INTERNATIONAL JOURNAL OF MOTOR SPORT MEDICINE ISSUE#20, AUGUST 2020

MARIO ISOLA Pirelli's F1 boss discusses the safety aspects of the new 18-inch tyres P20 HYDRATION A look at the importance of hydration in motor sport P26 JEHAN DARUVALA The F2 racer talks about a serious knee injury he sustained last year P34

THE FRONT LINE How key doctors at the front lines of racing are ensuring the safety of personnel at the track during the Coronavirus pandemic. AUTO+MEDICAL AUTO+MEDICAL

VIEW FROM THE GROUND/ INTRODUCTION/

P8 Dr Erik Beuls and Chris Dupont focus on Since our last edition the world has changed AUTO+ MEDICAL the medical operations at Circuit Zolder. significantly and motor sport has taken a back seat EDITORIAL BOARD while everyone, including the FIA and all the FEATURES/ medical fraternity, have focussed on the pandemic. CONTENTS But as racing returns, our cover story looks at how P12 THE FRONT LINE the FIA has introduced testing and special arrange- We speak to some of the key doctors on ments to ensure those involved in Formula One and the front lines of racing as they ensure the other championships can remain as safe as possible safety of personnel at the track during the from COVID-19. We also look at some of you who Coronavirus pandemic. are normally involved in providing medical care at Dr Paul Trafford Dr Robert Seal (Chairman) (Medical Director, motor sport events, what you have been doing, how P22 BIG INTERVIEW Canadian Motorsports it’s affected you and how you are getting motor Response Team) Pirelli F1 boss Mario Isola talks about the safety considerations of the new 18-inch sport back up and running. tyres and life as a volunteer ambulance The FIA has worked in partnership with the driver in his home country of Italy. International Federation of Red Cross and Red GLOBAL NEWS/ P28 WATER WORKS Crescent Societies, donating via an auction of Examining the importance of hydration in motorsport memorabilia over $2million as well as P4 FIA to investigate wide-ranging motor sport motor sport. supplying National Sporting Authorities with vital safety improvements P34 INSIDE THE: ZANDVOORT MEDICAL CENTER personal protective equipment (PPE). The way we all Dr Matthew Dr Pedro Esteban P5 Tom Weisenbach Named Executive A look inside the medical centre at work has changed, with PPE and electronic briefings Mac Partlin (Deputy (FIA Medical Delegate, Chief Medical Officer, World Rallycross Director for ICMS Zandvoort which was newly built for F1's and online meetings being the new “normal”. Australian GP & World Championship) P5 Leclerc volunteers with Monaco Red Cross return next year. Indeed, many planned medical meetings have been Rally Championship) P5 FIA appoints new Senior Research Engineer P38 THE ROAD BACK: JEHAN DARUVALA converted to online and this is likely to be the way P6 Coloured rain light system to be tested The Carlin F2 driver talks about a serious forward for most conferences for the rest of 2020. P6 Norris suffers from back pain from time knee injury he sustained towards the end Zolder, a circuit loved by many, near to the beach out of F1 car of last years season. in Holland with a direct rail link to Amsterdam is P6 Double Halo structure developed by the focus of our view from the grass roots interview Revolution Cars SCIENTIFIC ARTICLE/ with the Chief Medical Officer and Chief Nurse who P7 FIA raises €2m for global COVID-19 response explain how they work and train. Dr Jean Duby Dr Pau Mota fund with Red Cross (Medical Trainer, (FIA Head of Medical P42 CRASH INJURY RISK AND CHARACTERISTICS There is also a look inside the medical facilities FIA World Cup for and Rescue) P7 WRC Returns in September Under Revised FOR MOTOR SPORT DRIVERS at Zandvoort, and an interview with Pirelli F1 chief Cross-Country Rallies) Calendar A look at the differences in crash Mario Isola who unbeknown to many volunteers as P7 First biometric fire-proof underwear chracteristics in motor sport compared to a part-time ambulance driver in Italy. created road cars using NASCAR as an example Stay safe.

Editor: Marc Cutler The Editorial Board Deputy Editor: Rory Mitchell Dr Dino Altmann Designer: Cara Mills (Deputy President, FIA Medical Commission) We welcome your feedback: [email protected]

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TOM WEISENBACH NAMED initiatives in motor sport FIA APPOINTS safety, but that we EXECUTIVE DIRECTOR FOR ICMS continue to grow and NEW SENIOR disseminate our RESEARCH knowledge more widely.” ENGINEER the Motorsports Safety In addition to GLOBAL Education Foundation Weisenbach’s appointment where he worked with the ICMS headquarters will sanctioning bodies, race move to Indianapolis, Corrado Casiraghi, former tracks, and drivers on whilst the 2020 annual Technical Director of Tatuus safety education. conference set to take Racing, has been appointed “I am extremely excited place in December this year to the FIA Safety Department NEWS for my new position with will now to be hosted as a Senior Research the ICMS,” said virtually due to the Engineer. Weisenbach. Covid-19 pandemic. After studying for his Dr Rob Seal, chairman “After much master’s degree in aerospace of the ICMS said that the consideration, in view of engineering from Politecnico Veteran motor sport appointment of the global uncertainty di Milano university, Casiraghi executive Tom Weisenbach Weisenbach will enable created by the COVID-19 became aerodynamic has been named executive the ICMS to stay at the pandemic, the Board of designer for Tatuus Racing in director for the forefront of innovation Directors of the ICMS has 2000 before taking up the International Council of and initiatives in motor made the decision to host role as Technical Director in Motorsport Sciences. sport safety. its 2020 Annual Congress 2012. Weisenbach has over 23 “The ICMS is looking virtually,” said Seal. “It is The Italian chassis maker years of experience in forward to working with hoped that this format for provides cars for a number of motor sport including Tom as we build on our the 2020 meeting will single-make championships working with the NHRA, strengths," said Seal. permit the ICMS to reach including regional Formula 4, Indianapolis Motor “Not only to ensure that a broader international Formula Renault, and the W Speedway, IndyCar and we remain vibrant and at audience and to include Series. These are all crucial Keystone Marketing. In the forefront of a wider variety of stepping-stones for young 2013, Weisenbach launched innovations and presenters.” drivers looking to climb the ladder in motor sport. Casiraghi oversaw the development of numerous chassis used in these LECLERC VOLUNTEERS WITH championships, including the Tatuus FT50 used in the FIA INVESTIGATING WIDE-RANGING SAFETY IMPROVEMENTS MONACO RED CROSS Toyota Racing Series which featured innovations such as an electro-actuated gearbox. The FIA is investigating a number of they do,” said FIA Safety Director, Adam This work will also consider whether While racing was put on hold at the height “In this moment of emergency even the He was also involved in the safety-improvement across circuit Baker. future generations of single-seater of the Coronavirus pandemic, Ferrari F1 tiniest action can lead to an enormous design of the USF-17 and the racing, including the use of ‘deceleration’ The FIA Serious Accident Study Group, cars could incorporate front wing driver Charles Leclerc found time to result,” said Leclerc on his social media PM-18 which are all used in solutions in run-off areas, a review of led by President Jean Todt, approved a designs that include ‘controlled failure’ volunteer for the Monaco Red Cross. channels. “Let’s join together and continue junior categories for IndyCar’s front wing designs, improved debris number of solutions including measures points. For example, the front wing Leclerc delivered meals to elderly people fighting this challenge with courage. Help USF-2000 and Indy Pro 2000 containment and early warning that will prevent or mitigate debris from main plane could be frangible such who had to shield in their homes, helped me support those who never give up.” ‘Road to Indy’ series. systems. being ejected from single-seater cars tha, in the event that the outer transport equipment to the Princess Grace As with all FIA safety projects, this during an accident. sections of the wing receive an impact, Hospital Centre, and distributed meals to work incorporates the findings of Technical solutions will be developed only these sections would detach, in Red Cross volunteers. accident investigations, this time which aim to ensure large debris is order to relieve the load on the He as joined by footballers Cristiano including the 28 serious and fatal contained and/or restrained with the assembly and specifically nose Ronaldo and Paolo Maldini in supporting accidents that occurred in 2019. crashing vehicle. This includes the mounting. the Red Cross, with Leclerc also assisting “Our findings related to circuit racing development of tethering systems – In addition, efficient deceleration Princess Charlene of Monaco’s form the basis of a range of technical similar to wheel tethers on many single solutions for slowing out-of-control #BehindTheMask initiative to raise money and operational initiatives, both to seater cars – for larger components of cars within run-off areas are being for the World Health Organization’s prevent serious accidents occurring body work and less intrusive and more looked at, including the use of anti-skid Covid-19 response fund. and to mitigate the consequences if novel design solutions for small parts. paint and high-friction surfaces.

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NORRIS SUFFERS between the back-to-back events FIA RAISES €2M FOR GLOBAL FIRST BIOMETRIC COLOURED RAIN BACK PAIN FROM at the Red Bull Ring, Norris flew FIRE-PROOF TIME OUT OF CAR back to the UK to get a diagnosis COVID-19 RESPONSE UNDERWEAR LIGHT SYSTEM from specialists. “It’s just bruising from being out CREATED TO BE TESTED of the F1 car for so long, and then The FIA teamed up with the International auction to benefit the IFRC’s global COVID-19 getting back into it and straight Federation of Red Cross and Red Crescent response” said FIA President Jean Todt. The first fire-retardant back into a race weekend, doing so Societies (IFRC) to raise money for The FIA’s partnership with the IFRC undershirt equipped with The FIA will test a coloured rain many laps and so on,” said Norris. COVID-19 relief as part of their long- involves a number of joint initiatives to biometric sensors has been light system which will display flag “It wasn’t something I could really standing partnership. raise awareness on the importance of first homologated by the FIA, conditions on-track, as part of its prepare for or know about until The charity auction was held on 15-22 aid knowledge through the FIA worldwide enabling real-time recommendations for increased after we did the first weekend.” June with RM Sothebys, involving Formula network of clubs. monitoring of a driver’s driver safety. Norris said that he changed his One and other motor sport drivers under As part of this, the IFRC has delivered state of health. The system will utilize existing seating and steering wheel the banner #RaceAgainstCovid. first aid training to Cross Country The undershirt rain lights which are mandatory positions after the first Austrian The auction consisted of 95 motor sport competitors in Qatar, enabling them to developed by Marelli and on the rear end of all cars involved McLaren driver Lando Norris Grand Prix weekend, due to the memorabilia items, including a McLaren provide immediate assistance in remote OMP uses a Vital Signs in circuit racing, to display the revealed he suffered from back pain change in his body shape that MP4-24 Show Car which was sold for locations during events prior to the arrival Monitor (VISM) to monitor a current track flag conditions and on F1’s return at Austria, which was occurred while he was out of the £66,000, Damon Hill’s 1995 F1 racing suit of emergency services. driver’s physical health improve driver visibility of flags triggered by his time out of an F1 car. car and the UK was on lockdown. and helmet which was auctioned for including stress, fatigue, being shown by race control. Norris suffered from pain and “Having put on so much muscle £39,600, and an Eau Rouge sculpture by and alteration, through the This means if there is a yellow bruising in his back and chest over over the break, I was just a bit out,” Paul Oz which achieved a sale of £48,000. use of an electrocardiogram flag in a sector of the track then the course of the weekend. added Norris. “I was slightly Altogether the auction raised €944,392 and thoracic expansion. the rain lights would turn yellow, He eventually had to take shaped differently in my seat, so I which was added to the €1,000,000 OMP made the fire- with the FIA also proposing that painkillers to get through the second had to change a few pads around already donated by the FIA Foundation, resistant garments while the rain light could be used as race at Austria and in the days and a bit of my position.” which will go towards fighting the Marelli developed the extra warning for a driver COVID-19 pandemic. electronics, data acquisition approaching a yellow flag zone. “I am delighted to give a cheque for and telemetry techniques. “Although further testing and almost €2 million raised by the charity DOUBLE-HALO STRUCTURE The solution used by research is required, this Marelli complies with the adaptation of the rain light usage DEVELOPED BY REVOLUTION CARS FIA guidelines on the usage could reduce driver notification of biometric data, which time, improve the reliability of Revolution Cars has developed a WRC RESTARTS IN SEPTEMBER ensures a competitor’s driver notification and better version of the Halo cockpit safety privacy. allow drivers to make an device for use on two-seater sports UNDER REVISED CALENDAR “We believe this is a appropriate and proportionate prototype cars, calling it the major step forward in the reaction in the case of yellow flag ‘Double-Halo’. three that have already taken place in development of motorsport deployment,” said the FIA in a The new double-halo design is Monte-Carlo, Sweden and Mexico safety systems and active statement. designed to protect both the driver earlier in the year. driver aids for passenger Proposals for this system come and the co-driver and was Each event will be working under cars too,” said Riccardo after 28 accidents related to manufactured using an energy- the guidance outlined by the FIA De Filippi, Senior Vice circuit racing were approved by efficient infusion process. COVID-19 Code of Conduct, with each President and CEO of the FIA Serious Accident Study It utilizes FIA-approved ROPT510 promoter working hard to ensure Marelli Motorsport. Group, which is led by FIA roll cage which provides similar “By introducing the ‘double-halo’ there are mitigation plans around President Jean Todt. levels of safety as a closed cockpit of we are giving drivers and their The World Rally Championship will COVID-19 testing. a Le Mans prototype. instructors or corporate guests the restart in September under a revised "WRC Promoter has worked It will be fitted to the company’s same level of safety they would calendar, after the first part of the tirelessly with the FIA, our competitors, A-One sports prototype car and expect in a world championship type 2020 season was affected by teams and event organisers, in replaces the forward longitudinal race car,” added Abbott. Coronavirus in March. exceptional circumstances, to revise bars on the current FIA approved roll The device was also tested with The revised calendar will start from the calendar,” said WRC Promoter’s cages, weighing just an extra 2kg. several top drivers including Sir Chris September with Rally Estonia, a senior director events, Simon Larkin. “We designed the A-One to give Hoy, who regularly races LMP2 cars newcomer to the calendar, set to be “Our combined determination more elbow room than other at Le Mans. one of five events that the FIA and enables the WRC to restart at an prototype racing cars, making it easy “The double-halo gives a real WRC Promoter plan to run. appropriate time and we’re confident to operate both solo and with a sense of security and still has great This means there will be altogether of delivering a season worthy of world passenger aboard,” said Phil Abbott, visibility,” said Hoy. “I didn’t even eight rounds in 2020 including the championship status.” Revolution Cars managing director. notice it once up to speed.”

