one of the few places in the world where we still do motorsport on closed
public roads and so whenever we race motorbikes back home, we do on the
highways and byways and you can see from this picture of me at Armoy Road Races,
there's Not an awful lot of room there there's a lot of spectators in the background.
This is about 265-Kmh /165-MPH. We're jumping about 3 feet in the
air and the guys that are really fast are much faster than I'm going over
this so if Twitter's taught me one thing over
the last year it said anaesthetists fairly boring individuals, they sit in
theater and they give Propofol put laryngeal masks and they read the
paper, we'll invite anybody to come and sit in my office with me at the weekends
and we can see how exciting anaesthetists can be, so the Road
Racing scene is quite unique the circuits or maybe 11 to 14 km / 7 to 9 miles
long and the infrastructure isn't great you can see they're mostly hedgelined
they're public roads and their small roads so they're slightly too short for a
helicopter to be useful they're slightly too long to have a series
of ambulances and medical cars so one of our strategies is to use rapid response
motorcycles like I ride and they cut the circuit down quite quickly you
can be on scene very fast So this is one of the strangest conflict
of interest slides you're ever likely to see So I'm sponsored by Dainese Leathers, Arai Helmets, Daytona Boots, Bridgestone Tyres and Motul Oil so, if you don't use any of these
products you'll almost certainly die :) So this is our team it's not just a one man band we do have
fully stocked medical cars and paramedics other doctors but the first
response that in our environment is by fast response bike so this is me on my fast response bike
this is me talking to Michael Dunlop who's a multiple TT winner and he's one of the
most normal individuals you'd ever find when you're speaking to him one to one,
This is michael dunlop minutes later and this should give you some impression
of the environment that we race in and this is the 'Southern 100' this is
probably about 250-Kmh / 155-MPH. There's a stone wall
about maybe 2' feet away from Michael's head and he's in a group of bikes all
trying to get past each other and so these guys aren't sane :) the speeds are
incredible, this is the 'North West 200' somewhere like the 'North West' the 'ISLE OF MAN' TT the 'Ulster Grand Prix' the average speeds are now in excess of 210-Kmh / 130-MPH that's an average speed, maximum speeds in
excess of 322-Kmh /200-MPH. So whenever these guys crash they crash big and
whenever they come off their bikes they travel at an enormous speed they can be very lucky and they can be
very unlucky in their crashes so really what I'm going to try and do today is
take you through some of the cases that we've seen and some of the learning
points they're often this very unique environment, and so first of all this
case was actually from a short circuit so it's not a road race at all, but it's
to give you some idea of the acuity Did my microphone just die.
Ok so it gives you some idea of the
acuity that we work in and this is quite unique for us, so even the best
helicopter service in the world there's still a lag of a few minutes before they
can get patients sometimes we state patients and within the first seconds of
the dying process and this is just one such chap so to orientate yourself this is looking
dying the start/finish straight under the last corner and this chap came
powering out of the last corner down the start/finish straight and we
saw him coming and this was a practice session so he came out 80-MPH ,
90 , 100 , 110 200-Kmh / 120-MPH still accelerating you could hear i'm kicking up the gear
box in the bike, and as he came on to the start/finish straight he started looking
down the side of the bike and he started working at something down the side and he was adjusting a
transponder as he was coming down the start/finish and it was a bit like someone
changing a CD in a car on the motorway he slowly started drifting and we
were sat on the other side of this wall and we could see it coming and we
thought, awh surely Not, but yes he rode straight into the end of the pit
wall, at about 210-Kmh / 130-MPH. And you can see from sort
of the size of some of the stones that he's ripped out there, this was a massive
massive accident so we were on the scene really within
10 seconds of this guy's impact and he was dead he was in traumatic cardiac arrest and
we got the race stopped and like most services we have a very structured rapid
approach to traumatic cardiac arrest and so there's no CPR and no clear fluids no
idea access you get a tube bilateral thoracostomy a pelvic binder on quite
rapidly and then a reassessment and with those three interventions he had an output
back, so very very rapid bilateral chest decompressions, 2 lungs down,
dreadful maxillofacial injuries but he got an output back he was then anaesthetized and transferred
to the most appropriate hospital as is our want in the pre-hospital
environment but you can see from the sort of level of devastation this guy
decelerated from well over 200-Kmh / 120-MPH. Within a couple of
feet he just hit that wall and stopped dead and it's
sort of a reflection on how structured approach within the early stages of the
dying process and traumatic injury can have a good outcome this guy's now back running his own
business but you can see the sort of devastation it caused, so racing is
dangerous and this is me I know racing is dangerous, i have been
that man, I have lots of metalwork I've been in hospital lots of times, I've had
lots of operations and I still don't learn so all these are me, one of the principal
things about Racing on the roads is the furniture and it's the stuff that's
lying about this dangerous this is Michael Dunlop again and you can see how
close he's coming to that stone wall this is again in excess of a 160-Kmh /100-MPH wheeling leant over looking up the road and brushing a stone wall with his shoulder but you can see someone tied a straw
bale to this stone wall that's fine :) That's safe enough :) that's legit :) So the speed and the environment that
you race in is the problem this is 'Martin Finnegan' and this is again a
notorious section track at the circuit called the 'Tandragee 100' and this
is also again 260-Kmh / 160-MPH. Flying through the air and it's a
dreadfully cruel sport and literally about two corners after this was taken
and 'Martin Finnegan' was dead he overshot the corner and hit this grass
bank and he died so it's a fantastic sport, it's also very
cruel sport.
