Dr. Alin Simionica MBChB 1, Dr. David B. Stevens MBE 2, Mr. David Hedley MBChB FRCS PGDipFLM 3
1. Noble’s Hospital
2. Motorsport Medical Services
3. Noble’s Hospital
The Isle of Man is the motorcycle Road Racing Capital of the World with a speed record for the 37¾ miles long TT Course of over 130mph. Incidents are dealt with by a huge band of volunteers and casualty scoop stretcher evacuation by helicopter can be complicated by a riders protective clothing, requiring the unique solution below.
In the exciting world of motorcycle racing, incidents are an inevitable component. Even with continuous improvement in safety regulations and equipment, incidents still occur with an average on the Isle of Man of over 80 during each fortnight of the TT and MGP Races1.
Many of the present riders wear leather suits which incorporate a hump on the back. This is thought to improve straight line speed because of its aerodynamic effect on airflow. There are no official results for its efficiency but it is considered a must in the professional racing community. They may also contain data-logging equipment, or fluids in warmer climates, but they are not a safety device to protect the back.
From the medical point of view, the problem with the leather humps comes after a racing incident. According to ATLS Guidelines2, the cervical spine needs to be immobilised until an injury is ruled out. When a casualty is lying supine, it causes thoracic flexion with cervicothoracic junction hyperextension and lateral instability of the body. This may lead to spinal displacement and make laryngoscopy and intubation practically impossible. For these reasons, medical teams across the world either have to cut out the hump or use some sort of improvised support.
During the two main motorcycle events on the Isle of Man, the Motorsport Medical Services3 is the voluntary organisation that provides the pre-hospital medical and rescue care and equipment.
Two helicopters are used for transporting injured riders to Noble’s Hospital A&E Department. Scoop stretchers are the preferred transfer device as long spinal boards are not compatible with the aircraft.
Because of the possible increased risk of injuries when using a scalpel at an incident site with a trauma patient in a log-roll position, the helicopter crew prefer to deal with the leather hump problem by using a special head rest.
The person who came up with the idea and the design was Dr David B. Stevens, MBE, Medical Director for Isle of Man Motorsport Medical Services. After having to use anything from spectator’s clothing to hospital pillows for support, he identified the need for something to take up the gap between the back of the head and the scoop. This had to be soft enough and high enough on each side to provide a degree of stability of the head and stop it rolling to one side or the other. The high sides, with the head in the middle, could be taped across if necessary. The width of the head rest was wide enough to fit in the top section of a scoop stretcher, which stopped it sliding around. A sufficiently firm surface was needed, especially in the helicopter where the vibrations are transmitted through the aircraft’s fixed stretcher and the scoop stretcher, to the patients head.
For many of the older competitors and even younger ones, the red head rest takes up the gap between the back of the head and the scoop stretcher caused by the normal thoracic kyphosis. Whilst the red head rest is used in the vast majority of patients, the marshals and the medics are instructed that when they put the head rest into position, if it produces hyperflexion of the neck, then they are to replace it with something a lot thinner.
There are now many race fans who wear these humps for casual motorcycling. When they become involved in road traffic incidents, the Isle of Man Ambulance Service and Noble’s Hospital staff have found the red head rests to be an invaluable addition to their management repertoire.
In its sixth year, the red head rest has developed into an essential tool for the emergency services on the Island, making motorcycle trauma management easier and hopefully decreasing the number of post-trauma cervical spine complications.
1- Isle of Man Motorsport Medical Services; TT Course Incident Management Green Book, 19th edition
2- American College of Surgeons Committee on Trauma; ATLS Student Course Manual, 8th edition
3- Motorsport Medical Services website: www.mms.org.im