Kato Accident

[andrewmizzi]

First of all I'm sorry to hear of the passing of Dijiro Kato, I'm sure he'll be missed.

Anyway, I watched that race which was at Suzuka and it seemed to me that they moved him very quickly. I saw a 3 guys running towards the accident, one waving the yellow flag frantically, and the other 2 with the spine board.

I have a limited amount of knowledge, but I do know how to move someone onto a spineboard properly, and it seemed to me that they didn't do any form of assessment of Kato on the track. They got there, rolled him onto his side and placed the spineboard underneath him.

I spoke to a race medic regarding this at a recent race and he couldn't believe what he saw.

What is the stardard procedure then for first responders etc. to accidents where the injured is on the track?

[Mark Mitchell]

That's Bike Marshal's for you!

[Bruce_Parrot]

(Which seems to be prevalent in this forum whenever motorcycle racing is mentioned)

I have been involved in British Superbike marshalling for many years. Normally it is the reponsibility of the Incident Officer (IO = Sector marshal) at the scene to do a quick assessment and decide on appropriate action. This incident looked to me like a certain red flag, though in BSB we have the option of a pace car. In Racesafe ALL marshals are taught casualty handling using a scoop stretcher or spinal board by one of the series senior medical people. It is practised at every winter traning session and usually several times during the season. We use it a lot and have not damaged a casualty yet.

Often the pace car will give you plenty of time to move the casualty in safety, though if the situation warrants it , this can be upgraded to a red flag, which is exactly what happened at the Sntterton BSB meeting. We have been using pace car for a few years now and is has been so succesful that it has been adopted by World Superbikes and MotoGP (and some other motorsports) though I believe that MotoGP will only use it for climatic problems.

It's worth noting that MotoGP race management has a reputation of being notoriously reluctant to stop races which puts that marshals on the scene under great pressure. We don't have that problem with BSB or WSB (a world SuperSport race was stoped three times at Brands in pre-pace car 2002)

[paddy]

As a trained first responder I cannot believe what I'm reading here .If a casualty has suspected spinal injuries, which in the case of falling off a bike you will have, then only trained medics should move the person. You should always suspect spinal injuries and act accordingly. The race should be stopped immediately and the casualty treated in situ until a doctor or paramedic decides differently.
There should never be a reluctance to red flag a race at whatever level to treat an injured rider and allow marshals and meics to assist in safety.
If such basics cannot be put in place then riders should refuse to race. They could well end up being paralysed by poor treatment and not directly by the accident.

[Stephen Green]

Just a quick comment before we get back to the point of the thread.

We all know there are rivalries and in many aspects differences between bike and car marshalling. However, let's remember that this is a MARSHAL's forum which means we embrace ALL forms of marshalling. Please try to refrain from knocking one or the other!

Getting back to the forum topic once again, I suspect that the case in point highlights the differences in marshalling standards from one country to another. It would be nice to think that there were an organisation that was committed to global training and an equalising of standards throughout the sport.

My personal view is that Paddy has the right answer and that it is always better to wait for a trained medical person before moving the patient, especially so in the case of suspected back or spinal injuries. Organisers should be made aware that the rider/driver's health is of the utmost importance and that racing is very much the secondary concern.

[Dave Brand]

I didn't see enough of the Kato incident to comment in detail on it. However, from what I saw on the BBC's coverage it did appear that the first people to him had no idea how to use a scoop stretcher.

Moving from the specific to the general, I have had training in the use of the scoop stretcher, but I also appreciate that, in the wrong hands, it can be a very dangerous tool.

I am not a medic, I'm a marshal. There are very few possible scenarios in which I am prepared to use a scoop stretcher to move a fallen rider without medical supervision. I firmly believe that an unconscious rider should never be moved by anyone other than experienced medical personnel. Even if the rider's conscious, great care must be exercised - one thing I've learnt is that, because of the effects of adrenalin(?), a rider who's just crashed may not be feeling the pain from an injury; a few minutes later he can be in agony.

One of the basic rules of marshalling is never to do anything you consider to be unsafe. On that basis, I am prepared to refuse a request to move an injured rider if I consider it unsafe to do so; I expect the IOs I work with to be professional enough in thair approach to the job to ensure that I am never in the position of having to refuse.