So a couple of things I'm going to talk
about, first of all beware of fire we always start talking about scene safety
when we're pre hospitalists and there's a few ways that bikes can burn they can burn instantly, they can burn
after a couple of minutes, there can be a missed burn when you get some petrol/gasoline
leaking and then someone moves the bike and up she goes on a quick shifter as well as a
device that cuts the ignition and this can sometimes cause problems when you go
to move a motorcycle so this is an instant burn this is a
bike that's hit and has exploded the petrol/gasoline tank and up she goes so it's very straightforward this is
quite an obvious one. This is a delayed burn this is a bike that's fallen over
and has been leaking petrol/gasoline and the marshals have gone to lift the bike and
as they've done that petrol has poured onto the hot
exhaust and its burst into flames but you can see they're dealing with in
a fairly controlled and calm way :) this is the every man for himself
approach to, and you would expect that this guy here if he had the chance to be
throwing women and children behind him :) to try and douse the flames :) So this is
a friend of mine this 'Guy Martin' and this is racing in Germany racing go-karts
actually as a matter of interest you can see Guy's there in the first step of
the podium and then the second step of the podium the angry looking man on the
phone is actually the European go-kart champion at the time, he got fairly
roughed up during this:) but Guy had a very impressive crash at the TT races this
year, he crashed with a full fuel load the fuel tanks on these bikes superbikes are full of aviation fuel, so
they may be carrying 20 liters of the highest octane race fuel you could imagine and if you look high up in the photo you
can see the fuel tank flying through the air, up there, if you look a
low in the photo you can see Guy Martin there's his leg, so if you look down low
you can see Guy's leg coming out of the fireball, this was a big crash this was in an enormous crash.
There's what's left of the bike and Guy was fine he was grand, he'd a couple of
fractured vertebrae hemothorax, that's fine for a
racer :) So this is another example of a bike
burning this me standing about at a Road Race in the South of Ireland and
we do an awful lot of standing about waiting for things to happen. There
was an incident occurred the red flags went out, so we all mobilized and off we
went so the rapid response bikes took off and we
headed off to the scene. This is what we were met with the fairly standard
pre-hospital scene you roll up and with motorcycles the first thing you do is
count the number of patients, count the number of bikes, and see if they match
because if you have more bikes and you have patients someone's missing, they're either under a
hedge or there somewhere you don't expect them.
