. We have a Response Car that operates in this area and is able to provide the same sort of medical response as that available on other parts of the course via the helicopters. Transport to hospital from those areas is accomplished by a series of land ambulances. In the event of an incident in those areas, the car will be mobilised.

Incidents that occur in Ramsey are handled in a particular way. There are no helicopter landing sites in close proximity to the course in Ramsey, but the helicopter can land at Ramsey Cottage Hospital. Transport to RCH is accomplished by an ambulance located at May Hill in Ramsey, and then the casualty can be transported back to Nobles Hospital by helicopter.

There is a helicopter familiarisation session on the first Sunday of each event at the Helipad at Nobles Hospital. This takes place at 1pm usually. If there is any change to that we would let you know.

We would also advise that you watch the TTMA instructional video which can be found at www.youtube.com/watch?v=diecYaiZfQc

20. What to do after an incident

Once the dust has settled after an incident, you need to check the equipment that you have available to make sure nothing needs replacing. If you are short of anything let Race Control know (see above for numbers).

It is good practice to have a short debrief with the Marshals after any but the most minor incidents. Discuss things that went well, as well as anything that you feel could have been better. If you have any specific concerns about a particular incident, please let us know. You can phone on 07624 420085 or email [email protected] We carry out regular case reviews during the events to see what we can learn to improve the service for next time.

Some incidents can be very harrowing, and if you or any of the marshals at your location are suffering as a result of the experience, please let us know because we can arrange any support that is required.

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21. Record keeping

Keeping good records of our activities has never been more important than it is in this day and age. Within the Orange Boxes there are some yellow Patient Report Cards. Typically, one of these would be filled out by the medic on scene, and either handed to the helicopter crew, in the event that the casualty is evacuated by air, or to the ambulance crew or Response Car crew in the event that the incident is in a part of the course that the helicopters cannot access.

If the casualty does not require evacuation, we would still want you complete a Patient Report Card, and ask that you drop it in at The Hoggery, Nobles Park when you get the chance. We are hoping to develop an electronic version of the Patient Report Card, which will simplify the process. We will give further information about that when it is available.

The notes need not be exhaustive, but with the increased scrutiny that there is within all fields of healthcare these days, it is important that they reflect the care that has been given.

22. Professions Allied to Medicine – Physiotherapy & Psychology

Physiotherapy services for riders are available during both events based in the Paddock (just behind the First Aid Post)

During TT this is provided by Isla Scott and her team from Scott Physiotherapy Ltd. www.scottphysio.com During the Festival of Motorcycling this is provided by Cath Davies and her team from Rex Physiotherapy www.rexphysio.com

During both events we also work with Samm Shakespeare from IOM Therapy Services who is available to provide psychological support to members of the medical and marshalling teams should they need it. www.iomtherapyservices.co.uk

23. The Emergency Services

There is no doubt that both the TT fortnight and the FoM fortnight are very busy times for the island’s emergency services. We have a very close working relationship with both the Isle of Man Ambulance Service and the Isle of Man Police. During each event there are usually several occasions when we call upon the Ambulance Service to manage a particular situation, and similarly they will frequently call upon us to help

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deal with situations that they would otherwise find difficult to manage due to reduced access as a result of road closures.

It is also not uncommon for members of our medical team to be on duty, out in patrol cars, with the Isle of Man Police, during the periods of time between races. This is not a service that we specifically organise, but it is undoubtedly a relationship that works well for both the Police and our medics. If it is something that you think you might be interested in whilst you are visiting the island, let us know and we can put you in touch with the appropriate people. We should point out that it is unlikely that you will be in the patrol car pictured here!

24. Nobles Hospital

Due to the nature of the course, and the position of the Island’s main hospital, Nobles, we do not have a medical centre. Any casualties are taken directly to the ED at the hospital. We have an excellent working relationship with them and several of the ED doctors also work with us as a part of our team. In particular, one of the ED Consultants, Dr Gareth Davies, is also one of the Directors of Manx Roadracing Medical Services

25. Educational activities

Since we have been organising the medical services for the TT and the Festival of Motorcycling, we have always been struck by the enthusiasm of our volunteers and their eagerness to learn and to help us improve the service we are able to offer. As a part of that process, during the TT each year we organise a Trauma Symposium. This is held on the middle Sunday of the event (‘Mad Sunday’). We are able to hear about the latest advance in Pre-Hospital Care as well as undertake case reviews and practical sessions. In 2017 for the first time, during the Festival of Motorcycling, we held a Medics Briefing. It was used to discuss relevant topics and, again, carry out case reviews. These are both things that we plan to continue and develop in the coming years. These activities are held at Keyll Darree, the multidisciplinary education and training centre based at Nobles Hospital. Information relating to events that we hold there will be sent to all team members prior to each event.