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VIEW FROM THE GROUND: The latest column from the frontlines of grassroots motor sport focuses on the that there are little to no limits to Chris’ medical operations at Circuit Zolder. Chief Medical Officer Dr Erik Beuls and creativity when it comes to inventing new training scenarios. Surprises will happen, fake Chief Nurse Chris Dupont discuss the differences between paramedics and blood will flow, and sometimes even doctors in Belgium, and the rigorous training they give their medical team. pyrotechnics will be used!

In my opinion the nurse and the doctor in DR ERIK BEULS the team are complementary and Photo credits: synergistic: what they can do as a team is Circuit Zolder CHIEF MEDICAL OFFICER, CIRCUIT ZOLDER much more than the sum of what both of Medical Team them can do as individuals. They both I have always Nürburgring for the Historic Grand Prix, at contribute their own specific skills, knowledge had a special Ypres for the ERC rally, for some local rallies. and experience to the team and each of them interest in motorsport, Together with our extrication team I have also brings what the other one is lacking. Chris and so when I graduated been to Assen and Zandvoort in the I have been working together in motorsport as a medical doctor in Netherlands to help them train their medicine for more than a decade now and 1994 I contacted the extrication teams. over time we have become so responsive to Chief Medical Officer each other that there’s often very little at my local racetrack I have got about 15 medical doctors in my communication going on during a medical in Zolder and asked team at Zolder, most of them are regulars intervention: we both know what needs to be him if I could join the medical team. And 25 who have been on the team for a long time. done, know who’s going to do it and know years later I’m still there, enjoying myself as Apart from the medical team at Circuit Zolder what the other one is going to do. much as during my first race weekend. In there are quite a few doctors involved in 2010 I was asked by our CMO if I would be motorsport medicine elsewhere in Belgium, I would like to see more cooperation interested in taking charge of the medical for example at Spa or at the local rallies. between the different motorsport medical team and become the new Chief Medical Regrettably, there is (for the moment) not a lot teams across Belgium. It’s a tiny country but huge amount of work involved, mostly going Officer for Circuit Zolder. I put forward a of cooperation between the different teams, even both Zolder and Spa Francorchamps on behind the scenes and relying upon large couple of conditions such as having Chris something I would like to try and change in the each have their own medical teams numbers of volunteers passionate about as my Chief Nurse and assistant at the future. functioning completely independent from motorsport. These people usually do not get racetrack. each other. There are big advantages to be the recognition and appreciation they The Covid-19 pandemic has confronted us as found in working together and sharing deserve, and I’m not talking about just the Most of the motorsport work that I have medical professionals with some new and knowledge, experience and skills. medical teams. When I tell people that I’m a done has been at my “home” racetrack in unforeseen problems we will need to tackle. motorsport doctor they often think that I’m Zolder, but I have also had the opportunity to Over the last couple of years, we have been The biggest thing I have learned working in doing heroic stuff day in day out, when do some motorsport medicine related things making plans for a new medical center at motor sport is that when you look at the mostly it’s sitting in a car by the side of the elsewhere. I have been part of the medical Zolder and at the moment we are very close to world of high-level motorsport from the racetrack in the pouring rain or blazing sun team at Spa Francorchamps for the F1 getting approval so we can finally start outside it all looks very glamorous, for eight hours straight with nothing at all weekend, at Lydden Hill for the World building. A lot of effort goes into training and professional and well organized. But when happening! But I still love my job and Rallycross Championship, at the retraining our medical team, and I can confirm you’re on the inside you realize that there’s a wouldn’t trade it for anything.

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CHRIS DUPONT CHIEF NURSE, CIRCUIT ZOLDER MEDICAL TEAM doctors have specific medical knowledge and from the last year using the internal CCTV skills that we nurses don’t have. That’s why a footage from the start of the crash until the combination of a doctor and nurse/paramedic end of the medical intervention. First, we let I started responsible for the coordination of is the way to go in mine opinion. This is the them watch the crash and let them think working in interventions, contact with the local Emergency reason why for many years we work with a how they think they would approach the motor sport in 2005, Medical Services (EMS), training our team, the team consisting of an experienced driver, incident, followed by the actual footage of when I just graduated medical equipment, disaster preparedness doctor and nurse in our medical cars, the the medical intervention. After this we as a nurse, as and management. As medical team we do not same way our prehospital advanced trauma & discuss what went well and what we can do member of a local only cover the race events, but almost every critical care teams work, apart from the driver, better. For the practical part of the training medical team for event or training session for cars and during daily EMS calls. we exercise in the use of for example the rallies and member motorcycles. Apart from that we also organize vacuum matrass, rapid sequence of the extrication education and training sessions for our We don’t split it in training for doctors or intubation, failed airway management, team at Spa Francorchamps. That same medical team on a regular basis. I have quite a nurses/paramedics, EMT’s or extrication traumatic arrest, the approach and briefing year I joined the medical team from the vivid imagination when it comes to creating team. Two times a year we organize an entire of a victim in our medical center and racetrack at Circuit Zolder. In the following incident and accident training scenarios, which day of training about motor sport medicine, extrication training. We also use extensive years my engagement at the Zolder means every so often the team can get a call which is always a combination of some and realistic scenario training, where we racetrack and the work increased so much from race control during an event to respond theoretical parts and practical training. For this simulate a crash on the race track and the that I had the opportunity to work on a to a crash, but it turns out to be one of my we analyze the accidents and interventions crew need to do the whole intervention on freelance basis as a nurse/paramedic in unexpected exercises! They like it, they learn the scene, transport the victim(s) to the motor sports. from it, and they ask for more of the same. medical center and stabilize them in the That’s the great spirit of our entire medical I WOULD LIKE TO SEE resuscitation unit until transport to the I have previously worked at the circuits of team, they are always eager to learn and “MORE RECOGNITION FOR emergency department of a local (trauma) Zolder, Spa Francorchamps, Lydden Hill get better. MEDICAL TEAMS INVOVLED hospital is possible. and the karting circuit at Genk. This for IN MOTOR SPORT local races and karting, F1, F2, FIA GT1, FIA In Belgium we officially don’t have I would like to see more recognition for WTCC, FIA Truck racing, DTM, Euro NASCAR, paramedics, we have EMT’s or nurses. The ” the medical teams involved in motor local motorcycle races, IDM Superbike, and nurses who work at the EMS ambulances need sport. Not only in Belgium, but around the FIM Endurance. Besides the work at the to do EMT training or have a special degree in world. As with every event in motor sport, racetrack I also did some local rallies, the emergency medicine and intensive care. This music festival etc. around the world the FIA World rallycross, ERC Ypres rally and last group can be compared to paramedics. I’m medical aid is seen as a need to have, but the East African Safari Classic rally through certified as both a critical care and flight also as something that costs money. I Kenya and Tanzania. paramedic, so I know both sides of that field of would like to see more cooperation work. The difference between our work as a between all the medical motor sport teams, At this point I’m the chief nurse of our nurse/paramedic from a doctor is that we are there is so much knowledge scattered medical team at Zolder. It means that I’m more practical, we have more overview of the between the teams of the different race responsible for the planning for the nurses scene, we are used to work outside a hospital tracks when sharing this knowledge could and Emergency Medical Technician’s (EMT) with minimal equipment, we are good in benefit every team. This is also a thing for all the events we cover. I am also improvising at the scene. On the other hand that is going on around the world.

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FEATURES THE FRONT LINE As racing gets back underway, AUTO+ Medical speaks to the key doctors and personal at the front lines of motor sport who are ensuring the safety and wellbeing of everyone at the track during the Coronavirus pandemic.

Over 30,000 Covid-19 tests were administered over the first six Formula One Grand Prix weekends of 2020. Only a handful returned positive. The most public of these was the positive test for Racing Point driver Sergio Perez but, as with the other cases, he was isolated and his recent contacts traced. And Formula One cointinued to run without a hitch. The whole operation and the minimal positive results are testament to the preparation work that the medical community put in during the months leading up to the first race. “It’s really incredible,” says FIA Medical Commission President, Professor Gérard Saillant. “If you have told me that would be the case three months ago, I would not have believed you. But everybody was very involved in this challenge, from the FIA, Formula One, the teams, the staff and our responsibility was very well understood by them.” The most important aspect to this was not at the track but the checks that were in place before people even arrived at the event.