So we have one bike one
patient this is the patient, on first
assessment he was fine he was talking he was he was grand to all
intents and purposes, but there was an enormous amount of activity happening in
the garden that you can see in the background, there was an awful lot of
flapping and shouting and panicking going on so we did a quick assessment of this guy
he was fine we split the team and some of us went up into the garden to see
what the hell is happening up in there what we were met with was we find
the bike and it had made its way up onto this fence and unfortunately there was a
group of people leaning on this fence watching the races, if you're a fan
of motor sport the motorcycles you'll notice that the fuel tank is missing
from this bike and this is the first lap of the race so essentially this bike left the track
was a big tank full of 20 liters of high-octane aviation fuel strapped to the
top of it, it hit this fence where there was a lot of people enjoying a beer, and
exploded, so we find the fuel tank just over the side of the fence it was still on fire, hence the fire
extinguisher, so we had to go looking for the patients then, the first thing we did
was put out the fire very important, oxygen is supposed to
the first point of contact for critical illness not if the person is on fire, it isn't :) so, we then find the patient we find an
elderly gentleman on fire lying in the middle of the garden, so
the first thing we did was we put him out and there's a bit of a flurry of
activity going on here we got ourselves together, we were then able to assess the
patient this man was wearing a pullover, when he
was leaning against the fence you can see it's exploded and burnt
of him, you can see his trousers have been burnt, he's a bit combative, his airway
was rapidly being lost in front of us his face was visibly swelling because this was high octane
race fuel. This is my concerned face :) it's important to have a concerned face,
but your concerned face should never change regardless of the situation that
you're in, so even if you're faced with the dreadful airway in the pre-hospital
environment :) your concerned face should be no more severe than if you're taking
the fairing off a bike working in a workshop because you have to bring some
element of calm and control these situations they're not good ones there's nothing to be gained by panicking
and flapping about, so we know what this man needs he needs an RSI, we've got a
system to do that we've got a team that can deliver it so there's no need for concern here, so I
told myself :) So again like any structured pre-hospital service we've
got a way of doing this, we get our equipment together, we've got suction
and oxygen we've got expert help at our right hand
side, we haven't rushed in we're going through a checklist for checking
our equipment and this guy was tricky you can see the amount of equipment that
starts to build up when you're delivering a pre-hospital RSI it
shouldn't be done in a hurry it should be done in a controlled
fashion and this guy was tricky he was a tricky airway, he needed a
second look with a boogie, much smaller tube than we anticipated, it was a 6
tube was the only thing that would go through this guy's vocal cords, and he
remained with that size 6 tube for the first 3 weeks of intensive care
stay, because nobody had the courage to take it out :) This guy did very well he survived you can see obviously had
life-changing injuries, but he was alive because of a good intervention
from a well-drilled team. So you are faced with strange scenes
sometimes, and with bikes it's odd if you crash your car you can pretty much
predict what energy has been transmitted if the cars badly damaged, good
chance the patient is, not the same with bikes, so you have to treat the injuries
you find and also what you expect to find. So this is an accident scene, this is the first corner of a race we were sat at the back of the grid watching a chap as he
pushed the bike out of of the paddock and he was in a state of
tremendous anxiety, because the race has been called and he wasn't ready he
was still adjusting his brake lever as he got on to the start/finish straight
never a good sign so this guy was still working on his
brakes as he was by the set off and you can see eventually he reached a certain
stage and the bikes for setting off and he just went ah feckit it'll be
fine Waahhh, and off he went so this was the
first corner :) and he arrived at this and pulled the front brake lever and it made a
slightly funny noise and nothing else happened so he crashed, so this is what we were
faced with so we hopped over the fence and find the bike, very important part of
pre-hospital medicine is the concept triage if you have more patience than you can
deal with you have to assess who's salvageable and we made a quick call on
the garden gnomes :) down here in the bottom of the screen :) and you can you can see
they've just been flattened completely so no hope :) we had a quick look at the
bike you can see the forks have been ripped out of it, the wheels gone so we know
that the motorcycle is had a significant bang, fortunately some
keen environmentalist had dropped the fuel tank into a bucket for us which is good :)
The next clue that we find was a divot in the ground and that divot is
suspiciously person shaped so we know we knew that this guy had gone in and hit it
like a bouncing bomb and just skipped over So, we still hadn't come across the
patient by the stage but we're starting to build in our mind, you know, what this
guy is going to be like, in fact he was fine, his only complaint was of a
painful right ankle and you'll have to excuse the spinal board this was back in
the day.
So we packaged him as we did this was our want at the time and
we have to look at this guy's ankle and it was quite bad it's an obvious fracture dislocation
and his toes were going a bit white so we don't only deal with just a big
life threatening complications we also deal with
life-changing complications like ischemic feet so with a good performing team we can do
sedation analgesia and reduction of these things and this was a Ketamine sedation. Now if you look closely you can see that
the Ketamine syringe has ended up in this marshals mouth here :) because sometimes you don't always have
a clean environment to set your equipment down, and our doctor fred
decided the cleanest environment was just to pop into that guy's mouth then :)
You can see that Ketamine is quite clearly a dissociative anesthetic because all the pain has moved into the marshals face :) If you look here closely :) So types of crashes, there's a few
different ways to crash a motorbike the commonest one and you'll see this if
you're a pre hospitalist is someone arrives at a corner and they just give
up they think we're going too fast and they
run out of Road and they hit usually an oncoming vehicle is the most severe one
if you're going to have a crash all on your own you can do it two different ways, you can
either lose traction from the front tire so you're going around a corner
the front tire loses grip and the bike just falls over and you slide and crash
very pleasant way to crash if it's not your own bike :) and you just sort of slide
to stop. The other way though is a high-side high-side, this is not so comfortable if
you've ever done it This is when the rear wheel loses
traction, so the bike sort of spins out it will eventually grip and it'll launch the
person into the air, this is a rider called 'Jamie Whitham' if you've read
Jamie's autobiography this is one of two occasions in his
racing career when he shit himself :) so this is quite unpleasant for him. But you can see if you get
information from an ambulance crew that someone's had a high side crash,
it's a fall from height and this can be 210-Kmh / 130-MPH, so it's
essentially like climbing out the roof of your car, by the windscreen and jumping
off, so it's not a very pleasant way to crash, the other unique aspect of bikes
is that there is a potential for you to be run over by your own vehicle once you've fallen off it, or someone
else.