[andrewmizzi]

Is anyone supprised that there isn't any debate over this topic in the media, especially after Kato's death. It always takes something bad to happen before anything is done to resolve the problem.

I don't want to lay blame at anyone, as its unknown where Kato recieved which injuries from where, and the first responders are fellow marshals in the marshalling community, so I guess my question is, will anything change to do with practices which we saw, red flags/pace cars, etc?

[Mark Mitchell]

Originally posted by observer
That's Bike Marshal's for you!

This comment was unfair and for that I apologise.

[Stephen Green]

That's cool...

[Muppetrescue]

As an EMT running a rescue unit I have to keep my teams well drilled in using spine boards and scoop stretchers. However the use of these is dictated by what you find during a patients primary survey. No patient should be moved until an assessment of airway , breathing , circulation and cervical spine has been completed at absolute minimum.

My own teams operate on over 60 days of the year at car, bike , kart rallycross, rally sprint and rallies and they can get rusty and miss things if not continuously training.
I would be very nervous about letting entirely non medical personnel move riders without a full assessment. Circulatory, neurological and motor function must be assessed both before during and after application of any immobilisation device. Also no spinal immobilisation system is complete without a cervical collar and I do not see these being measured or applied at Moto Gp events. Some may argue that manual stabilisation can be applied. That is fine at an RTA with a 10 yard walk on smooth tarmac , with all the trip hazards at a race track it is unwise. There are well documented studies that show a couple of things;

1) There is no one device that immobilises perfectly. Combinations of collars, boards and vaccum mattresses have been shown to be the most effective.

2) A significant portion ( 10% + )of spinal damage is caused by rescuers attempts to extricate / treat patients.

This may all come across as a little intense but I am due in the High Courts tomorrow as a witness in a personal injuries action against our circuit where a rider was paralsyed 12 years ago. I was the medic on scene treating him as we had a multi bike incident and the docs were dealing with a blocked airway on an unconscious rider. I will have to detail every action I took and why I took it. With the memories of seeing Wayne Rainey sprawled on a stretcher being jog trotted into a medical centre I am a little bit concerned about the perception of Emergency Care trackside.

[Gizmo]

As a r4escue crew member I have to agree entirely with muppetrescue`s comments and in particular we should all take note of the last paragraph. Only yesterday I was discussing such matters with our paramedic at Loton Park during a British Hillclimb round. when we got on to helmet removal he stressed that he NEVER removes the helmet either trackside or during his day /night job, he insists on taking control of the head, reason is simple, he is the qualified medic on scene and as such is responsible for events at the scene, he does not expect unqualified personnel to take that responsibility.

[andrewmizzi]

Any speculations on why they moved him so quickly then?

[Lee Janotta]

Poor judgement and poor training, I'd guess.

Sadly, with Kato, it wouldn't have made a difference in the eventual outcome no matter what they'd done. But the way he was removed from the track was, by all accounts, inexcusable. And rather than sharply criticising the Suzuka facility, there needs to be an official FIM inquiry into and upgrading of marshalling standards and emergency procedures in Japan, for the benefit of everyone who races there.

I'm sure the people on the scene were doing what they thought was best, but it was a shameful display of incompetence and unpreparedness.

[andrewmizzi]

Is it standard for marshals or IO's to have a spinal board on hand?

I would have thought only medical's had spinal boards.

[Stephen Green]

Certainly not for car meetings, nor I suspect for bikes.

[Dave Brand]

Originally posted by andrewmizzi
Is it standard for marshals or IO's to have a spinal board on hand?

In the UK, for BSB, WSB & MotoGP there's a scoop stretcher, not a spinal board, on every post. There will also usually be some medical presence on each post, at least a trained first-aider (St John's, Red Cross) & quite often a doctor. (Although at least on of the doctors is a gynaecologist! )

[andrewmizzi]

Thanks Dave.

Does that then mean that the people that attended straight away to Kato were medical's, since they used a spinal board with him? Or is that just a supply problem, that they were given a spinal board.

[EvilPumpkin]

Well I have had a certain level of training although I'm not at first responder level and my attitude is that if they're breathing and not gushing blood, that's what we have rescue crews for. My job is to keep them stable, keep them calm, maybe start a prelim assessment if appropriate and yell for the cavalry. Where necessary, I'm ok with taking c-spine immobilise until they show up, but that's about as far as I'm prepared to take it unless the circumstances are extreme. Even with a non-breathing casualty, I'm going to have full assistance within 45 seconds to a minute - which is barely (if even) enough time to safely get the helmet off (assuming you have another marshal with you also trained in helmet removal), let alone begin CPR.