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“Before the Grand Prix it was very important STRICT MEASURES “We set up weekly meetings with Public F1 motor homes replaced by temporary to prepare and to be sure that everyone was Normally F1 teams would take around 400 to Health Officers from Austria, Hungary, cabins to help with negative, everybody was in a good shape, 500 personnel to each race, but under the new Silverstone, and Barcelona since the end of social distancing they have not had any contact with a positive guidelines this was reduced to the bare May,” says Dr Pau Mota, FIA Head of Medical case and so on.” minimum of 80 people to limit the risk of and Rescue. “The idea is not to engage with No doubt this was the major factor in there spreading Coronavirus. the normal medical staff of the event. It’s close being so few positive tests on event itself, Regular testing must take place for all work with the testing company, Public Health especially in the early part of the season trackside personnel, officials, and media, Officers, and the Covid-19 staff from the FIA to where there were just two positive cases over ensuring social distancing is practiced, with ensure that any suspected case, uncertain three races. personal protective equipment (PPE) masks case, or positive case is managed in a legal This preparation was a key element in the being worn at all times in the paddock. and transparent way.” 81-page Return to Motorsport guidelines that They must also stay within ‘team bubbles’ to At each race a public health representative were issued by the FIA in May. Saillant and his limit the risk of an outbreak, which means was present to announce cases to the BEFORE F1 THERE WAS team collaborated with FIA Member Clubs, personnel from Ferrari would not be able to government and declare if there is an outbreak, ONLY NATIONAL FOOTBALL governments, and the World Health mix with Mercedes personnel. In the case of or management of positive cases onsite. The “EVENTS IN GERMANY, SPAIN Organization to come up with the guidelines Pirelli, the strict guidelines mean that when challenge for the FIA is to adapt to the different and assess the feasibility of hosting races delivering the tyres to each team garage their ways of managing cases in each country, as AND THE UK safely in what is considered to be a ‘mass representatives must wear full PPE to be they found between Austria and Hungary. ” gathering’ during a pandemic. compliant. “Every day we did an average of 500 came from the pre-appointed hygiene officer. He “It was three or four very difficult months The FIA has to work closely with Public Covid-19 swab tests and in that you always was the one that was informed first, and they because the situation is not so good with Health Officials in each country to determine have between five and 10 cases that are not take all the further steps towards the local health Coronavirus still circulating,” says Saillant. “For the protocol for suspected or actual positive clear and you have to manage,” says Mota. “In authorities and discusses quarantine or contact the FIA it was quite a big challenge to do the cases, while also ensuring that Covid-19 Austria, the Public Health Officer and I agreed tracing. Then it’s taken over by the local restart for F1, and to be honest I was not so procedures do not become an additional to manage that together. We then gave them authorities and they run essentially their normal confident. But we changed the impossible to responsibility of the normal medical staff or data on the unclear cases, which they use to procedure as per the country.” possible due to the fantastic job by the FIA Chief Medical Officer at each race. follow the official procedures. In Hungary it In Hungary the circuit promoter teamed up Safety Team, technical department, and was the other way around, they just with Budapest-based clinic Semmelweis, to everyone who was involved.” announced every single suspected case and pre-test each of their staff members and With F1 being the first international sporting we adapted our strategy to that.” medical team. But within the F1 paddock it is event to restart, Saillant says the sport has For each test result the FIA will keep track and Eurofins, one of the top global scientific been a test bed for the WHO and inform the Formula One Management testing companies, that provide each of International Olympic Committee (IOC) as accreditation department, in case there is a the Covid-19 swab tests throughout the they plan the safe return of the Olympic positive result and a pass needs to be season. games in Tokyo which have been postponed deactivated to stop access to the paddock. In Eurofins brings 70 people at each race to until 2021. Hungary, where the first positive case showed conduct the testing, with 15 test stations “Before F1 there was only national football up, there was a clear chain of command that complete around 7,000 tests every five events in Germany, in Spain, and in UK,” says that kicked into action when isolating their days; first on Wednesday and then again on Temperature checks Saillant. “The WHO and IOC are very happen on the way positive case. Sunday. The main reason for this is to interested in our work, especially with the into the paddock Ariane Frank Meulenbelt, Vice President of the ensure that all the key players such as Olympic project in Tokyo for next year.” Hungaroring, explains: “Locally the decisions drivers and mechanics that work on the cars

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are tested early, to give the teams time to As Formula One gets underway, other categories are now react if there is a positive case. RETURN TO restarting worldwide including the British Touring Car Championship in the UK, Supercars in Australia, Stock Car Racing “If you have these people being tested on MOTOR SPORT in Brazil, and national motor sport in Norway. Friday or Saturday, before the qualifying, AUTO+ Medical spoke to some of the doctors on the front-line at you put all the event in danger,” says Mota. GUIDELINES these events to see how they are coping with the return of motor “We decided to test them at the latest on sport events in their country, and to know the type of restrictions IN ACTION they are under based on their country’s current situation. Wednesday, so you have the results on Thursday morning and then you have time to react and replace the whole team for the AUSTRALIA BRAZIL NORWAY event on Sunday. The same thing applies if In Australia a lot In Brazil, together In Norway national you test on Sunday, because you have the of medical staff with the motor sport training results on Monday morning you can plan for returned from Confederação has been underway helping out in Brasileira de since the start of the next event, if it’s the following week. So it’s Masks must hospitals at the Automobilismo April, with motor be worn at all about how you manage a suspected case or (CBA) and FIA sport events taking all times in height of the a positive case to keep the event running.” the paddock Coronavirus pandemic, notably club members, protocol was place since May. Each team has their own testing station those who were present at the determined based on the FIA’s “Norwegian associations and I behind their garage at the same distance so Australian Grand Prix when F1 framework to restart motor were in discussions about the had to abandon the start of sport. return and we opened fairly early as no team feels there is any unfairness from a the season. “We based our own protocol on well,” says Thomas Heggelund, Chief sporting perspective. Other stations are “For a short while, those of us the FIA’s one which facilitated our Medical Officer of Norwegian situated at the main gate of the circuit for working in medical careers work, adapting it to our reality,” Motorsports Federation. “We made marshals. The test samples are then taken diverted all of our attention to says Dr Dino Altmann, President rules and regulations based on the preparing our workplaces for the of CBA Medical Commission. “We national guidelines adapted to offsite to a laboratory in another country to expected tidal wave of coronavirus first discussed it with our motor sports.” be analysed, with the results appearing just patients,” says Dr Matthew Mac promoters and brought it to “There is a limit of 200 people on a few hours later. Partlin, Deputy Chief Medical government authorities to have the track which means no “In Austria we did all the testing in There are plans to keep Eurofins as the Officer Australian GP. “Thankfully, their approval and permission to spectators,” explains Heggelund. Germany and in Hungary we do all the main test provider for the season as it in Australia at least, that wave was restart.” “There are cohorts in the pit for the not anywhere as big as in many “Restrictions are related to the cars and crews, anti bact hand testing using a lab in Vienna,” says Mota. enables the FIA to keep track of each of the other countries.” course of pandemic in each sanitizer must be used and least “That makes sense because from a political pre-tests and onsite tests between races, Once the government health region, state or city, pending on one meter between people.” point of view you are not using resources creating a ‘health passport’ for those who department started to lift government permission,” says However, the amount of motor from the country, and therefore not taking will be regularly attending. lockdown restrictions, the Altmann. “A COVID-19 RT-PCR test sport events that have restarted is out testing capacity from the local society.” “Having the same test provider for the Australian Institute for Sport is required for all participants of limited due to the impact on (AIS), in collaboration with the events and a sanitary barrier revenue that it would have got from whole season, where they can provide a Motorsport Australia, released is mounted at the entrance of entries and spectators. global agreement for anywhere, enables us its motorsport focussed Covid every circuit to check everyone’s “The really big problem is the EVERY DAY WE DID to have a common database,” explains Mota. preventative guidelines. health condition.” limited entries in races, and no “This means you can have a pre-test if you “With two weeks’ notice the “It is strange to have an event spectators, which means there is no AN AVERAGE OF AROUND first Supercars race was held at with the participation of fewer profit in having races,” says are coming from different countries. It “500 COVID-19 SWAB Sydney Motorsport Park in June, people and no public but with Heggelund. “They are all not allows us to restart the bubble or the cycle there were no spectators and no time we will get used to it.” adds financially viable, hence very few TESTS of three races, knowing the pre-test result support categories,” explains Altmann. “Altogether it is great to races are being held as motor clubs ” before people join their bubble.” Mac Partlin. be back to races in a safe way.” are making its money this way.”

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THE RETURN OF FANS Instead of a similar situation. But the medical coverage of In recent months it has been commonplace media pen, the FIA is only for the FIA family not for the it is now a to see fans celebrating sporting events from media maze spectators so it’s down to the hosting home, but with more races being added to country.” the F1 calendar the prospect of fans As for establishing motor sport calendars returning to stands is gaining more traction going forward it will largely depend on the as countries in Europe and Asia start to individual situation of each country, and how ease their lockdown restrictions. Coronavirus outbreaks are being managed to The key thing from the FIA’s point of view ensure the safe running of each event. is not avoiding cases but being able to “My opinion is that it will be easier to go to manage positive cases when they crop up. the to the east then to the west part of the The challenge going forward will be to world, because in the west part the virus is maintain the strict measures to ensuring currently more aggressive especially in South the risk of transmission is still low, similar America,” added Saillant. “I think it would be to how governments around the world are impossible to go there this year.” coping with the ‘R’ rate of infection number. Whatever happens in uncertain times F1 is “People were discussing at the second being used as a testbed for global sport to race in Austria, the local promoter wanted restart, and with the strict guidelines outlined to host 18,000 spectators,” says Mota. “They by the FIA that were created in collaboration will push to have the events as they used to with the WHO, everything is being done to be, and you have to negotiate again and say ensure the safety of personnel at the track in ‘Listen, we were lucky. Don’t push too much the post-COVID era. because we might have an outbreak!’” There may also be limitations from governments in countries, as in some it is Eurofins conducts the Covid-19 swab illegal to stage mass gatherings of more tests at each race than a certain amount of people such as France, UK and Italy. For F1 races the responsibility of the wellbeing for spectators would be down to the local promoter of the race, rather than the championship or the FIA according to Saillant. “It’s another issue, to be honest it’s not coming from the FIA or FOM, it’s coming from the company of the hosting country,” says Saillant. “Our regulations in France for example, it’s impossible to have more than 5,000 people attending an open area sports event and currently in UK and Spain it’s a

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200 | 3000 BELGIUM

5020 NETHERLANDS

5020 SWEDEN

1020 FINLAND PPE SENT 200 | 10040 UNITED KINGDOM 5000 GERMANY WORLDWIDE 400 IRELAND 600 LITHUANIA 4020 REPUBLIC OF BELARUS

4020 POLAND

During the height of the 2500 SLOVAK REPUBLIC

coronavirus pandemic personal 520 HUNGARY protective equipment (PPE) 2520 SLOVENIA supplies experienced a global 3020 KAZAKHSTAN 200 KYRGYZSTAN shortage caused by a rise in 5020 CANADA 200 | 8040 FRANCE demand and panic buying. To help 5020 ITALY 3030 KOSOVO with the shortage the FIA teamed 1520 SAN MARINO 4020 BULGARIA 200 | 4020 AZERBAIJAN 1000 | 5020 MEXICO 200 | 1020 MONACO up with the International 200 | 3000 REPUBLIC OF KOREA 5020 PORTUGAL 5020 TURKEY Federation of Red Cross and Red 400 | 13060 SPAIN 200 JAPAN 3015 IRAQ Crescent to ship out over 200,000 400 | 2020 JAMAICA 3020 BAHAMAS 1515 MOROCCO 4020 JORDAN 3020 HONG KONG 400 | 4020 HONDURAS 500 ANTIGUA & BARBUDA 3020 MOLDOVA supplies of PPE consisting of masks 200 | 1040 NEPAL 4020 EL SALVADOR 200 | 3020 DOMINCA REPUBLIC 400 | 4020 ROMANIA and goggles, to hospitals and 200 | 10040 INDIA 4020 NICARAGUA 2020 BARBADOS 4020 GREECE COSTA RICA National Sporting Authorities 200 2020 GUYANA 5020 PHILIPPINES ETHIOPIA 200 | 3020 TRINIDAD & TOBAGO 1000 throughout June and July. This 1000 MAURITANIA 400 VIETNAM 1020 COLUMBIA 8040 KENYA 2520 SINGAPORE graphic illustrates all of the 5040 MALTA 400 | 4020 RWANDA individual countries that were sent 5020 PERU 600 | 5020 NIGERIA 3020 LIBYA 4020 ANGOLA PPE globally, to help front line 1000 BOLIVIA 1000 MAURITIUS workers in the fight against 4020 BRAZIL 200 | 1000 MADAGASCAR COVID-19. 4020 PARAGUAY 400 INDONESIA

200 | 5020 URUGUAY 200 ARGENTINA 2020 MOZAMBIQUE GOGGLES

MASKS 200 AUSTRALIA

200 SOUTH AFRICA

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MARIO ISOLA PIRELLI HEAD OF F1 AND CAR RACING

Mario Isola is Pirelli’s Head of F1 and Car Racing, overseeing the development of the 18-inch tyres that are set to debut in the championship in 2022. AUTO+ Medical spoke to him about the safety considerations that have been made for the 18-inch tyres, and about his life on the front line as a part-time ambulance volunteer in Milan.