This is 250 championship this is 'Andrew Courtney' and 'Davy Morgan' and
Andrew Courtney fell off and Davy Morgan ran him over. Both riders were fine, apart from
Andrew Courtney's boxing fracture which he development in this sort of post race
analysis here :) So, a top tip would be don't punch
someone with the motorcycle helmet on :) So this is another example of someone
running over themselves this is 'Cameron Donald' and if you look at the second
picture you might be able to appreciate that his front Tire is slightly turned so he's
lost traction and he fell off now this should have been a pleasant
crash nice little Low-Side crash because he's only got six inches to fall and in
theory he should slide to stop but Cameron's bike had other ideas and it chased him, and clip him in the back of the head and pushed him across the circuit
into the straw bales so he had a fairly significant thoracic spinal fracture
simply because a simple accident the bike chased him and hit him. You can get run
over by other people as well this is me yet again this is me racing some supermoto in
the offseason and I thought I was quite the chap here until a few corners later when I fell off and got run over by
my own bike and then by someone else :) This is an interesting slide actually, I've had 2 crashes racing supermoto and this same guy has ridden
over me on both occasions :) So I'm going to go through 4
mechanisms of concern because I've tried to keep this concise I don't want to rabbit
on too long, so 4 mechanisms of concern if you're pretty hospitalist or
if you're receiving physician in the emergency department, 4 things that
should alert you as areas of concern he had the curb, he's got broken feet, but
is unexpectedly unconscious there was a boot that's come off, or he's had a head-on collision on the apparently isolated femur fracture so (1) first hit the curb, if you're sliding
along your back an 18" inch high Kerb might as well might as well be a 10'
foot high brick wall so if a rider has hit a kerb one of two
things will happen, they'll either stop dead or the launch off that kerb and go flying
through the air this is someone hitting a kerb and stopping
dead, and then getting ridden over so this is a compound injury, so although
this chap was quite well the photographer that took these photos
rushed up to us and said you want to see this, because you can see the amount of
rotation he's had on his head when he's hit that, and then someone's ridden over him.
So we were careful with this guy we packaged him appropriately. (2) The other thing you can do is use it as
a launch pad, this is Steve Plater at the 'Northwest 200' Steve hit the Kerb and
launched himself through the air so he didn't come to a dead stop he
had a big fall from height because he hit the kerb steve was also fine he had a few
fractures that needed attended to, but he was grand afterwards you can see, a
couple of fractures cervical spinal injury, chicken feed for a racer :) (3) Helmets :) this is this is one of my favorite
slides because this guy actually has a helmet it's down there, in the front of his bike, but
he's too cool for that :) Helmets have made an enormous
difference in reducing injuries this is a great example of it, this
is a chap called James McCann who crashed at 'Kells Road Races' now even if you're not
interested in motorcycle sport you can probably tell he's gone in too fast to
this corner and he's not making it so he had a crash, and he took out he took out this rider called James
McCann on his way, poor old James didn't know what hit him.
Now James slid along and he's sliding
towards what looks like a suspiciously soft grassy Bank there, but things
sometimes aren't always what they seem James hit this with his head and this is
about 210-Kmh / 130-MPH. By the way, and you can see this is actually a
stone wall so if you look very carefully he's
ripprd out the first stone with his head, there, and he proceeded to slide up
the road with lots of stones following him. So if you look you can see the sort of
stones that have been ripped out of that wall with James head, if you also
look along the grass verge you can see James up and walking about so there he is there, and the reason he's up
and walking about is because he's looking for his bike to get back onto it :) So mechanism of injury sometimes is
unreflective whenever it's describing people say, he slid along, hit a stone
wall, and you think, he looks suspiciously good. Helmets also come into their own if
there's a bit of wildlife about :) this happens quite a lot of phillip
island in Australia, it also happens in the 'ISLE OF MAN' TT - where you can collect
all sorts of wildlife, this is 290-Kmh / 180-MPH.