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26. Social activities

There are plenty of opportunities for social activities during both of the events, ranging from the funfair that appears on Douglas Promenade during TT and the beer tents, to secluded beaches and stunning scenery. During the Practice week of each event, we organise medics lunches (subsidised) at the Talk of the Town, which is close to The Hoggery in Nobles Park. We also try to organise a medics night out during the event, usually on the middle Saturday after racing has finished, although it is subject to there being no delays. We will keep you informed of any activities via the Group Text system that we use.

27. Payments to medics

We appreciate how expensive it is for people to travel over to the Isle of Man and to stay here during the events. We also understand how much of an investment of people’s time it is, and we are hugely grateful for the support we get. Whilst we are not able to pay people the going rate for the job, we do try to do all we can to ensure that people are not out of pocket. To that end we are able to pay expenses to all of the Doctors and Paramedics that volunteer to work with us. We have a fixed pot of money to pay the expenses out of, so the exact amount that we are able to pay does depend upon a number of factors, including how many people volunteer, how many sessions there are in that particular event etc. In order to give a rough idea, someone that worked all of the Practice sessions and all of the Race days for one of the two week event would probably be paid in the region of £800 in expenses. We pay these after the event, by bank transfer, so please make sure that we have the correct bank details for you when you sign on.

Finally

If, having read this guide, you have any further questions, please email either Gruff Evans, [email protected] or our Administrator, Stuart Greaves, [email protected]

If you want to register to be a part of the medical team for a unique event please do so on the registration page of our website http://mrms.im/registration-form/

Remember to upload your CV if it is your first time working here, and please also remember to upload a current passport style photo. This can be taken on your phone or with a web cam, and then uploaded via the Registration Form.

We look forward to seeing you on the Isle of Man.

Manx Roadracing Medical Services LLC Updated Nov 2017 Registered Company No. 985L

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Appendix 1: Radio points around the course Thanks to Mike Stewart for providing this information