AUTO+ Medical: How has the restart been for you? Mario Isola: Strange! It’s different from the normal situation, but I can say it has so far been successful. We had to work together with the FIA to implement all the COVID procedures, but they were working well since the first race in Austria. We had these few days mainly for communication with the teams because we have our engineers that are working in the back of the garage, they are not mixing with the team bubble and so they are a bit blind because they cannot see the car, they cannot see which tyres are being put on with the data, so we also need the support of the team’s engineers and personnel in order to have to get the information we need that to do our job. But it is working well, considering the situation.

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A+M: What have you done differently to in F1 we implemented a new test, a new way industry is moving. Recently we bought a of this new product, the grip level is in line ensure that your tyres have been delivered of stressing the tyre in order to replicate simulator in Pirelli rather just relying on the with 13-inch tyre. Being the sole supplier, on time to the teams? what happens on track. It is very useful for simulator software of the teams. This is quite it is not our priority to supply a tyre with a MI: First of all, we have a schedule that is us because F1 is an environment where our important because it’s a good investment in much higher performance, this is a difference agreed with the teams, in order to not have product is stressed at the highest possible terms of money, but it is really helpful in our between being in competition with other all the teams come into the fitting area at level. That means that the methodologies that development process. tyre suppliers compared to a sole supplier the same time. We have one team in each we developed for F1 are also useful to test our environment. Clearly we have to provide a tyre dedicated slot across two different fitting road the tires. A+M: How will these new tyres affect with some characteristics that are required by areas. We have a dedicated area for the But consider that F1 tyres are working with drivers physically? the promoter, talking about F2 the promoter delivery of the rims, we have another area the temperature that can go up to 150-160 MI: If I make a comparison with Formula 2 is still asking for a high degradation tire or for the collection of the fitted units, so there degrees, in terms of forces acting on each tyre, where we have a clear comparison because tires that enhance the show, encourage is no. We have our engineers in the back we are talking about in some conditions you the cars are the same cars of last year, just the overtaking, so having a certain amount of of the garage which is organised by the have a vertical load that is more than 1,000 tires are different, we are running with a lap degradation is clearly going in this direction. team, so again there is no mixing. We are kilos - can you imagine on a single tyre? That time that is similar to what we had last year. But the 18-inch tyre has proved to be more following all of the procedures that have been is quite a lot of weight, a lot of force acting, Consider that 18-inch tyre is a new product, we consistent anyway and the drivability is quite implemented for the situation with the Covid and it’s the same for longitudinal forces like are just at the beginning of the development good. The feedback that I had from drivers test and all this kind of stuff. We have our acceleration and braking, and for lateral dedicated area for catering, everything that forces. So we have the opportunity to test the has been organised for the teams is also valid tyres in the most stressful environment. This year F2 cars for us, the difference is that we are a provider The other point that it is good to highlight is introduced 18-inch tyres for all the teams so we have to pay additional the cooperation that we have with the teams, attention to our procedures in order to avoid with vehicle models and with simulators. any mixing or any risk of spreading the virus For this we provide them with a black box, if we ever suspect a positive case in our team. which is a virtual tyre they can plug into That didn’t happen, but we will continue with their simulators, and thanks to that we can this kind of attention, all of our engineers are speed up the development, we can better wearing face masks as advised. We have also understand the expected performance of another dedicated area for analysing the tires the prototypes, and then we can test these after usage, that is reserved for our engineers prototypes with our indoor facilities to that are here on track with us. reduce the number of these that require the final validation on track. This is the future A+M: You are working on new 18-inch and the direction in which the automotive lower profile tyres, which have been brought into F2 this season and are set to be introduced to F1 in 2022. What are the safety considerations for them? WE ARE FOLLOWING ALL MI: We pay the utmost attention to safety “THE PROCEDURES THAT HAVE and that means that before any tyres in BEEN IMPLEMENTED FOR THE a prototype are going on track, we run a SITUATION WITH COVID number of indoor tests. During these years ” 24 25 AUTO+MEDICAL FEATURES AUTO+MEDICAL FEATURES

after Austria was quite positive and we had Isola has been a are a team of 150 volunteers. It’s something also the opportunity to test the wet the tires volunteer on the different, it’s a way to see something different front line for on the Saturday. So it was a good test for our 18 years from your normal life, keep your feet on 18-inch product for both dry and wet. It is a the ground and understand that F1 is a nice different tyre, it is more reactive, in terms of environment, but outside the F1 bubble there drivability. In during our development tests is something else. last year, they reported or no differences in Especially in this period with the COVID-19 running on curbs compared to the 13-inch situation and unfortunately Milan was tyre, that was another aspect that we had to heavily affected by the Coronavirus, the consider because with the low sidewall profile situation was difficult, and I did do some you expect that hitting the curb can be much shifts during this period, it was not easy not harder with unbalancing the car and so on, so only because we had to implement different they reported that it was not a big issue. It was procedures like wearing protection with a probably a bit worse in Austria because the mask, a visor, all this kind of stuff, but also kerbs are higher, so they had to pay attention different procedures. For example, we are to not hit the kerbs to badly, but it is still part not authorised to bring with the patient of the competition. When we go to Monza any friend or family member, because it with very high kerbs, with F2 they will have to was a protocol to avoid the spreading of pay attention not to cut the chicane too much the infection. And in some cases it was not because this can unbalance the car and make an easy situation on the psychological side, the driveability quite difficult, but it is the because you had to take an old man or an old same with GT cars for example, they are using lady with this terrible coronavirus, they take 18-inch tyres with a sidewall that is less part of him or her from the family without bringing the suspension compared to the 13-inch tyres, anybody and it was maybe the last time they a very high side-wall is working as part of the Then we will move a couple of years to were going to see him. suspension. the removing blankets. Obviously F1 is the VOLUNTEERING IS A So it was also not easy on the operational pinnacle of technology, but it is also a sport WAY TO SEE SOMETHING side and not easy on the psychological side, A+M: In future, tyre warmers are set to be and it is also a show, so we have to consider “ but luckily now the situation is much better banned in F1, what affect will this have? all these aspects and make a good mix to DIFFERENT FROM YOUR we are back to more normal activity, but MI: For F1 it was decided to move the ban give spectators what they want to make the NORMAL LIFE I will I will continue as I did in the last 30+ on tyre warmers from 2023 to 2024, so at championship successful and also to keep the years or so. It’s nice and I hope that with the the moment we are working still with the DNA of F1 to develop technology that is also ” Coronavirus maybe other people will decide blankets. I believe that is a sensible idea the reason why Pirelli is in F1 for the long run. doing this as a volunteer. I started to do it to use their spare time to engage in these because we have to move step by step, so it because some friends were able to convince activities, not just the ambulance but you can is probably not good to introduce too many A+M: You were on the front line as an me who were doing this activity. At the be useful in many other activities and it’s a variables at the same time. We have a new ambulance driver during the height of the beginning I was not 100% sure, but I did my way to learn something from your experience. technical regulation, new cars, new tires, Coronavirus crisis in Italy, what was that training, passed the exam to be a volunteer. Sometimes we say that being a volunteer is for the first couple of years we will we will like? We don’t have paramedics in Italy so I can I something that gives you more than what you keep the blankets so we don’t have another MI: I started many years ago when I was 18 don’t want to use the word paramedic, but give to the others, because at the end of the variable that is coming into this equation. years old, and this is now 32 years that I’m we do First Aid with the ambulances and day this is true.

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The Abu Dhabi Desert Challenge is one of the “We get quite a lot of people who fall victim toughest races for a driver to take part in to simply not being hydrated enough and physically. Over the course of five days, they get dizzy, make errors, or they simply temperatures in the desert can often run up to stop in the desert and press their alarm,” says 40 degrees centigrade and reach up to 67 Dr Petherbridge. “When we go to the aircraft WATER WORKS degrees centigrade in the car. and pick them up, we often find that hydration That's why drivers must carry three liters of is the main issue.” Examining the importance of hydration in motor sport water with them to ensure they are hydrated Lack of hydration occurs when the body during the race. Even so, lack of hydration is one doesn’t have enough water or salts to create of the main reasons for drivers having to blood volume, causing your heart rate to be withdraw from the event, according to event higher and your cardiac output to be lower. Chief Medical Officer Dr Sean Petherbridge. The main area this affects is stamina and can

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sometimes be the reason as to why a driver Lack of hydration can electrolytes and you start with low blood falls off the pace during a race, as opposed cause fitugue and limit sodium levels, which can be quite to it being linked to anything mechanical reaction times dangerous,” explains Blow. with the car. “A couple of hours before the race we usually In the case of the Desert Challenge, it not get drivers to have an electrolyte drink which is only affects drivers but can also take its toll about three times stronger than a regular on the officials that run the event. Around 50 sports drink in a fairly small quantity,” says marshals are exposed to intense heat for up Blow. “The extra sodium in that drink gets to 12 hours during the Abu Dhabi Desert pulled from the gut into the bloodstream, and Challenge, and research has found that then gives you a little bit of extra blood volume maintaining good hydration levels can be a - which is what good hydration should do.” key mental performance aspect. The main electrolyte that people lose in their “We did some research into hydration in sweat is sodium, but the amount of sodium terms of fatigue and reaction times and we that people lose can vary from person to found that reaction times get worse, fatigue person. This is why Precision Hydration tests increases over the course of the event, and it the sweat profile of athletes to help them figure does relate quite strongly to hydration,” says out whether they lose a tiny amount of sodium, Dr Petherbridge. “Where officials and a moderate amount, or really high amount. competitors are dehydrated, then we find For this they use at-rest Sweat Testing that performance degrades. technology that can stimulate the sweat glands “The issue with a big event like that in the arm, then generate a sample which is run conducted in the sun is with the staff, through a desktop analyser and tells you how particularly marshals who have to sit much sodium concentrate is in the sweat. around the course for long periods. We give So how do athletes and officials maintain lose electrolytes in your sweat. Being able to “The range of sodium loss in sweat in them shade, water, and encourage good good hydration? According to Andy Blow who is maintain those levels is something drivers can humans is quite dramatic. At the lower end nutrition. But often these are people who the CEO of Performance Hydration, a company often get wrong on the run up to big events. you might see someone losing 200 milligrams are volunteers, and they may work in that focuses on sweat testing and the science of “When I was working in Formula One many in every litre of sweat, and at the higher end environments where they’re not adapted hydration, in normal non-stressful or non- years ago, hydration was always talked about someone could be losing 2,000 milligrams in to being outside all the time.” challenging conditions drinking an adequate as a big issue,” says Blow, who started out as every litre of sweat,” says Blow. At some event Dr Petherbridge and his amount of water is all you need to do. a driver performance coach at the Benetton Having worked with a number of teams and colleagues have found a significant number Where it gets a bit more difficult is when F1 team. “Drivers would habitually drink lots drivers up and down the Formula One grid, of marshals needing treatment. sweat loss becomes very high and you start to of water in the days before a race thinking Precision Hydration has recently partnered “In Bahrain, there was one event where we that it would help them from a hydration with Williams to look at how hydration can saw close to 100 or so needing treatment in standpoint, because that’s the logical thing to affect every aspect of the team from the one day,” says Dr Petherbridge. “Thankfully IN BAHRAIN THERE WAS do isn’t it?” drivers to the mechanics and personnel. we have good marshal support, which we “But if you do that with plain water, your “Williams were extremely interested because ONE EVENT WHERE 100 back up with the medical center to ensure “ body tries to maintain an equilibrium and of what we could potentially bring to the pit that the marshals and officials around the PEOPLE NEEDED TREATMENT you end up in a situation where you suffer crew and wider team, not just the drivers,” course are given water, rehydration DUE TO DEHYDRATION from hypernatremia, which is where you pee explains Blow. “They want to look at it from an solutions, and are checked on.” ” out so much fluid that contains these overall point of view, because those guys work 30 31 AUTO+MEDICAL FEATURES AUTO+MEDICAL FEATURES