A lot depends on local protocols and the relationship between marshals and rescue/medical backup. We're lucky at Mondello in that we all know our Rescue Crews and are all aware of how these things should be handled.

However, I don't think this is the case with all circuits. If there was a falldown in this case, it may well have been lack of communication between the marshals representatives and the medical teams on precisely who was responsible for what?

[Dave Brand]

Originally posted by andrewmizzi
Does that then mean that the people that attended straight away to Kato were medical's, since they used a spinal board with him?

I didn't see enough of the incident to be able to make informed comment - I prefer to be able to quoter facts, not speculate.

I don't know who the first people to Kato were, but it appeared to me that they were carrying a scoop stretcher, NOT a spinal board. The scoop stretcher is designed to be opened up so that the parts which support the casualty can be slid under him, the stretcher locked together & the casualty lifted with support under most of the body. Whether the scoop stretcher was used properly in this instance I will leave to others with more knowledge than me to comment on.

[Bruce_Parrot]

Wish I could look at this more times a day to join in.

Re moving casualties, yes in BSB we do move casualties regularly but NOT if a spinal injury is supected, that would always be a red flag. On the other hand some argue that ANY casualty should be suspected as having a spinal injury, and only a qualified medic (or even an x ray can show other wise) but that is hardly practical as then every faller would result in a stopped race.

So how do we proceed , well you train your people to recognise when it is very unlikely that a faller has a spinal injury and it is safe to move them. Then you move them as if they did have one. The number of casualties I have moved in this way is well in to three figures without mishap.

To put this in context we do indeed have a Gynaecologist amongst the medical people, last time I came across him he asked me to take charge of moving the casualty "as you have more experience than me". I worry that sometimes we stick to fixed rules in almost a "jobsworth" way, in defiance of common sense and to the detriment of the sport.

Re helmet removal. Yes I have done it in emergency circumstances on a very few occaisions and the argument I give for it, is that there is one person alive who would not be if I had not removed his helmet and cleared his airway. This was confirmed to me by the track chief MO on the day. Toby Branfoot and other medics who are deeply involved with motorcycle racing have put a huge amount of effort into getting the message across that a helmet *should* be removed when circumstances demand, and I for one am convinced.

[EvilPumpkin]

Bruce - sounds to me like you have things organised and everyone knows what they're supposed to be doing - and where necessary, how to do it. That's the way it should be.

[Dave Brand]

Originally posted by Bruce_Parrot
I worry that sometimes we stick to fixed rules in almost a "jobsworth" way, in defiance of common sense and to the detriment of the sport.

That's a good point! No two incidents are ever the same, the competences of the teams vary from post to post,etc. The rules provide the framework within which we work, but they cannot possibly cover every eventuality; it's up to every individual to do the job to the best of his/her ability in the safest possible way.

As for the gynaecologist, I've worked with him a couple of times; a great guy to have on post, even if the chances of a rider giving birth during a race are fairly remote!

[Gizmo]

Bruce, an interesting point although I would stress that helmets should only be removed if there is a restricted airway and that an airway can most often be cleared WITHOUT removing the helmet. It should be understood that ABC is always the way to go with c spine immob after A but that an intact c spine is bugger all good without an airway. To further complicate matters most medics will say that it is not always that easy to achieve one without compromising the other. EP has got it right, keep em still, safe and calm until the cavalry arrive, they aint that far away.

[DarrellB]

Gizmo raises a good point that helmet removal is only really urgent if an airway is unable to be maintained and this would need qualified medical assistance to achieve. Basic airway management can be done with a helmet in place. helmet removal is one of those things that takes much parctice and most marshals will only have limited opportunity for this practice. Even some experience rescue personnel do not get regular experience in anger and have a great deal of training organised for this reason.

[DarrellB]

As for the use of a scoop strecher these do not provide any spinal support for potential spinal injuries and are rarely used by rescue personnel who will use a spinal board which privides better support or even better a vacuum mattress. With bikers the other problem it the humps fitted to the back of their leathers these also cause problems with spine control and are not ideal with the use of a scoop.