SECTOR 1 SECTOR 2 (cont) SECTOR 4 (cont) SECTOR 6 (cont) Parkfield DSM Crosby Crossroads Glen Helen Helicopter site Slieau Curn KM St Ninians X Rds Crosby Hotel Glen Helen 1 White House Flag Inner Circle Ballaglonney Close Glen Helen 2 White House Highview Rd Bottom Crosby Hill Flag Glen Helen Car Park Birkin's DSM Bottom Bray Hill Crosby Hill (Rock Farm) Sarah's Cottage Faaie ny Cabbal Ago's Leap Highlander Sarah's Cottage (Exit) White House Cottage Selbourne Drive Greeba Verandah Flag Salt Bin Birkin's Flag Alexander Drive Pear Tree Cottage Lambfell Moar Birkin's Bend Quarterbridge 1 Greeba Castle Scaffold Upper Lambfell Rhencullen Flag Quarterbridge 2 Greeba Castle Exit Lambfell Beg Rhencullen QB DSM SECTOR 3 Cronk y Voddy Dip Rose Cottage Braddan Flag Approach Cronk y Voddy X Roads Bishops Court Port e Chee Gate Appledene 1 (Flag) SECTOR 5 Orrisdale Road North Braddan Oak Appledene 2 (DSM) Cronk y Voddy Flag Alpine Flag Braddan Old Church Appledene 3 (Kennels) Burnside Alpine Cottage Braddan Exit (DSM) Greeba Bridge Flag Stockade Ballacurn Braddan Church Greeba Bridge DSM 11th Flag SECTOR 7 Transmann Hawthorn 11th Milestone Ballacob Rural Industries Harold Leece's (Knock Breck) Ballig Cottage Ballaugh Flag Ashlar Drive Gorse Lea (DSM) Mac's Cottage Snugborough Bridge Handleys flag Ballaugh Village Railway Pub Ballacraine Flag Handleys Gwen's DSM Union Mills Ballacraine DSM 12th Milestone Ballacrye 1 Union Mills Post Office Ballaspur DSM Shoughlaige Farm Ballacrye 2 Union Mills Sun Light Ballig Farm Approach Shoughlaige Bridge Ballacrye 3 Trollaby Lane Ballig Farm Ballaskyr Ballacrye Road end SECTOR 2 Ballig Flag Top of Wildlife Approach Ballavagher Ballig Bridge DSM Barregarrow Xrds DSM Quarry Bends 1 (marshals hut) Quayle's house Ballig Exit Barregarrow Flag Quarry Bends 2 (field entrance) Ballafreer Doran's Bend DSM Barregarrow Hill Quarry Bends (forestry yard) Glen Lough Campsite SECTOR 4 Bottom of Barregarrow Flag Quarry Bends 3 Glen Lough (Dip) Doran's Exit Bottom of Barregarrow Gob e Volley Ballagarey Flag Beary Bridge Cammal Farm Cooil Bane Ballagarey Corner Laurel Bank 1 – Rock Face SECTOR 6 Ballacaley Ballagarey Bus Stop Pump House Cronk Urleigh Sulby Crossroads Mylchreest's Paddock Laurel Bank 2 Westwood 1 Sulby Straight Ballagarey Lodge Laurel Bank 3 Westwood 2 Sulby Village 9th milestone Erinville Sulby Millrace flag Glen Darragh Road Helicopter Field Douglas Road Corner Flag Sulby Bridge Glen Darragh Dip Black Dub 2 Douglas Road Corner Ginger Hall Bottom Car Park Church Vaaish Moar Mitre Hotel Ginger Hall Crosby Village Hall Black Dub KM Village Continues on next page

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Appendix 1: Radio points around the course (continued)

SECTOR 8 SECTOR 8 (cont) SECTOR 9 (cont) SECTOR 11 (cont) Kerrowmoar West Cruiskshank's Casey's Kate's Cottage Kerrowmoar Flag White Gates Flag Black Hut Creg ny Baa Flag Kerrowmoar 1 White Gates SECTOR 10 Creg ny Baa (DSM) Kerrowmoar 2 Stella Maris Flag Verandah Flag 1 Lanjaghan Lane Kerrowmoar 3 Stella Maris Verandah View SECTOR 12 Kerrowmoar East Hairpin 1 Verandah Shelter Sunny Orchard SECTOR 9 Graham Flag Brandish Flag Glen Duff Farm Hairpin 2 Graham Memorial Brandish Garey Road Flag Waterworks 1 Bungalow Flag Brandish Exit Glentramman Corner Waterworks Bungalow Slegaby Lane Glentramman Loop Rd Waterworks 2 Hailwood Rise Hillberry Flag Ballakillingan Farm Brandywell Flag Hillberry Churchtown Tower Layby Brandywell Glen Dhoo Campsite Churchtown Caravan Gooseneck Brandywell Exit Cronk ny Mona Flag Sky Hill Gooseneck Flag Duke's Flag in Cronk ny Mona Pinfold Flag Gooseneck Duke's Shelter Signpost flag Pinfold Cottage Elfin Glen Duke's Flag out Signpost Corner Gardeners Lane Joey's 3 SECTOR 11 Bedstead Flag Glen Auldyn Bridge Joey's 2 Windy Flag Bedstead Glen Auldyn School Joey's 1 Windy Corner The Nook School House Flag Guthries Windy Quarry Governor's flag 27th 33rd Approach Governor's Bridge/Dip Bircham Avenue Approach lay-by 33rd flag Governor's Exit Parliament Sq Flag Mountain Mile 33rd shelter Glencrutchery Rd Bus Stop Parliament Sq 1 Mountain Box Approach lay-by 33rd lay by Duke's Avenue (Police Rd) Parliament Sq 2 Mountain Box Bridge Keppel Gate Flag Ramsey Bus Station Mountain Box Keppel Gate Cruickshank's Flag Casey's Advance Keppel Gate 2

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Appendix 2: TT Course locations – Course order