in pretty heavy clothing, it can be a very physical job, and often in extreme heat. YOU CAN LOSE AN “And it’s not just for the period of racing, INCREDIBLE NUMBER OF they’re working pretty hard in the days leading “ELECTROLYTES IN A SHORT up to it before, during and after. You can lose an incredible number of electrolytes in short SPACE OF TIME space of time and that’s really what is the ” deterioration function that leads to lack of concentration, muscle cramps and “Drivers in the rallies have resorted to overheating.” running air conditioning units,” says Dr Petherbridge. “They take a horsepower hit, HEAT CHALLENGE but their physiological performance is slightly Typically, in F1 races such as the Singapore better because it’s an endurance event. It’s and Bahrain Grand Prix, drivers lose up to similar to aviation in that respect where the three kilos of body weight which is pilots are a component of the aircraft which predominantly sweat. Blow says for every kilo has a failure rate accordingly. We should treat of body weight a driver loses; it amounts to at our drivers as components of the of the least a litre of sweat. vehicle as a whole.” “The vast majority of any weight loss in that Australian V8 Supercars and IndyCar drivers period of time will be sweat lost, so if you lose have experimented with cooling shirts, where a kilo of body weight, you’re losing about a it takes away the heat during the race. Some litre of sweat. I’ve worked with drivers who are F1 drivers also have also resorted to cooling easily losing three litres in a Grand Prix which vests, which they wear on the grid before the is starting to get to the sort of level of fluid loss race to help manage their temperature. where performance can start to deteriorate. “If you look at some of the research of “We would always expect drivers to cognitive performance, and body dehydrate to an extent in your car, but they’re temperature, it goes down when your body not going to be able to drink as much as they temperature gets above 38 degrees lose. The idea is just to make sure that they do centigrade,” adds Dr Petherbridge. “It’s not two things; get in the car optimally hydrated unusual to find body temperatures in race so they’re not behind when they start, and car drivers who are half an hour into an event then make sure that you can just stay above and up to something like 38 to 38.5 degrees that critical line when performance starts to centigrade because of the heat of the fall away, because after the race, they can physical activity of racing.” obviously rehydrate and recover.” This is where good hydration becomes In other championships, drivers may also more than just a matter of performance but maintain that equilibrium throughout the also a safety issue. The simple solution of races using other means such as onboard air drinking the right amount of fluids can conditioning, which Dr Petherbridge says is an ensure that drivers, team members and effective trade-off between physiological officials keep themselves and others safe on Drivers can lose up to three kilos in performance and horsepower. and around the track. body weight from sweating 32 33 AUTO+MEDICAL FEATURES AUTO+MEDICAL FEATURES

Credit: Chris Schotanus

INSIDE THE… For the first time in 36 years Formula One will “It was a great opportunity for us because we an ambulance is needed to stop on them and make a return to Zandvoort in the Netherlands, could make a wish-list of whatever we wanted,” use a stretcher in the event of an emergency. for the Dutch Grand Prix in 2021. The track has says Koolen. “The architect who built them came to me and ZANDVOORT undergone significant changes since the Grand Part of the process for Koolen was taking asked if it was possible to drive an ambulance Prix was last held, the most notable additions into consideration what F1 require to stage the on a banked corner, which we can manage,” being two steep 18-degree banking corners. race, including the location of the new building says Koolen. “But is it possible to stop an MEDICAL There is also a new state-of-the-art medical in relation to the track and creating space for a ambulance, to park it on a steep banking corner center which will house the 35-strong medical helicopter to land. like this? CENTER team, which is comprised of 15 doctors, a “I had to talk to the architect and figure out “I had to talk to some of our ambulance trauma surgeon, an emergency physician, a where we can locate the medical center and drivers and they said it was possible, but now AUTO+ Medical takes a look at the family doctor with expertise in car racing, and where can we put the helicopter platform,” we have to train ourselves because when you facilities and equipment inside the newly the others are nurses who work in the pre- says Koolen. “I had to talk to one of our get out of the ambulance you have a procedure, hospital environment. other doctors who said, ‘It depends on the and if you need to put someone on a gurney on build medical center at Zandvoort, as Located in the in-field section coming off Turn type of helicopter’ and he showed me the a banked corner that’s 18-degrees it’s really, it prepares to host its first Formula One 14 before the pit straight, it was built by De common type that is used and that’s what really steep,” explains Koolen. “These are things race at the circuit in 36 years. Groot Vroomshoop in consultation with the we built it for.” most circuit designers don’t think about, how to circuit’s architect Dromo and Chief Medical Zandvoort’s unique banking’s also posed a accommodate all of the medical facilities, and Officer, Erik Koolen. challenge and required a new protocol incase other things you have to take into account.” 34 35 AUTO+MEDICAL FEATURES AUTO+MEDICAL FEATURES

Credit: Chris Schotanus The medical center has two treatment rooms; Here there is a monitor near the bed one which is a high care facility, and one and also a bottle of oxygen on the with three beds which is a low care facility. ground. There is a light in for stitches or These carts are in the high care facility, surgery, on the right side of bed you can where there is one for major trauma victims also see a bottle oxygen on the ground, and there is everything from intravenous and the green thing is a perfusion pump access to incubation gear. The other cart is so if you have to give medication by for bandages, plasters, for burn victims they continuous perfusion they put a syringe have special bandages, and by putting it all in the pump which is electrically driven. in this cart it has two major advantages; it is altogether in one place and it can be moved from room to room if needed.

Credit: Chris Schotanus

“We didn’t have these things in the old building, and to be honest it’s still not completely This is the low care facility, here there finished because when F1 comes next year we will have some additional ventilators, are two carts which are similar to the ultrasound devices, some of the doctors working on site are anesthesologists so they are ones in the high care on the left-hand skilled in using ultrasound for medical diagnosis, so next year we will also have one or two side, but on the right hand side there is a ultrasound devices,” says Koolen. cart for trauma, and in the middle there is one for CPR which has a defibrillator if needed.

Credit: Chris Schotanus Credit: Chris Schotanus

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THE ROAD BACK: JEHAN DARUVALA Towards the end of the 2019 season, Formula 2 racer Jehan Daruvala sustained a serious knee injury while he was playing football as part of his training regime. The Indian driver tore both his ligaments and damaged his meniscus. The incident subsequently forced him to miss the final event on the FIA Formula 3 calendar, the Macau Grand Prix, as he had to have surgery to his right knee close to the race. He eventually returned to the car at the F2 pre-season test at Bahrain in February, where he impressed enough to be signed by the Red Bull F1 team Junior Driver Programme. He recently took part in the three rounds at Austria and Hungary with Carlin, achieving three top 10 positions. AUTO+ Medical speaks to him about his injuries and recovery.

AUTO+ Medical: How did you get injured? Jehan Daruvala: I was playing football with my friend back home in Mumbai in India and basically the ground was a bit wet, my knee got stuck in the ground, and my leg twisted. I heard quite a big ‘pop’ in my leg, and I was in excruciating pain for the first couple of minutes, but then it eased off. I went to hospital in Mumbai where I got my MRI done as soon as possible, and the result was that I tore both my ligaments and I also damaged my meniscus, so it was a big impact for my knee.

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A+M: Where did you get the MRI scan? Daruvala took three top 10 positions ITS BETTER TO FOCUS ON JD: I went to Breach Candy Hospital in in Austria and THE REHAB SIDE AND MAKE Mumbai, which I know quite well. I got the Hungary “ scan as soon as possible on the same night, SURE YOU'RE FULLY FIT BEFORE then I got in touch with a top surgeon in India, GETTING BACK IN THE CAR Dr Dinshaw Pardiwala. I got my surgery done two days after my accident on my right knee, ” and I was home four to five days after that. other G-forces you have to look out for, and I was clear to drive a race car after three A+M: What sort of treatment did you have months. for it? JD: After damaging my meniscus, the surgeon A+M: What was it like getting back suggested I go to rehab but don’t rush into into the car? things. I had protocol which said that I couldn’t JD: Well the first time I was back it was at put my foot down for six weeks after the the F2 test in Bahrain, and to be honest surgery, so there was not much I could do it went quite smooth I didn’t really feel rehab wise except do some exercises for any trouble from the outing. At that my leg. But after those weeks I started to do time, I was just struggling a bit with full proper intensive rehab at a clinic like 15-20 bending of my leg, so getting out of the minutes from my house back home. For this car within the timeframe that we have to I just worked on my leg, it took a long time to do was a bit hard then. Obviously now walk normally and still after seven or eight it’s been another three months since months now I’m still not allowed to run on then, so my knee is practically back to my leg. It was all about doing the fitness stuff normal. that I required for driving my car and not pushing into stuff that could lead to damaging A+M: What sort of advice do you have my knee again. Now I’m almost clear to do all for drivers that suffer similar injuries? exercises, although not too many open chain JD: It’s a pretty tough situation to be in exercises with heavy weights. But running or when you’re competing in a high level of jumping are all the main things that I still have don’t want to risk putting that in jeopardy, but sport. Injury like this is a major setback. to avoid. I also have a nutritionist and I take right now I can do most things, such as cycle, But I think the main thing is to just focus Optic Turmeric every morning along with my row and swim. on getting better as soon as possible and other vitamins, as that helps cleaning up the listening to the surgeon and the people joints or ligaments quicker. A+M: Was that the reasons you couldn’t who give you the advice, because it’s contest the Macau GP? easy to want to get back to sport, playing A+M: Is there a timeframe on when you’ll JD: That was a month and a half after surgery, sport early, but it leads to more injury. get fully fit? so a definite ‘no’ from the surgeon. I had to wait So even though it’s hard at the time, it’s JD: I feel pretty fit right now, but I’m still not at least three months before I could step back Photo Credit: better to focus more on the rehab side clear to run. I think regarding the meniscus, in a car. Luckily the race car is not too harmful Jehan Daruvala and make sure you’re fully fit and ready Instagram apparently it takes really long to heal and you or demanding on the knee itself, but there are before you get back.

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SCIENTIFIC ARTICLE: ESTIMATED CRASH INJURY RISK AND CRASH CHARACTERISTICS FOR MOTOR SPORT DRIVERS The crash dynamics in motor sport can differ vastly to those on the road. This literature review looks at the different crash chracteristics in motor sport compared to road cars.

Authors: John P. Patalak, Matthew G. Harper, Ashley A. Weaver, Nicole M. Dalzell, Joel D. Stitzel.