This is coming down to the top of Bray
Hill, a seagull to the forehead at 290-Kmh / 180-MPH, I can assure
you hurts, so helmets are quite good at protecting against the unexpected. (4) His helmet came off,
this is something that we used to hear a
bit the old style helmets are quite poor sort of central bits in them, so
sometimes they would rip the center of the helmet out, and the helmet would come
off and the lining would stay on the head. We don't see it so much anymore.
This is one that we did have recently though you can see the scene of the accident is
farther back up the road and the white object in the middle of the slide is the
guy's helmet this chap crashed at about 220-Kmh / 135-MPH at the same place that i showed earlier on,
'Cooly Hill' and his helmet came off as part of the accident his helmet came off because he got hit
by the bike and it split the helmet you can see it's sort of bull's-eyes and
crosshaired the helmet and it ripped it right off his head this guy was another shining example
of how well functioning pre-hospital team can change lives, because this guy
was GCS 3, blown pupil, unconscious, snoring, face down, helmet lying further up
the road, he had a rapid sequence induction, neuroprotective ventilation,
thoracostomies, pelvic binder, transferred to a
neurosurgical center, we had a dreadful head injury, but he got out
of hospital just in time for the birth of his baby daughter, so you can
actually change lives with a high performing team. If you're examining a
helmet be very careful with your assumptions these things are designed to be a
crumple zone so sometimes the helmet can look dreadful and the patient will be fine sometimes
the helmet can look fine on the patient will be dreadful so we do look at helmets, we do examine
them, but we don't draw too many conclusions from them now if you want a good example of a
high-functioning team this is probably as good as slide as any and this is a sort of 3 or 4
consultants working on a trauma patient the chap at the airway is a GP,
the chap doing the thoracostomies is me, that's an anesthetist, we have a cardiologist putting on
pelvic binder and oversight by a G.P.
General Practitioner so if you've got a good functioning team
any member of it should be able to do most roles. Broken feet reduced level
of consciousness this is one that caught us out a couple of times in the early
days, if someone has slid along at a significant speed and have hit something
feet first it's like fall from height so you'll get
the occasional typical calcaneal fractures in someone that's unconscious,
so if someone has broken feet and are a bit think obtunded, think internal cerebral hemorrhage or base of skull or high spinal. Okay helmet removal, helmet
removal is safe, I just wanted to put a couple slides in here, use 2 hands
2 people take the helmet off we do this about 200 times a year
we have no second a neurological sequelae, we've done about 2,000 over the
last 10 years taking helmets off is fine it's safe. Occasionally you need a plan
'B' though, we've had a couple of helmets I've seen someone hospital practice were a rider has crashed and the public roads and have lain for a while before
they've been found and they come in with their heads swolen into their
helmets and you can't physically get it off so our strategy for this if you've got
very little space in there sometimes the helmet simply won't come off, use the old jiggly saw, so if you do have
a helmet that stuck and simply will not come off you can destabilize it provide a route for
oxygenation and ventilation and then take it off in a controlled fashion so
if you use a jiggly destabilize it and just remove the entire front of it you'll get good access to the airway and
then you can then proceed in a controlled fashion so if you're, so you can get right at
the face, now this is not a plan 'A' this is a plan 'B' it's extremely rare for this ever to
happen, just take the helmet off would be my advice, if you're a
little bit worried about getting a jiggly saw in by someone's face
cut an ET tube and push that in first and that will give you a little conduit to put
your jiggly saw down through and then you can take the face plate
off, so very rare but a bit novel.