SECTOR 1 Mile SECTOR 2 Mile SECTOR 5 Mile SECTOR 7 Mile SECTOR 9 Mile Start - Finish Line 0 Greeba Castle 5.9 McGuinness's 12.1 Sulby Glen H’tel 19.3 27th Mile Mark 27 Glencrutchery Rd 0 Hall Caine's Crnr 5.9 Shoughlaige Br 12.1 Sulby Straight 19.4 M’ntain Mile Appr 27 Noble's Park 0.1 SECTOR 3 Mile Ballaskyr Farm 12.5 Sulby Bridge 20 Mountain Mile 27.1 St Andrew's Chch 0.2 6th Mile Mark 6 Top Barregarrow 12.7 20th Mile Mark 20 M’ntain Mile L’by 28 St Ninian's 0.3 Appledene 6.2 Barregarrow x Rd 12.7 Ginger Hall 20.3 28th Mile Mark 28 Top of Bray Hill 0.4 Cronk Dhoo Farm 6.5 Barregarrow Hill 12.8 SECTOR 8 Mile Mountain Box 28.7 Inner Circle 0.5 Greeba Bridge 6.7 13th Mile Mark 13 Kerrowmoar 1 20.6 E. M’ntain Gate 28.7 Port-e-Chee Ave 0.6 Cronkbreck Farm 6.9 Bttm Barregarrow 13.1 Kerrowmoar 2 20.7 E. Snaefell Gate 28.7 Bray Hill Bottom 0.7 Knock Breck 7 Cammall Farm 13.2 Kerrowmoar 3 20.8 29th Mile Mark 29 Ago's Leap 0.7 7th Mile Mark 7 SECTOR 6 Mile 21st Mile Mark 21 George's Folly 29.3 Selborne Drive 0.9 Gorse Lea Corner 7.1 Cronk Urleigh 13.6 Glen Duff 21.3 Rice's Corner 29.3 1st Mile Mark 1 Gorse Lea House 7.3 Westwood Cott. 13.7 Bernaharra Rd 21.3 Mike Casey’s 29.3 Alexander Drive 1.1 Ballagarraghyn Bdge 7.4 Ballalonna Brdg 13.8 Dpt Transport 21.4 Black Hut 29.5 Woodlands 1.1 Ballagarraghyn Fm 7.5 Brake Leg 13.9 Glen Duff Farm 21.5 Stonebreaker Hut 29.5 Eyreton Corner 1.1 Ballacraine 7.7 14th Mile Mark 14 Glen Tramman 21.8 SECTOR 10 Mile Quarter Bridge 1.3 Ballaspur 7.9 D’glas Rd Corner 14.3 22nd Mile Mark 22 Verandah 29.7 Port-e-Chee Fld 1.4 Ballig 8 Kirk Michael C’ner 14.3 Churchtown 22 30th Mile Mark 30 Jubilee Oak 1.7 8th Mile Mark 8 Kirk Michael 14.5 Ballakillingan Fm 22 Bob McIntyre’s 30.2 1.7 Ballig Bridge 8.2 Mitre Hotel 14.6 Conker Fields 22 Bungalow Bdge 30.4 Braddan Church 1.8 Doran's Bend 8.3 Slieau Cern 14.7 Sky Hill 22 Graham Mem. 30.4 2nd Mile Mark 2 SECTOR 4 Mile Whitehouse Pk 14.8 Church 22.2 Bungalow 30.8 Parkinson's Yd 2.1 Beary Bridge 8.4 Faaie ny Cabbal 14.8 The K 22.3 Tholt-y-Will Junc 30.8 Transmann 2.2 Ebenezer Lane 8.6 White House Cott 14.9 The Caravan 22.5 31st Mile Mark 31 Rural Industries 2.3 Laurel Bank 1 8.6 Cooper's Close 14.9 The Bttm Sky Hill 22.7 Hailwood's Rise 31.3 Ashlar Drive 2.4 Pump House 8.7 The Old Vicarage 14.9 Pinfold Cottage 22.8 Hailwood's Hts 31.5 Snugborough 2.5 Laurel Bank Cott. 8.7 Penny Bridge 14.9 Milntown 22.8 Brandywell 31.6 Union Mills 2.6 Laurel Bank 2 8.8 15th Mile Mark 15 Ramsey 22.9 32nd Mile Mark 32 Railway Inn 2.6 9th