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1. INTRODUCTION While the motor sport restraint system is driver injuries, across eight race seasons of system prior to the race. When on-track Accidents or unintentional injuries are unique to its environment, it shares with two racing divisions. Weaver et al., developed crashes occur, incident reports are created in continually listed among the top five causes of passenger vehicle restraint systems a common risk curves to estimate driver injury risk using the NASCAR Safety & Crash Analysis (NSCA) death in the United States. An estimated 7.2 goal of successful occupant protection. During vehicle IDR and other factors as inputs database, which includes IDR data, crash million police-reported motor vehicle crashes frontal impacts, a seven- or nine-point seat (Weaver et al., 2015). These relationships can information, vehicle pictures and restraint (MVC) accounted for 37,461 fatalities in the belt restraint system, head and neck restraint, provide guidance and insight for at-track survey information. United States during 2016 (Heron, 2018). While full face helmet, all-belts-to-seat containment emergency response, driver triage and Similarly, when drivers present at a racetrack traffic fatalities have followed a general seat and energy absorbing toe-board foam treatment protocols as well as influence Infield Care Center (IFCC) they are triaged, downward trend over the last several decades, provide restraining forces to load-bearing future expenditures on motor sports safety treated and released or transported as when adjusted for miles travelled, opportunity areas of the driver’s body. During side impacts, research (Bahouth et al., 2004; Champion et determined by the IFCC medical staff. The for driver safety improvements remain the driver’s containment seat with head al., 2004; Kononen et al., 2011). NASCAR Medical Liaisons update and maintain (NHTSA, 2019). Motor sport participants surround provides the primary means of driver medical records during NASCAR events, present a unique subset of drivers subjected restraint via lateral supports at the driver’s 2. METHODS including the addition of Association for the to MVCs. While driver safety has always been a head, shoulder and pelvis. Bilateral leg Monster Energy NASCAR Cup Series (MENCS) Advancement of Automotive Medicine (AAAM) primary goal in motor sports, during the first extensions and a padded knee knocker & NASCAR Xfinity Series (NXS) vehicle chassis Abbreviated Injury Scale (AIS) scores. This few years of the twenty-first century a large complement the seat lateral supports and acceleration data is recorded during a crash coding system is used to anatomically classify and deliberate effort to advance driver safety provide lower extremity restraint. The rigidly by the IDR. The current IDR, implemented in and capture the severity of injuries. There are in the National Association for Stock Car Auto mounted seat provides occupant restraint 2011, was supplied by Diversified Technical eight anatomical body regions (head, face, Racing, Incorporated (NASCAR®) was during rear impacts. The development and Systems, Inc. (DTS, Seal Beach, CA) and neck, thorax, abdomen, spine, upper extremity undertaken. Notable advancements resulting effectiveness of this restraint system has been records tri-axial acceleration at 10kHz (Patalak and lower extremity) and six levels of severity from this effort included compulsory use of presented in previous publications (Melvin et et al., 2011). The IDR is rigidly mounted to the (minor = 1, moderate, serious, severe, critical head and neck restraint devices, introduction al., 2006; Patalak et al., 2013; Patalak et al., vehicle left frame rail, near the driver’s left and maximum/untreatable = 6). AIS 2005 was of the Steel and Foam Energy Reduction 2015; Patalak and Melvin, 2008; Patalak knee. The IDR utilizes an 8G X (longitudinal) or used for all driver records in this study (SAFER) Barrier and advancements in driver and Stitzel, 2017; Smith et al., 2011; Somers 18G Z (vertical) or 12G Y (lateral) trigger (Association for the Advancement of restraint systems. The SAFER barrier has been et al., 2011). threshold which must be maintained for at Automotive Medicine, 2007). documented to reduce peak chassis Motor sport crash events are complex and least 14 consecutive samples (1.4ms). When Combining the NSCA and IFCC databases accelerations by 30–80 percent. These driver restraint systems are unique to the this threshold is satisfied, a recording for 20s provides an opportunity to evaluate and reductions in peak acceleration are paired with motor sport environment. NASCAR crash and is logged. Typical IDR downloads are only two estimate driver injury risk as it relates to increased crash time durations, resulting in medical datasets provide an opportunity to seconds, but the full 20s may be downloaded specific crash attributes, such as principal very similar change in velocities (ΔV) between assess crash statistics and the specific for atypical events such as rollover or when direction of force (PDOF), ΔV, peak acceleration similar SAFER and non-SAFER outer wall relationships between motor sport crash multiple impacts are observed. During each or others. While IDR data is available from impacts (Bielenberg et al., 2004). Together characteristics and driver injury. A limited MENCS and NXS event, inspectors survey and 2002, the season ranges of 2011–2018 were these changes trans- formed the safety of overview of portions of the NASCAR crash data catalogue each vehicle’s driver restraint strategically chosen for this study. A 5th motor sports. The research supporting these has previously been published which included generation vehicle chassis, first introduced large safety advancements benefited from the estimates of mileage covered, full time driver in the MENCS series in 2007, was also utilized implementation of the NASCAR medical liaison participation and a summary of lower MOTOR SPORT CRASHES by the NXS series since 2011. Major program with advanced driver incident record extremity injuries (Patalak and Stitzel, 2017). In improvements to the driver restraint system keeping and the deployment of Incident Data order to generate overall estimates of driver “ARE COMPLEX AND DRIVER including head and neck restraints, full face Recorders (IDR) by NASCAR in 2002. These injury, which spans multiple seasons, this RESTRAINT SYSTEMS ARE helmets, reinforced driver containment seats programs have evolved and grown since study expands that previous research by UNIQUE TO MOTOR SPORT and anti-sub-marine seat belts were all 2002 and continue currently. generating driver injury risk curves using all ” implemented between 2005 and 2011. Lastly, 44 45 AUTO+MEDICAL SCIENCE AUTO+MEDICAL SCIENCE

Fig 1. Visual depiction of how battery power. Occasionally, after the crash duration was calculat- ed: dashed red vertical line conclusion of the race event, the action of ON AVERAGE NASCAR indicates when the average removing the IDR from the shoe results in an acceleration for a 15-milli- EXPERIENCED A CRASH RATE second window of each IDR event being logged. Trivial and non-crash “136 TIMES LARGER THAN channel and the resultant related IDR data files which had a ΔV less than of the longitudinal (X) and lateral (Y) were simultane- 8kph (5mph) were removed. PASSENGER VEHICLES ously < 3G (For interpretation Each IDR data file was further processed to of the references to colour ” in this figure legend, the determine if additional crash events occurred reader is referred to the web version of this article). beyond the 3G crash pulse end point, using database without regard to if a crash occurred. the IDR trigger thresholds. If additional crash NASCAR medical liaisons also conduct post- events were present in a data file, the crash event follow ups with all drivers seen in the event with the largest ΔV was used to IFCC. These follow up notes occasionally represent the data file. The total number of contain additional diagnosis or injury crash events were tabulated for each data file information. The following steps were as well. When a NASCAR inspector completes conducted to process the medical record data. a NSCA incident report a field for rollover is IFCC staff will always triage/treat any driver included. This field indicator was used to at any time for any reason. Drivers are able remove incident data files associated with and encouraged to also self-report at any time rollover incidents. These processing steps to the IFCC for evaluation. Across the seasons produced 2065 individual incident reports of NASCAR competition on which this study is with associated IDR data files. The PDOF of based, the policy which dictated when a driver each of these IDR data files was calculated must be evaluated at the IFCC evolved, which starting in 2002 deployment of the SAFER a 15-millisecond window of each IDR channel using the following process. A linear resulted in an increase of medical record barrier at all MENCS tracks was complete by and the resultant of the lateral (Y) and regression line was fit to the longitudinal reports in later years. Initially, if a post-crash 2005. While safety improvements continued longitudinal (X) accelerations) were versus lateral ΔV line for the duration of the vehicle could be driven by the driver into the since 2011, this study season range simultaneously < 3G. Fig. 1 shows an example crash as determined by the 3G criteria. garage area, that driver was not required to be represents the modern vehicle chassis, driver of this termination point, which is highlighted The angle of the linear regression line was triaged at the IFCC. Later, this policy was restraint system and track barriers. by the dashed red vertical line. This time then calculated and used as the resulting updated to require all drivers whose vehicles duration was used for calculations of ΔV and incident PDOF. could not continue in the event to be triaged 2.1. NSCA DATABASE PROCESSING the PDOF. For this study the longitudinal, at the IFCC. For the purpose of this study if a Post-impact NASCAR inspectors attach the IDR lateral and vertical vehicle axes are denoted by 2.2. MEDICAL RECORD DATABASE driver was involved in an on-track crash with a data file to a unique incident report within the X, Y and Z respectively. PROCESSING NSCA incident report created, but for which NSCA database. For this study, all MENCS and Occasionally, non-crash events are recorded IFCC reports for the MENCS and NXS seasons there was no corresponding medical record, NXS car IDR data for the 2011 through 2018 by the IDRs. These may include pit stops, of 2011–2018 were combined from the the incident was categorized as non-injurious. race seasons was used. This included 2527 chassis contact with racetrack transitions medical record database for all driver incident Of the 1,738 total medical record incidents, total incident reports (1578 MENCS + 949 between the apron and banked surfaces, or re- ports and injuries. This final dataset 415 were categorized as containing an injury. NXS). MATLAB Version 2018b (The MathWorks, even removing the IDR from the vehicle. Each included 1738 unique medical record The remaining 1,323 records were categorized Inc., Natick, MA) was used to process the IDR is installed in a vehicle mounted shoe. This incidents. For the NASCAR driver medical for injury as “No Injury – MVC” and “MVC No incident report IDR data files. Crash pulses shoe contains a magnet used to indicate to the record keeping, all driver injuries and/or New Complaints” for follow up. Of the 415 were determined to be complete when the IDR its presence in a vehicle. This system is diagnoses occurring while a driver is in the cases of injury, 129 included one or more AIS absolute value of the average acceleration for used to prolong the limited self-contained IDR vehicle are included in the incident medical scores. After a manual review, the follow up

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column was searched for the following key the sole injury present for a NSCA crash, the words: Soreness, Pain, Stiff, Headache, Tender, RIGHT LATERAL IMPACTS crash was listed as non-injurious. Abrasion, Spasm, Contusion and Strain. This WERE FOUND TO HAVE A LOWER produced 65 additional findings of a diagnosis “ 2.4. INJURY RISK MODEL or injury based on follow up. An AIS score of 1 INJURY RISK THAN ALL OTHER The resultant of the lateral and longitudinal was assigned to contusions, abrasions and PDOFS change in velocity (XY Res ΔV), peak resultant sprains identified in the follow up notes when of the lateral and longitudinal acceleration the body region was identifiable. A category of ” (XY Res Peak G), Z peak acceleration, sub-injury, meant to encompass clinical signs medical record. Using the driver full name, number of impacts and impact duration and symptoms that would not necessarily incident date and racetrack name columns the were calculated for each data file. For use in themselves be diagnosed as injuries, was two datasets were merged by row to match NASCAR, the model was generated with XY created in order to categorize diagnoses. This injury records to corresponding IDR data files. Res ΔV in miles per hour (mph). Figures have category included generalized soreness, This resulted in 246 injury records being been converted to International System of headache, neck soreness, stiff neck and matched to specific IDR data files. The Units (SI units), except Figs. 6 and 7. An others. Where recorded details permitted, remaining 234 injury and sub-injury records indicator variable was created for PDOF these sub-injury diagnoses were attributed to were manually reviewed to confirm no IDR using four binned categories of 90 degrees: Fig. 2. AIS Scores by Body Region & Severity. a body region. Generalized soreness and/or data file matches were available. The Frontal, Right, Rear and Left impacts, as stiffness was categorized as sub-injury and unmatched injury records were categorized as shown in Fig. 4. These quadrants maintained 49 attributed to the whole body. non-crash related. For the purposes of this the visible incident clusters as shown in Fig. was used to produce five injury risk curves (R There is not a distinct field in the medical study, when non-crash related injuries were 4. Multiple logistic regression modelling in R Core Team, 2019). Logistic regression assumes database which indicates driver injuries which the response variable is a binary random are solely associated with or due to a NSCA Equation Probability of Coefficients - Estimate P-Value Standard Error AUROC Deviance variable (injury or no injury) and was modelled description Reduction (%) reported vehicle crash. Many medical records with a Bernoulli random distribution with P 1 Sub-injury or AIS 1+ βo - Intercept −4.565 < 0.001 0.250 0.80 19.5 contained potential non-crash related injuries probability of injury. Table 1 - Model β1 – XY Res ΔV (mph) 0.050 < 0.001 0.007 or diagnoses including nausea, CO Coefficients. Predictors with coefficient β2 – XY Res PeakG 0.057 < 0.001 0.010 intoxication, burns, blisters, smoke inhalation, estimates (p < 0.05) are shown in bold. dehydration, foreign body in eye, heat β3 - Right −0.806 < 0.001 0.161 Manual exploratory data analysis was exhaustion, generalized fatigue and β4 - # of Impacts 0.340 0.007 0.125 conducted, and linearity was checked with generalized cramping. 2 AIS 1+ βo -Intercept −4.235 < 0.001 0.201 0.79 16.8 empirical logit plots and deviance β1 – XY Res ΔV (mph) 0.045 < 0.001 0.007 comparisons. Impact duration was initially 2.3. NSCA AND MEDICAL RECORD β2 – XY Res PeakG 0.054 < 0.001 0.011 included as an IDR generated proxy for