Now speed humps these are a curse, speed
humps are a device that are there to allow the rider to be more aerodynamic
on the bike so it allows the airflow over the motorcycle to be quite
smooth they have no relationship to safety
whatsoever what they do, is render someone in an un-intubateable
position if they're flat on their back so this is a rider lying flat on his
back with the speed hump in, and you can see from the position his neck is in, he is un-intubateable, the c-spine is not safe and you will not be able to intubatabe
this man, so it's the opposite of this position really so if you encounter someone with a speed
hump take it out it's very simple to do, if you just
run a knife down the outside and cut the leather the hump comes out, you can also then spin
it round and use it as a little pad for the back of the head to elevate them
into the neutral position, so we do this as almost the first thing we do when we
encounter a rider, cut the hump out and take it out of the
equation. Right last case i think this is a head-on collision apparently isolated femur it's virtually
impossible on a road bike they had something head on and just
break your femur because you always rotate around the tank, so the tank will hit the femur and the femur will open so if you get an isolated femur be
highly suspicious of the pelvic injury. Always put a binder on these guys if
they're in any way sketchy, this is one of my best mates, this is a guy called
'Herbie Ronan' again if you're not a motorcycle enthusiasts you can probably
recognize that Herbie is not making this corner he blames this chap on the yellow bike
exclusively for this accident and the guy on the yellow bike was nowhere
near him, but Herbie didn't have a good day, this is another suspiciously
soft looking hedge and again it's another suspiciously soft looking hedge with a
stone wall behind it, so Herbie went sliding up the road, and Herbie got his foot stuck in the hedge, and that opened his pelvis big style, so Herbie's boot got tore
off, you can probably see see it following him up
the road big pelvic splay injury there's the boot
following him, Herbie slid to a halt up the road and came to rest, and this is
not a great situation to come around and find your best mate, head down, fractured
pelvis, no boot, broken arm not in good shape at all, so Herbie,
we have a fair idea his pelvis was broken from the mechanism and from the fact that
Harvey said to us feck my pelvis is broken :) :) so There were two very strong diagnostic
clues in that picture, this is Herbie's X-ray not good, I'm pleased to say Herbie's now fine
again this is him in his element with an
ice cream, loving it :) so Herbie's now back racing again and after long
protracted stay in hospital so beware of the boot lying in the road,
so for some reason if you're about to have a crash in a motorbike your brain
reverts back to when you were 8 8 years old riding a BMX and you try and put your
foot down, I have no idea why this is but everyone does it this is a world champion that's about to
make a fairly sketchy overtake and he's panicked a little bit he's put his foot
down, if you put your foot on the ground 290-Kmh / 180-MPH you're foot will point
backwards within about half a second so the only way for a
motorcycle boot to get torn off if it's appropriately fastend and fitting is for
the foot to face backwards and that's the only way the boot can come
off, so if you find a boot in the middle of the road it means that leg has faced backwards
and the only way for that leg to face backwards at 160-kmh / 100-MPH is
for the foot to rotate the tibia and fibula to break, the femur to break, and
probably the pelvis as well, so if you find a boot has come off be very
suspicious this is what it looks like, the first
picture wasn't captured by the photographer, but if you look there
you can see a boot flying through the air so if you have a look high up in the
slide there's a boot so the rider that's just out of shot was coming down to start
finishing and the chap on the yellow bike panicked him a little bit, so he put his foot down and as soon as he did that his leg went
through a couple hundred degrees of rotation and tore his boot off, broke his
leg and he fell off the bike now there's a couple of things to notice from
this from the sequence of slides the first thing I want you to keep your eye
on is the guy sliding up the road with no boot on, so you can see him there
with no boot on and the other thing is the marshal
behind this pole because this man is like a ninja, he's unbelievable so this bike is coming at him
at probably about 210-Kmh / 130-MPH. And it's flying through the air there it is about
6' feet away from him at head height and again have a look at the chap sliding
up the road with no boot on.
So the bikes coming at him again, it's about 3' feet
away from his head now, and he's kind of he's casually taking his hands out of his
pockets :) and preparing to mosey mosey out of the way in a controlled
fashion, so the slide we see he's now had a wee sit down :) and the bike has hit the
telegraph pole just behind him and again you can see our chap sliding up the
road here in the foreground, and on the bike bounced off, and you can see this
marshal just bounces straight back up onto his feet again as if nothing has
happened so it's really quite impressive and he put his flag out then at that stage :)
So you can see our rider, when we arrived to him he had no obvious complaints apart from the
fact that his leg was sore and you could be fooled into thinking this is an
isolated ankle fracture but if the boot has come off there has been devastation
has gone on in that leg and we had a series of these now. LEM injuries are quite
prevalent in our sport so you can see this is a significant degloving injury, I like this slide for a couple reasons because there's the
first responders on team are a consultant anaesthetist senior paramedic and another
couple of paramedics are not one of them is looking at the degloved foot they're going through their structured
approach ABC CABC whichever you prefer and they've given
the obvious injury a damb good ignoring, and we have a cohort of these
guys now that are racing, and this is 'Robert McCrum' if you look very carefully you'll
see Robert's has a false leg on, this is Robert's walking leg this is Robert's racing leg, so he's got
two different legs the walking leg stays back in the paddock and the racing leg
goes on when he was out on the bike this is 'Robert McCrum' with his walking leg on
sitting in the paddock, Road Racers are tremendous that ignoring risk this is the first time that Robert was
back on the bike after his below knee amputation, and you can see he's quite pleased
that he's back out on a motorcycle again but Robert is tremendous and ignoring
risk, if you look closely in this photo you'll see first of all he's
sitting on 40 liters of aviation fuel :) and secondly he's smoking a roll up cigarette :)
That's pretty hardcore. So this is Robert the first time he was
back out, he won the senior classic championship
on the roads, and this is him with Dean Cooper who was the chap you saw on the other slide
with his foot degloved both back racing. So 4 mechanisms of concern
if you hear these be aware, he hit the kerb or the person has broken feet but
they're suspiciously unconscious there was a boot lying in the middle of
the road, or it was a head-on collision and apparently an isolated femur, and last
couple of slides I just wanted to do a couple of them if i'm okay for time.