Mile Mark 9 Birkin's Bends 15.3 Glen Auldyn Bdge 23 32nd Milestone 32 Lhergy Cripperty 2.6 Glen Mooar Mills 9.1 Rhencullen 15.3 Gardener's Ln. 23.1 Duke's 32 Strang Road 2.7 Glen Mooar Garage 9.1 Orrisdale South 15.2 23rd Mile Mark 23.2 SECTOR 11 Mile Union Mills Grge 2.8 Black Dub 9.2 Cloudy Lane 15.4 Schoolhouse 23.5 Windy Corner 32.5 Union Mills Chch 2.8 Glen Mooar 9.2 Lyndhurst Junc 15.6 Crossag's Lane 23.5 33rd Mile Mark 33 Trollaby Lane 2.9 The Vaaish Mooar 9.3 Bishopscourt 15.8 Parliament Sq 23.8 33rd Milestone 33 3rd Mile Mark 3 Glen Helen 1 9.4 16th Mile Mark 16 Raymotors 23.9 Keppel Gate 33.7 SECTOR 2 Mile Glen Helen 2 9.8 Orrisdale North 16 Albert Rd junc. 23.9 Kate's Cottage 34 White Lady's Fm 3 Glen Helen Hotel 9.8 Dub Cottage 16.3 Albert Terrace 23.9 34th Mile Mark 34 Ballahutchin 3 Sarah's Cottage 9.9 Iceman's Cott 16.4 Queen's Pier Rd 23.9 Creg-ny-Baa 34.5 Ballafreer 3.3 Saltbin 10 Alpine Cottage 16.5 Bus Station 24 Lanjaghan Ln 34.7 Ballahutchin Hs 3.3 Creg Willy's Hill 10 Ballacurn 16.7 Coronation Pk 24 SECTOR 12 Mile Elm Bank 3.3 10th Mile Mark 10 SECTOR 7 Mile Cruickshank's 24 Sunny Orchard 35 Glen Lough 3.5 Lambfell Mooar 10.2 Ballacobb 16.9 May Hill 24.1 Gob-ny-Geay Fm 35 3.7 Cronk-y-Voddy Strt 10.6 Picasso 16.9 White Gates 24.2 Brandish 35.4 Ballagarey 3.8 Cronk-y-Voddy X Rd 10.8 17th Mile Mark 17 24th Mile Mark 24.3 Slegaby Lane 36 4th Mile Mark 4 Sartfell Crossroads 10.8 Ballaugh Bridge 17.2 Stella Maris 24.4 Hillberry 36 Glen Darragh Rd 4.1 SECTOR 5 Mile Gwen's 17.5 Ramsey Hairpin 24.5 36th Mile Marker 36 Marown Church 4.2 Cronk-y-Voddy Flag 11 Coan Buigh 17.5 SECTOR 9 Mile Glendhoo Camp 36.1 Twisted Chimneys 4.3 Molyneux's 11 Ballacrye Bend 17.7 Waterworks 1 24.8 Cronk-ny-Mona 36.4 Crosby 4.4 11th Mile Mark 11 Ballacrye Jump 17.9 Waterworks 2 24.9 Signpost C’ner 36.6 Crosby Chch Hall 4.6 Burnside 11 Ballavolley Bends 18 Tower Bends 25 Bedstead 36.8 Crosby X Road 4.7 Stockade 11 18th Mile Mark 18 Albert Tower 25 The Nook 37 Crosby Hotel 4.8 Drinkwater's Bend 11.5 Wildlife Park 18.4 25th Mile Mark 25 Governor's Bdge 37.2 5th Mile Mark 5 Ballig Cottage 11.7 Gob-y–Volley 18.5 Tit Corner 25.4 Governor's Dip 37.3 Wagon & Horses 5.2 Mac's Cottage 11.8 Quarry Bends 18.6 Gooseneck 25.5 The Highlander 5.5 Handley's 11.9 Cooil Bane 18.6 Centenary Bnd 25.7 Greeba Veranda 5.7 Ballameanagh Cott 12 19th Mile Mark 19 26th Mile Mark 26 Fern Bank 5.7 12th Mile Mark 12 Sulby 19.1 Joey's 26 Pear Tree Cott. 5.9 Shoughlaige Farm 12 Sulby Crossroads 19.3 Guthrie's Memor’l 26.7