ASSEMBLING β3 - Right −0.718 < 0.001 0.169 whether a crash involved the SAFER barrier

The processed NSCA dataset contained 2065 3 Thorax AIS 1+ βo -Intercept −6.988 < 0.001 0.808 0.87 27.2 but was not included in the final model due to incidents or unique events. The medical record β1 – XY Res ΔV (mph) 0.088 < 0.001 0.016 large multicollinearity with XY Res ΔV. Inclusion dataset contained 480 unique injury and sub- of an interaction between XY Res ΔV and XY 3 Upper Extremity AIS 1+ βo -Intercept −4.651 < 0.001 0.393 0.74 10.9 injury incidents. Each NSCA incident is unique Res Peak G was also assessed. However, this β1 – XY Res ΔV (mph) 0.056 < 0.001 0.010 to a driver/vehicle. For example, if three interaction lowered model deviance R2 and 3 Lower Extremity AIS 1+ βo -Intercept −6.449 < 0.001 0.733 0.80 18.6 vehicles all collided with each other increased the model Akaike information simultaneously on-track, each vehicle β1 – XY Res ΔV (mph) 0.073 < 0.001 0.016 criterion (AIC) and was therefore not included represents a unique NSCA incident, with a in the final models. The Z peak acceleration, Table 1: Model Coefficients. Predictors with coefficient unique IDR data file and a unique driver estimates (p < 0.05) are shown in bold. frontal, left and rear impact PDOFs were not

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outcome event to in- dependent variable Specific body region models shown in Figs. ratio, or events per variable (EPV) may 8–10 were limited to a single predictor of XY produce biased or inaccurate regression Res ΔV for comparison purposes to prior re- coefficients. An EPV of 10 was high- lighted as search. The final model coefficient estimates, a guideline for a sufficient ratio (Peduzzi et al., associated P-values, standard error, Area 1996). Eq. (1) had an EPV of 60.5 and Eq. (2) Under the Receiver Operating Characteristic had an EPV of 36. Eq. (3) had EPVs of 11, 29 (AUROC) curve and percent reduction in and 10 for thorax, upper extremities and deviance (between null and residual) are lower extremities, respectively. shown in Table 1. Model curves for Eqs (1 and 2) are shown in 3. RESULTS Figs. 6 and 7, respectively. Model curves for Fig. 2 shows the matched injury records by AIS Eq. (3) are shown in Figs. 8–10. The dashed body region and severity along with the sub- lines represent the 95% confidence intervals injury and whole-body categories. Figs. 3 and for each curve. Weaver, et al. body region 4 show the AIS 1+ injury, sub-injury and non- specific curves for NASS-CDS (passenger cars,

Fig. 3. Non-Injury, Sub-Injury & AIS 1+ Injury Plot. Fig. 4. Non-Injury, Sub-Injury & AIS 1+ Injury PDOF Plot. injury incidents plotted against IDR generated light trucks and vans) belted frontal occupants attributes. are included for comparison purposes in Figs. Fig. 5 shows the annual totals for No Injury 8–10. significant predictors and were removed from available cases, but with the sub-injury cases and the AIS 1+ & Sub-injury crashes. The As shown in Table 1 and Figs. 6 and 7, in- the final models. As shown in Table 1, a binary designated as non-in- jurious, which is shown annual average XY Res ΔV and average XY Res creasing XY Res ΔV, XY Res Peak G and the indicator for Right PDOF is included in the final in Eq. (2). The number of impacts was no Peak Gs for non-injury and AIS 1+ & Sub-injury number of impacts during a crash event all in- model. If the PDOF ≥ 45 and < 135 degrees longer a significant predictor. incidents are also shown. crease estimated driver AIS 1+ injury and sub- then Right is 1, otherwise Right is 0. Nested Across all race seasons in this study the injury risk for the Eq. (1) model. After account- P(AIS1+Injury) = likelihood ratio tests and best subset selection e(βo+β1(XYResΔV)+β2(XYResPeakG)+β3(Right)) overall average XY Res ΔV was 34.4 kph (21.4 ing for the other predictors in the model, right were also used to confirm predictor selection 1 + e(βo+β1(XYResΔV)+β2(XYResPeakG)+β3(Right)) (2) mph) and the overall average XY Res Peak G for Eqs. (1 and 2) models. Best subset selection was 19.0 G for an average of 258 crashes per was performed with the best glm function in R Previous research has developed injury risk season. The overall average XY Res ΔV for (A.I. McLeod and Xu, 2018), using AIC and curves for specific body regions and AIS non-injurious incidents was 31.6 kph (19.6 Bayesian Information Criterion (BIC) as metrics severities using frontal impacts from the mph) versus 55.5 kph (34.5 mph) for AIS 1+ & to compare models. Both criteria resulted in National Automotive Sampling System sub-injury incidents. The overall average XY the same predictor selection. Eq. (1) shows the Crashworthiness Data System (NASS- CDS) Res Peak G for non-injurious incidents was final model for the probability of driver injury (Weaver et al., 2015). Using only frontal 17.9 G versus 26.9 G for AIS 1+ & sub-injury risk for any sub- injury or AIS 1+ Injury using all impacts (per Fig. 4) and the XY Res ΔV, body incidents. 2065 available cases. region specific injury risk curves were In order to generate Figs. 6 and 7 XY Res ΔV developed where sufficient injury cases were ranged from 0 to 100 mph with 101 samples. P (sub injury or AIS 1+ Injury) =

e(βo+β1(XYResΔV)+β2(XYResPeakG)+β3(Right)+β4(#ofImpacts)) present and are shown in Eq. (3). XY Res PeakG was calculated using XY Res

1 + e(βo+β1(XYResΔV)+β2(XYResPeakG)+β3(Right)+β4(#ofImpacts)) (1) PeakG = 0.453 (XY Res ΔV). 0.453 was the P(AIS 1+ Injury) = slope of a linear regression applied to the Fig. e(βo+β1(XY Res ΔV)) The same methodology was used to develop 1 + e(βo+β1(XY Res ΔV)) (3) 3 data after centering. 95 % confidence Fig. 5. Annual IDR data summary: Total incidents of Non- a model for the prob- ability of driver injury intervals for all injury risk curves were Injury & Sub-Injury/Injury bars (primary vertical axis) with overall annual means for ΔV and peak acceleration of non- risk for any AIS 1+ Injury also using all 2065 Peduzzi, et al. demonstrated that a small computed using the standard error. injury & Sub-Injury/Injury incidents (secondary vertical axis).

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lateral impacts were found to have a lower The National Center for Statistics and larger injury rate, which includes injuries to estimated injury risk than all other PDOFs for Analysis (NCSA) of the National Highway Traffic DATASET REPRESENTS driver and passenger vehicle occupants. Eqs. (1 and 2) models. As shown in Table 1 and Safety Administration (NHTSA) annually While passenger vehicle fatality statistics are Figs. 8–10, increasing XY Res ΔV during a crash NASCAR RACE CAR CRASH publishes summaries of passenger vehicle “ available during this comparison period, no event increased driver AIS 1+ injury risk for Eq. CHRACTERISTICS AND DRIVER crash statistics. While the NHTSA National driver fatalities were experienced during this (3) models. Automotive Sampling System (NASS) General RESTRAINT PERFORMANCE time period in NASCAR. As shown in Fig. 11, This dataset represents NASCAR race car Estimates System (GES) was replaced in ” NASCAR drivers experienced a lower injury crash characteristics and driver restraint 2016, statistics from 2011 through 2015 were rate than passenger vehicles, even when system performance which provides an reviewed and compared for this study. NCSA including the sub-injury data. This difference opportunity for comparisons to passenger often uses 100 million vehicle miles travelled may be attributed to many factors including vehicle systems and statistics. The 2011–2018 (100M VMT) to normalize passenger vehicle seat belt use and driver restraint system race season dataset of MENCS and NXS crashes travel exposure-based statistics. Police- design. includes 577 race events. There were 39 reported crash rates (crashes per 100 VMT) MENCS races (including 3 non-point races) per and injury rates (injury per crash) for 4. DISCUSSION year, and 33 NXS races per year, except 2011 passenger vehicles and NASCAR were Multiple logistic regression was used to which had 34 races. Using NASCAR Timing & calculated for each year from 2011 through estimate AIS 1+ injury only and AIS 1+ with Scoring data, the total mileage (practice, 2015 and are shown in Fig. 11. sub-injury risk for motor sport drivers using qualifying and race) by all drivers in these 577 On average for the five years shown in Fig. motor sport-specific crash and medical record events is 8,096,475 miles. For these 577 races, 11, NASCAR race cars experienced a crash rate databases. As shown in Fig. 2, modelling of the final dataset includes 2065 unique crash 134 times larger than passenger vehicles per AIS 2+ injuries were not possible due to the IDR data files (excluding rollovers/atypical mile. With NASCAR sub-injuries removed, on limited occurrences of these more severe crashes and trivial/non- crash impacts) with 246 average, for the same five years passenger Fig. 8. Thorax injury risk models for belted frontal occu- injuries. Model predictors were limited to AIS 1+ and sub-injury findings. vehicle occupants experienced a 9.3 times pants with 95 % confidence intervals (dashed lines). processed IDR data and included XY Res ΔV,

Fig. 6. AIS 1+ or Sub-Injury risk model with 95 % Fig. 7. AIS 1+ Injury risk model with 95 % confi- Fig. 9. Upper extremity injury risk models for belt- Fig. 10. Lower extremity injury risk models for confidence intervals (dashed lines). dence intervals (dashed lines). ed frontal occupants with 95 % confidence inter- belted frontal occupants with 95 % confidence vals (dashed lines). intervals (dashed lines).