So Spectators spectators are our biggest pain in the
ass the racers are fine spectators are a nightmare bloody
spectators as we call them because if you think road racers are good at
ignoring risk spectators are in another league altogether,
this is one chap for example :) it was watching the races at the 'Northwest 200'
and this guy, this slide is quite impressive, this slides even better when
you see where is, because every time we came round on a lap this guy was
swaying slightly more in the tree because between each race he would scuttle down
like a monkey and bring another six pack up with him back up to the top of the tree :) This is another great example of a
spectator, this chap we got called to at the 'Northwest 200' this guy was watching
the races, had a of feed a drink, needed to go for a piss, couldn't find anywhere
thought that cliff edge looks like the very spot.
So this chap sort of rambled up to the cliff
edge and was having a pee off the edge of it as you do, he got caught by an unexpected
gust of wind and over he went, this is over 100' feet
of a drop, we know that because we couldn't winch with a
helicopter, we had to do a ground winch. This is a great human factor slide
as well, this guy was very badly injured and closed head injury GCS 6, obvious
humerus, pelvis, femur, he'd had a big smack so intubated, and then we had to
get him out. A great human factors slide because this is me here, we
don't train for winch retrieval because there's only one cliff in northern
Ireland and this is it :) This chap fell off it, so it wasn't
something that we had really prepared for, so if you look from left to right
you'll see a hard hat, hard hat, Hard hat woolly hat :) and if you look from left to
right you'll see safety harness, safety harness, safety harness, and see if you can spot
my safety harness in this picture :) there it is down there at the bottom of the cliff.
So I was about 80' feet up when I realized that I didn't have my harness on, and i can tell
you I had a Kung-fu death grip on that stretcher :) So this guy got winched up did very
well, we flew him to again to the most appropriate hospital with appropriate
anesthesia and he did very well and he actually released a press release, and
said I'd like to thank all the staff at the Royal Victoria Hospital who helped me
intensive care, surgeons, nursing staff. One of our paramedics said
afterwards no that's gratitude for you how does he think he got there ?
In Santa's Fecking Sleigh! :) :) So, sometimes your input is
unappreciated, but that's not why we do it, We do it, for this reason! So I think that's me out of time,
so I think I'll stop there.
So thank you very much. Wow that was an awesome talk, thank you
very much does anyone have any questions to put to
this man he's clearly seen it all. And practice and I mean we we do the way
that we run this usually we do the first lap of each risk the warm-up lap in the
last lap and that allows us a bit of oversight so we do the first lap last lap and warm
up lap for a few reasons so if an incident is going to happen it will
usually be on one of those three when you have a pack heading out
together on cold tires for fuel loads and it means that we have oversight as
well so if something has happened on the last lap of various has been lost and
radio traffic we can still pick it up and it allows us
to keep a little bit of temperature in the tires so just enough to go ecology has yeah we do it's one of the reasons we
put such a strong perspective in the scene sometimes we will get through them and
they're so soon after the incident and these guys are operating up to your
close to their lactate threshold this has been quite well studied and
professional motorcyclists there they're like any other athlete throughout their
lock threshold so all of them are sweaty all the more tachycardic all of the
dreadful and some of them are altered because they're very agitated they want
up you know they've just crashed out of the race and so you sometimes have to take a
little creative time just to let the dust settle and I like him to declare
themselves and be cognizant of what just happened to them so if we see is some of the scenes that
we've seen with the writers been fine we give them a couple of minutes to
declare themselves and the flip side is true as well and there's been some bad
talks done recently a directed graph the visas talked about the impact bring out
there and we see that a lot we see lots of guys that you get to them
and build up dad you know they're there are no breathing
they're blue or black you take the helmet off you do simple
maneuvers provide oxygen while you're setting up for an RSI and by the time
you've set up your cat dump their week and they're saying you know what what
happened was the bike or position of my own that I went to sort of thing so so
we see that a lot we see me before five of those a year and it's just a sort of
reflection on this sort of quickly were on scene and because we have the luxury
of being side these guys often let me crash but we do see that a lot more
simpler way maneuvers and these guys are back on our feet in a few minutes speed the live is another yes they are I have lots of slides and
this is well but just time was of the essence so they have the letters are
becoming more and more and elaborate before it was just lather at now you've