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Appendix 2: TT Course locations – Alphabetical

LOCATION Mile LOCATION Mile LOCATION Mile LOCATION Mile LOCATION Mile Cammall Farm 13.2 Glen Mooar Mills 9.1 Mountain Box 28.7 The Bttm Sky Hill 22.7 Ago's Leap 0.7 Centenary Bnds 25.7 Glen Tramman 21.8 Mountain Mile 27.1 The Caravan 22.5 Albert Road 23.9 Churchtown 22 Glen Vine 3.7 M’ntain Mile App 27 The Highlander 5.5 Albert Terrace 23.9 Cloudy Lane 15.4 Glencrutchery Rd 0 M’ntain Mile Lby 28 The K 22.3 Albert Tower 25 Coan Buigh 17.5 Glendhoo 36.1 Noble's Park 0.1 The Nook 37 Alexander Drive 1.1 Conker Fields 22 Gob-ny-Geay Fm 35 Orrisdale Nth 16 The Old Vic’age 14.9 Alpine Cottage 16.5 Cooil Bane 18.6 Gob-y–Volley 18.5 Orrisdale Sth 15.2 The Vaaish Mooar 9.3 Appledene 6.2 Cooper's Close 14.9 Gooseneck 25.5 Parkinson's Yd 2.1 Tholt-y-Will Junc 30.8 Ashlar Drive 2.4 Coronation Pk 24 Gorse Lea C’ner 7.1 Parliament Sq 23.8 Tit Corner 25.4 Ballacobb 16.9 Creg Willy's Hill 10 Gorse Lea Hse 7.3 Pear Tree Cott 5.9 Top B’garrow 12.7 Ballacraine 7.7 Creg-ny-Baa 34.5 Governor's Bdge 37.2 Penny Bridge 14.9 Top of Bray Hill 0.4 Ballacrye Bend 17.7 Cronk Dhoo Fm 6.5 Governor's Dip 37.3 Picasso 16.9 Tower Bends 25 Ballacrye Jump 17.9 Cronk Urleigh 13.6 Graham Mem’l 30.4 Pinfold Cott 22.8 Transmann 2.2 Ballacurn 16.7 Cronk-ny-Mona 36.4 Greeba Bridge 6.7 Port-e-Chee Ave 0.6 Trollaby Lane 2.9 Ballafreer 3.3 Cronk-y-Voddy X Rd 10.8 Greeba Castle 5.9 Port-e-Chee md 1.4 Twisted Ch’neys 4.3 Ballagarey 3.8 Cronk-y-Voddy Flag 11 Greeba V’nda 5.7 Pump House 8.7 Union Mills 2.6 Ballagarraghyn Bdge 7.4 Cronk-y-Voddy Strt 10.6 Guthrie's Mem’l 26.7 Quarry Bends 18.6 Union Mills Chch 2.8 Ballagarraghyn Fm 7.5 Cronkbreck Fm 6.9 Gwen's 17.5 Quarter Bridge 1.3 Union Mills Gar 2.8 Ballahutchin 3 Crosby 4.4 Hailwood's Hts 31.5 Queen's Pier Rd 23.9 Verandah 29.7 Ballahutchin Hse 3.3 Crosby Chch Hall 4.6 Hailwood Rise 31.3 Railway Inn 2.6 Wagon& Horses 5.2 Ballakillingan Fm 22 Crosby Cross Rd 4.7 Hall Caine's 5.9 Ramsey 22.9 Waterworks 1 24.8 Ballalonna Bdge 13.8 Crosby Hotel 4.8 Handley's 11.9 Ramsey H’pin 24.5 Waterworks 2 24.9 Ballameanagh Cott 12 