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XY Res Peak G, the number of impacts during Criteria (Nij) may not exceed 1.0 (SFI. SFI alternating inputs to the steering wheel, The purpose of this con- straint was to an event and the PDOF. Injury risk estimates Foundation, Inc., 2015). The SFI 38.1 necessitating the driver’s hands to sweep past permit exploration for future use of the were also generated for AIS body regions acceleration pulse has become a motor sport the seat belt re- lease mechanism located models for emergency response vehicle during frontal impacts where sufficient data industry standard for assessing motor sport inferior to the navel. Following an inadvertent dispatch prioritization and IFCC driver triage allowed. safety equipment beyond head and neck release, the driver has returned to pit road to applications. Previous research has identified Injury risk estimates for the thorax, upper restraints. Applying Eq. (1) with inputs of 39.1 redon the seat belt assembly. There are no advantages of Advanced Automatic Crash extremity and lower extremity were compared mph, 68 G, Right = 0 and number of impacts = documented cases of unrestrained NASCAR Notification (AACN) systems in passenger to models developed by Weaver, et al. For 1 produces an AIS 1+ or Sub-Injury risk drivers involved in crashes. vehicles. The benefits of these automated these models only frontal impacts were estimate of 0.83 (95 % CI [0.66, 0.92]). Applying Early coupling of occupants to the vehicle is post-crash passenger car systems can considered. This data subset consisted of 721 Eq. (2) with the same predictor values a maxim of good occupant restraint (Hahum include reduced emergency responder frontal cases of which 11, 29 and 10 contained produces an AIS 1+ injury risk of 0.78 (95 % CI and Melvin, 2002). Passenger vehicle seat belt dispatch/arrival times, reduced fatalities and AIS 1+ injuries for the thorax, upper extremity [0.58, 0.89]). Reduced injury risk with pretensioners increase the seat belt improved trauma center transport decisions. and lower extremity, respectively. The models increasing injury severity is consistent with restraining forces earlier during a crash event. During NASCAR National Series sanctioned compared with the belted Weaver, et al. Weaver, et al. findings for specific body Motor sport seat belt restraint systems do not events, emergency vehicle dispatch to on- models for each body region are shown in region models. include crash activated seat belt scene arrival time is measured in seconds. Figs. 8–10. The Weaver, et al. models were Seat belt restraint use has consistently been pretensioners, as driver’s manually pretension Crash incidents have involved up to 25 limited to 105 km per hour (kph) and used the shown to reduce injury risk. While nationwide their restraint systems. Previous research has vehicles simultaneously. While there are longitudinal ΔV. In each of the three body passenger vehicle restraint use shows an in- shown normal motor sport seat multiple emergency response vehicle units at regions, the NASCAR model estimates a lower creasing trend over the last decade there are belt pretensions to be 91.2 N (20.5 lbs) for each event, the models developed in this injury risk for a lesser AIS severity where the still substantial numbers of occupants injured shoulder belts and 110.3 N (24.8 lbs) for the study could be used for additional input to risk is greater than 0.1. At less than 0.1 injury or killed who are unrestrained annually. Seat lap belts (J. Patalak et al., 2018). Further, emergency vehicle dispatch to aid in risk, the NASCAR AIS 1+ curve predicts higher typical non- crash impacts which occur during prioritization of available emergency medical injury prob- ability compared to the Weaver, et normal racing make activation logic for such resources. al. AIS 3+, AIS 4+ and AIS 5+ curves in thorax THERE ARE NO DOCUMENTED systems challenging. The NASCAR driver and upper extremity body regions. CASES OF UNRESTRAINED restraint system is also fully customized for NASCAR requires drivers to use a motor “ each driver. Drivers are coupled to their all- sport specific restraint system. One of NASCAR DRIVERS INVOLVING belts-to-seat containment seats using custom components of this system is a head and neck CRASHES molded foam inserts. These inserts must restraint device meeting the SFI Foundation meet SFI 45.2 (SFI. SFI Foundation, Inc., 2013) (SFI) 38.1 Head and Neck Restraint Systems ” and fill the void between the driver’s body and specification. For initial head and neck belt use in NASCAR is compulsory and tight the internal structure of the seat. The lateral restraint design vali- dation, two zero-degree seat belts are favoured by drivers due to head surround wings are lined with defined frontal sled tests and one thirty degree right improved feel and coupling with the vehicle. minimum thicknesses of SFI 45.2 foam and frontal oblique sled test are required by SFI Prior to the start of a race, NASCAR drivers must be positioned at the appropriate height 38.1. The sled tests use a 68 G peak don their restraint systems, often with the for each driver. Lateral leg support extensions, acceleration and a 63 kph (39.1 mph) velocity help of an interior technician. There have been energy absorbing toe board foam and a knee change test pulse. The specification limits peak a few cases of motor sport drivers knocker increase lower extremity protection. 50th percentile male Anthropomorphic Test inadvertently releasing their seat belt restraint While additional crash event information is Device (ATD) upper neck forces to ± 2500 N systems, typically while warming tires. available, such as driver age, medical history, (562 lbf) from zero through 80 ms and ± 3200 Warming tires is a common prerace or caution restraint design and manufacturer, this study Fig. 11. Annual NASCAR & NHTSA Passenger Vehicle N (719.4 lbf) from 80 to 120ms. Neck Injury period motion which consists of large limited model inputs to IDR originated data. crash & injury rates.

54 55 ACKNOWLEDGMENTS

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ACKNOWLEDGMENTS 5. LIMITATIONS acceleration and the number of impacts The IDR data in this study does not include during a crash event all increase estimated The authors would like to thank Pam Sicking, D.L., McClellan, S.B., Maynard, Traffic Inj. Prev. https://doi.org/10.1080/ Talbert, Wil Stead and Ray Smith of E., Donegan, M.W., Mallott, A.M., 15389588.2017.1354128. pre-trigger threshold acceleration information, driver AIS 1+ injury and sub-injury risk for NASCAR for their help with database Gideon, T.W., 2006. Crash protection which slightly underestimates the actual ΔV of the Eq. (1) model. After accounting for the queries. of stock car racing drivers – application Peduzzi, P., Concato, J., Kemper, E., of biomechanical analysis of Indy car Halford, T.R., Feinstein, A.R., 1996. A the crashes. In 2019, updated IDR firmware other predictors in the model, right lateral https://cran.r-project.org/web/ crash research. Stapp Car Crash J. 50, simulation study of the number of was deployed in the MENCS IDRs which impacts were found to have a lower packages/bestglm/index.html. 415–428. events per variable in logistic regression captures the pre-trigger threshold data. estimated injury risk than all other Association for the Advancement analysis. J. Clin. Epidemiol. 49 (12), of Automotive Medicine, 2007. The NHTSA, 2019. Motor vehicle traffic 1373–1379. https://doi.org/10.1016/ Analysis of available 2019 MENCS IDR data principal directions of force for Eq. 1 and 2 Abbreviated Injury fatalities & fatality rates. Fatality Analysis S0895-4356(96)00236-3. with and without pre-trigger accel- eration models. On average, for 2011 through Reporting System (FARS) Total Traffic Scale 2005 Revision. Fatalities (1899-2017). Retrieved from. R Core Team, 2019. R: a Language and show an average difference in ΔV of 3.5 kph 2015, full time NASCAR drivers experienced Bahouth, G., Digges, K., Bedewi, N., https://cdan. nhtsa.gov/tsftables/ Environment for Statistical Computing. (2.2 mph). Modeling of higher severity AIS 134 times the crashes per mile than Kuznetsov, A., Augenstein, J., Perdeck, E., FatalitiesandFatalityRates.pdf. Retrieved from. R Foundation for 2004. Statistical Computing, Vienna, Austria. injuries were not possible due to the limited passenger vehicles, but experienced 9.3 Patalak, J., Davis, M., Gaewsky, J., http://www.r- project.org/. occurrences of these injuries in the NASCAR times fewer injuries per crash. Thorax, Development of URGENCY 2.1 for the Stitzel, J., Harper, M., 2018. Influence data set. The po- tential for NASCAR drivers to upper and lower extremity body region prediction of crash injury severity. Top. of driver po- sition and seat design on SFI. SFI Foundation, Inc, 2013. Emerg. thoracolumbar loading during frontal Specification 45.2 Impact Padding, withhold injury or sub-injury signs and specific models for frontal impacts impacts. SAE Technical Papers 2018 Pub. L. No. 45.2. Retrieved from. symptoms from medical staff exists and only estimate lower injury risk for NASCAR Med. 26 (2), 157–165. (April). https://doi.org/10.4271/2018-01- SFI Foundation Inc.. http://www. Bielenberg, R., Faller, R., Sicking, D., 0544. sfifoundation.com/wp-content/ pdfs/ injury information collected in the IFCC or drivers than for passenger vehicles. Rohde, J., Reid, J., Polivka, K., Holloway, J., specs/Spec_45.2_032713.pdf. upon follow up is available and included in this Incorporation of this model into future 2004. Patalak, J., Gideon, T., Beckage, M., study. While this limitation is difficult to vehicle IDR systems could serve as an White, R., 2011. Testing, Development SFI. SFI Foundation, Inc, 2015. Initial in-service performance evaluation & Implementation of an Incident Data Specification 38.1 Head and Neck quantify, no NASCAR driver has missed a additional input for emergency vehicle of the SAFER racetrack barrier. SAE Recorder System for Stock Car Racing. Restraint Systems, Pub. L. No. 38.1. subsequent race event due to an undisclosed dispatch to aid in prioritization of available Society of Automotive Engineers, Inc. Retrieved from. SFI Foundation Inc.. Technical Paper Series 1–6. https://doi. https://doi.org/10.4271/2011-01-1103. http://www.sfifoundation.com/ wp- previously incurred on-track crash related emergency medical resources during on- org/10.4271/2004-01-3526. 2004-01- content/pdfs/specs/Spec_38.1_031615. injury. The curve comparisons shown in Figs. track crashes. 3526. Champion, H.R., Augenstein, J.S., Patalak, J., Gideon, T., Melvin, J.W., pdf. Blatt, A.J., Cushing, B., Digges, K., Siegel, 2013. Examination of a properly 8–10 include the Weaver et al. models which J.H., restrained mo- torsport occupant. Smith, R.D., Hayashi, S., Kitagawa, Y., used AIS version 98, while the NASCAR AIS is FUNDING SAE Int. J. Transp. Saf. https://doi. Yasuki, T., 2011. A Study of Driver version 2005. This work was supported by NASCAR. This Flanigan, M.C., 2004. Automatic org/10.4271/2013-01-0804. Injury Mechanism in High Speed crash notification and the URGENCY Lateral Impacts of Stock Car Auto research did not receive any specific grant algorithm. Patalak, J., Gideon, T., Melvin, J.W., Racing Using a Human Body FE 6. SUMMARY from funding agencies in the public, Rains, M., 2015. Improved Seat Belt Model. SAE International. https://doi. Top. Emerg. Med. 26 (2), 143–156. Restraint Geometry for Frontal, Frontal org/10.4271/2011-01-1104. Eight race seasons totaling more than 2000 commercial, or not-for-profit sectors. Hahum, A.M., Melvin, J.W. (Eds.), 2002. Oblique and Rollover Incidents. SAE crash incidents were processed and Accidental Injury: Biomechanics and Int. J. Transp. Saf. 3 (2). https://doi. Somers, J.T., Granderson, B., Melvin, J.W., assessed to develop a relationship between DECLARATION OF COMPETING INTEREST org/10.4271/2015-01-0740. 2015- Tabiei, A., Lawrence, C., Feiveson, A., et Prevention, 2nd ed. Springer-Verlag 01–0740. al., 2011. Development of head injury crash char- acteristics and driver injury risk. The authors declare that they have no New York Inc.. assessment reference values based on 246 of the 2065 crash incidents contained a known competing financial interests or Heron, M., 2018. Deaths: leading causes Patalak, J., Melvin, J.W., 2008. Stock Car NASA injury modeling. Stapp Car Crash for 2016. Vital Stat. Rep. 67. Racing driver restraint – development J. 55. finding of sub-injury or AIS 1+ injury. personal relationships that could have Kononen, D.W., Flannagan, C.A.C., Wang, and implementation of seat Multiple logistic regression was used to appeared to influence the work reported in S.C., 2011. Identification and validation performance specification. Sae Int. J. Weaver, A.A., Talton, J.W., Barnard, of a logistic regression model for Passeng. Cars - Mech. Syst. https://doi. R.T., Schoell, S.L., Swett, K.R., Stitzel, develop estimates for sub-injury and AIS this paper. predicting serious injuries associated org/10.4271/2008-01-2974. J.D., 2015. Estimated injury risk for 1+ injury using crash attributes including with motor vehicle crashes. Accid. specific injuries and body regions in delta-V, peak acceleration, principal Anal. Prev. 43 (1), 112–122. https://doi. Patalak, J.P., Stitzel, J.D., 2017. Evaluation frontal motor vehicle crashes. Traffic REFERENCES org/10.1016/j.aap.2010.07. 018. of the effectiveness of toe board Inj. Prev. 16 (June), 108–116. https://doi. direction of force and the number of McLeod, A.I., Xu, C., 2018. Best Subset GLM and energy-ab- sorbing material for foot, org/10.1080/15389588. 2015.1012664. impacts during an incident. Increasing Regression Utilities. Melvin, J.W., Begeman, P.C., Faller, R.K., ankle, and lower leg injury reduction. resultant delta-V, resultant peak

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