got angry skin and there's ray skin on some of the abrasion areas and this
areas of titanium hips are reinforced Kevlar and so you have to the structured
approach the calling ladders if you just go out it with a part of
cuts and try and cut through race again you have no chance and so you have to
take a moment and actually it's a nearly like finding an extrication from the
vehicle you have to look at the person's letters
and decide where the seams or the stretch panels where's the reinforced areas I'm going
to cut this so that it doesn't turn into a bitch recession and ideally you want
the ladders to come off and look a bit like a bear skin rug afterwards so there's only a couple of cuts and a
whole thing falls away but you did it does take a bit of forward planning to
come up with a strategy for each different set of letters each
manufacturer will be slightly different yeah quad bikes i think pined for pine
to the most dangerous vehicle in the entire world so that's why i only have
to them the quad bike sir are a funny based
because it's quite difficult to be ejected from a quad bike without it
rolling over you and that's the classic quad bike injury is a rollover injury
and where someone flipped it on the bikers has provided over the top of them
so they seem to be tremendously unforgiving so i would say and be aware
these patients come have continuous injuries and different body systems and
and that seems to be the our findings from quad bikes is that you rarely have
an isolated injury because the only way ready to break your tab and fed with a
quad bike is for it to roll over the whole body so be aware and like any trauma patient
you know it expect the unexpected with them yeah yeah this there's a lot of work has gone into
this cat and a rate which we've gone through a thief it through a few things
as we tried Thomas packs and which was impossible you know after three weeks or three days
of the Northwest 200 you just you can try them anymore so this system is an American system at
swedish and it's four punches that said at waist level so when your site on the bike was very
light load on you and it keeps the center of gravity in the middle so it
doesn't really affect writing and in the backpack we try to keep the weird as low
as possible in it so we still care about 20 25 kilos worth
of cat but it's spread quite nice and evenly and and there's a lot of work
goes into try and keep ourselves reasonably fit for the start of the
racing season because this is hard work this is really hard work and and it's
difficult jumping out of a helicopter to treat someone it's even more difficult if you have to
write nine miles flight on cold tires and operating a hundred eighty miles an
hour at times and then jump off and then run into a field and then treat the
patient so there's so we have to the equipment
has to be right and yourself has to be right and free hospital medicine is
probably one of the only feelings in medicine were your health can actually
even in an impact on the patient cycle so we think very carefully about how we
package the kit and we keep ourselves and reasonable next so that we can do
the job yeah we control the tightly in the systems
that we run a very very robust and this radio communication from every side .
Around the circuit and in between so that we usually set off before the race
is nearly come to stop so if an incident happens it stopped by
way of red flags so flags might everyone slows the racing
speed dying and we go life so by the time that we reach an accident
the track is still life but controlled and and then whenever you reach the
accident the bikes will start to filter back to
the grid and then the track is it still not open and but that's when you'll find
that for example spectators start wandering Knight and so part of our
strategy is to go quickly and the citizen instance declared and then the
circuit can be gradually brought down to stop and I'm bringing something like the
northwest 200 to stop this very difficult you can have 50 bikes over
nine miles holding three figure speeds and so it has to be it can't just be
stopped it has to be sort of brought down
gradually over a minute or so and so we do have quite a lot of systems and
placed to make it see if okay one final question from anybody ok but track it depends we have a number of people
that would be able to set up to transfer and when we used to just pick the most
appropriate one and method for transfer is quite difficult northern islands the
only place in Europe that doesn't have an air ambulance we don't have a helipad that are
allegedly regional trauma center and so we very often do most of our transfers
by land and which is why the the interventions done on scene and on writ
or so important and so we do you like any service to try and deliver them as
optimized as we possibly can generally if it's a big enough incident
that all the medical staff for that will attempted and four races stopped and
everyone just comes and generally they arrived in dribs and drabs as they can and so there is everyone's usually
involved in some way and either infrastructure taking care of the track
you fearing an exit for the ambulance and so everyone is usually fairly brief
as to what's happening and then the most appropriate person goes yeah yeah.
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