Crossag's Lane 23.5 Hillberry 36 Raymotors 23.9 Westwood 13.7 Ballaskyr Farm 12.5 Cruickshank's 24 Iceman's Cott 16.4 Rhencullen 15.3 White Gates 24.2 Ballaspur 7.9 Dept. Transport 21.4 Inner Circle 0.5 Rice's Corner 29.3 White House 14.9 Ballaugh Bdge 17.2 Doran's Bend 8.3 Joey's 26 Rural Industries 2.3 White Lady's Fm 3 Ballavolley Bends 18 Douglas Rd C’ner 14.3 Jubilee Oak 1.7 Saltbin 10 Whitehouse Pk 14.8 Ballig 8 Drinkwater's 11.5 Kate's Cottage 34 Sarah's Cott 9.9 Wildlife Park 18.4 Ballig Bridge 8.2 Dub Cottage 16.3 Keppel Gate 33.7 Sartfell X Rd 10.8 Windy Corner 32.5 Ballig Cottage 11.7 Duke's 32 Kerrowmoar 1 20.6 Schoolhouse 23.5 Woodlands 1.1 Barregarrow X Rd 12.7 Duke's Avenue 37.4 Kerrowmoar 2 20.7 Selborne Dr 0.9 Barregarrow Hill 12.8 E M’ntain Gate 28.7 Kerrowmoar 3 20.8 Shoughlaige 12.1 Beary Bridge 8.4 E Snaefell Gate 28.7 Kirk Michael 14.5 Shoughlaige Fm 12 Bedstead 36.8 Ebenezer Lane 8.6 Kirk Michael C’ner 14.3 Signpost C’ner 36.6 Bernaharra Road 21.3 Elm Bank 3.3 Knock Breck 7 Sky Hill 22 Birkin's Bends 15.3 Eyreton Corner 1.1 Lambfell Mooar 10.2 Slegaby Lane 36 Bishopscourt 15.8 Faaie ny Cabbal 14.8 Lanjaghan Lane 34.7 Slieau Cern 14.7 Black Dub 9.2 Fern Bank 5.7 Laurel Bank 1 8.6 Snugborough 2.5 Black Hut 29.5 Gardener's Ln 23.1 Laurel Bank 2 8.8 St Andrew's Chch 0.2 Bob McIntyre Mem Box 30.2 George's Folly 29.3 Laurel Bank Cott 8.7 St Ninian's 0.3 Bttm of Barregarrow 13.1 Ginger Hall 20.3 Lezayre Church 22.2 Start Finish Line 0 Braddan Bridge 1.7 Glen Auldyn 23 Lhergy Cripperty 2.6 Stella Maris 24.4 Braddan Church 1.8 Glen Darragh Rd 4.1 Lyndhurst Junc 15.6 Stockade 11 Brake Leg 13.9 Glen Duff 21.3 Mac's Cottage 11.8 Stonebreaker's 29.5 Brandish 35.4 Glen Duff Farm 21.5 Marown Church 4.2 Strang Road 2.7 Brandywell 31.6 Glen Helen 1 9.4 May Hill 24.1 Sulby 19.1 Bray Hill Bottom 0.7 Glen Helen 2 9.8 McGuinness's 12.1 Sulby Bridge 20 Bungalow 30.8 Glen Helen Htel 9.8 Mike Casey’s Sh 29.3 Sulby Cross rd 19.3 Bungalow Bridge 30.4 Glen Lough 3.5 Milntown 22.8 Sulby Glen Htel 19.3 Burnside 11 Glen Mooar 9.2 Mitre Hotel 14.6 Sulby Straight 19.4 Bus Station 24 Glen Mooar Gar 9.1 Molyneux's 11 Sunny Orch’d 35

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Appendix 3: Trackside Medics SOP

Trackside Medical Officer – Role & Responsibilities

Distribution MRMS medics TTMA Chair TTMA Sector and Deputy sector Marshalls Related Documents Date of Review 1/2/18

1. Aim:

1.1. Provide clear instructions to medical staff arriving at their location. 1.2. Promote integration between the medical team and the marshal team on location. 1.3. Promote medic’s and marshal’s exposure to the contents of the orange first responder boxes. 1.4. Promote moulaging / exercising prior to each practice / race session.

2. Principles:

2.1. Trackside medics: 2.1.1. Have been through the signing on process for each event and collected reflective tabard. 2.1.2. Have the necessary skill set, qualifications and registration for taking on the motorsport medic role. 2.2. Marshals on scene will have action cards that are congruous with those given to medical team.

3. Role & Responsibilities:

3.1. To ensure safe and effective care of fallen riders, marshals, & members of the public at their location. 3.2. To ensure the medical equipment on station is fit for purpose and in date where appropriate. 3.3. To communicate deficiencies to the Chief Medical Officer in the control tower 3.4. To ensure they are wearing a reflective MRMS tabard and wearing appropriate clothing for the role. 3.5. As an aid memoir each location will be equipped with an action card (see appendix 1) inside the orange first responder box.

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Action Card For Trackside Medics

1. On arrival:

a. Let the CMO in control know you have arrived on scene by texting 07624 420085, or phoning 01624 644607. In the event you cannot get a mobile phone signal, speak to the DSM who will inform Race Control via the Tetra Radio system. b. Put on reflective tabard c. Introduce yourself to the marshals on location d. Familiarise which marshals are allocated to: i. Radio duties ii. Casualty care (including scoop, head rest allocation) iii. Bike recovery iv. Flagging e. Agree with Marshalls likely Places of Safety* for casualty assessment and treatment in the event of an incident. f. Break seal on orange box: i. Ensure contents is complete and in date. ii. Offer to run through any equipment in it with marshalls iii. Organise and lead a brief moulage around: iv. Casualty handling and placement on scoop. v. Helmet removal

2. In the event of an incident:

a. Affirm radio marshal has pressed red button b. Ensure flags have been deployed c. For riders that don’t immediately get up, quickly assess whether their location will allow them to be rapidly placed on a scoop and moved to one of your chosen places of safety, or will require treatment elsewhere. If the latter take orange case to patient. d. Assess patient and ask radio operator to give a “windscreen condition code”: i. Alpha –(unconscious/incomprehensible words/confused). ii. Bravo (conscious, able to speak with obvious injuries). iii. Charlie (up and walking). iv. Obvious need for Airmed. e. For all Airmed patients establish IV access when in Place of Safety.

3. Post Incident:

a. Ensure kit is replenished ASAP b. Undertake hot debrief **

* Place of Safety is an area where a casualty can be rapidly moved (< 1 minute) for helmet removal, assessment and treatment. It should be an area off the course, protect the patient, marshalls and medical staff and give 360 degrees of access to the patient. For eample; a side road, a drive way, a garden, a field.

** Allow all involved to describe what they did. Establish any learning points. Reinforce good practice.

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Appendix 4: TT Course incidents by location 1993-2014

LOCATION No. LOCATION No. Governor's Bridge 150 26th/Joeys 16 Mayhill 84 Quarry Bends 15 Waterworks 70 Whitegates 15 Quarterbridge 69 Alpine Cottage 12 Braddan 63 Glentramman 12 Sarah's Cottage 62 Pinfold/Milntown 12 Sulby Bridge 60 Black Hut 12 Creg-ny-Baa 60 Ballagarey 11 Gooseneck 48 Birkins/Rhencullen 11 Bungalow 46 32nd Milestone 11 Windy Corner 44 Ginger Hall 10 Keppel Gate 44 Verandah 10 The Nook 37 Coan Buigh 9 Uninon Mills 36 Hilberry 9 Laurel Bank 35 School House C’ner 8 Ballacraine 33 Top of Barregarrow 7 Glen Helen 32 Tower Bends 7 Parliament Square 31 Crosby Crossroads 6 Ramsey Hairpin 31 Lambfell 6 Brandywell 28 B’ttm Barregarrow 6 Start Line and Pits 27 Alexander Drive 5 Kerrowmoar 27 Gorse Leigh 5 Black Dub 26 Handleys 5 Greeba Castle 25 Casey's 5 Bray Hill 23 Appledene 3 Bedstead 23 13th Milestone 3 27th Milestone 22 Sulby X Rd/Straight 3 Guthries 20 Ballig Bridge 2 Mountain Box 20 Bishop's Court 2 Brandish 20 Ballacob 2 Signpost 20 Mountain Mile 2 Ballaugh Bridge 19 Cronk-ny-Mona 2 Greeba Bridge 17 Doran's Bends 1 Douglas Rd Corner 17 Glen Duff 1 Graham Memorial 17 Stella Maris 1 Ballaspur 16 TOTAL 1687 The figures above give the frequency of incidents at various locations around the course, but that does not always tell the whole story. For instance, the most common place for incidents to occur, by a long way, is Governor’s Bridge. However, the majority of incidents there are low speed, and the risk of significant injury is small.