Motorcycle rescue sim from SMACC Dublin 2016

Training as a team is really important. Technical skills are honed, communication becomes targeted and succinct and deficits are identified and can be troubleshot. Organising and running team training sessions takes a lot of work and commitment on everyone's part, but it pays dividends.

The Social Media And Critical Care (SMACC) conference does its best to evolve each year and seeks to explore some of the outer edge areas of acute care medicine. Last year's conference was held in Dublin and amongst many of the well run prehospital workshops was a session on motorsport medicine. It consisted of a motorcycle road race scenario played out by the MCI Medical Team (with whom Dr John Hinds formerly worked), followed by an expert panel discussion that covered topics such as the differences and similarities between civilian and motorsport prehospital medicine, impact brain apnoea and managing celebrity patients in the age of social media.

There is a lot of good stuff in here, so it is a well spent 36 minutes.

Here is the video:

If you just want the audio (but really, watch at least the simulated scenario), here it is:

These media were originally released via the SMACC website here: Motorcycle simulation -

Podcast 16 – Michael Hoffer and Virtual Reality for concussion

(Image from Dr S. Olvey's presentation slides at the ICMS 2016 AGM)

More concussion. We can't get enough of it. It has mushroomed over the past few years and is firmly in the public awareness, especially amongst sports competitors.

Until recently, there have been two levels of diagnosis; point of care and clinic-based. Point of care testing occurs on the sidelines or in the event medical centre and needs to be:
  • rapid,
  • easily applied,
  • cheap,
  • easily accessible
  • and have good test characteristics (sensitivity, specificity, PPV, NPV, repeatability, reliability and validity).
For this, in addition to clinical assessment we have test like the ImPACT, SCAT and King-Devick which we've discussed previously.

Clinic testing, while more accurate, tends to:
  • require specialised training to conduct and interpret
  • need a specific appointment to attend which take a reasonable amount of time
  • be conducted only at specific centres
  • be expensive

If only there was something to bridge the gap.

Luckily, some plucky researchers and engineers have taken a simple concept that uses bulky equipment and applied virtual reality style technology to try and develop a portable, easy to use and interpret diagnostic modality for concussion called the IPAS Goggles. And they sound great.

Prof. Michael Hoffer is one of the lead researchers on this project and I met him briefly at the recent ICMS meeting in Indianapolis where he showed me how the goggles work. He agreed to come on the podcast and discuss the background to the goggles and the evidence that his team has produced to date. He also talks about issues such as the potential to game some of the current sideline assessment tools that use a baseline, the potential for young, fit athletes to outperform tests even when impaired (similar to how they may outrun a treadmill ECG during assessment for chest pain) and a little bit about the potential for placing commercial gain over test validity for conditions such as concussion that may be hard to diagnose and yet have significant possible consequences and popular and media attention.

The IPAS set up at the ICMS conference.

An example of the real-time data display

Here's the podcast

Here are three papers that link vestibulo-occular deficit to concussion:

And an overview of occular defects in concussion in general:

Sports-Related Concussion: The Eyes Have It. Leonard V Messner. Department of Optometry, The Illinois College of Optometry, USA.

Here are the two published papers mentioned by Michael in the podcast:

Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury. Balaban C, Hoffer ME, Szczupak M, Snapp H, Crawford J, et al. PLoS ONE 11(9)(2016): e0162168. doi: 10.1371/journal.pone.0162168. PubMed PMID:27654131
Clinical trials in mild traumatic braininjury. Hoffer ME, Szczupak M, Balaban C. J Neurosci Methods. 2016 Apr 30. pii: S0165-0270(16)30073-5. doi: 0.1016/j.jneumeth.2016.04.021. [Epub ahead of print] PubMed PMID: 27141855.

One concern regarding these goggles is that they rely on the concept of occulovestibular dysfunction (measured via reaction time; hence OVRT) reflecting the presence of concussion through disturbance of vestibulo-occular reflexes such as the optokinetic relex, cervico-occlar reflex and the vestibulocolic (not what you think that is) reflex. Reports suggest that anywhere between 10-80% of concussed patients with have an occulovestibular defect (either of version or vergence). So while the sensitivity of the goggles might be excellent in patients with an occulovestibular defect following concussion, what is it for a concussed patient with no OV deficit and therefore should test candidates be pre-screened for dizziness, vertigo, balance and visual impairment first?
(Version = saccadic movement, gaze fixation and smooth pursuit. Vergence = diplopia, accomodation, strabisumus)

If you want to know more, you can email Michael Hoffer directly or go and have a look at the NKI website.

What do you think? Possible game-changer?

Podcast 15 – Fabian Berger, tornado jets and human factors training

Fabian Berger is a tornado pilot with the German air force and amateur race car driver. He is also an aircraft accident investigator.

He was inspired to take his aviation experience of simulator based training, crew resource management (Fabian calls it Race Resource Management to better contextualise it) and human factors education to race officials and motorsport medics, so that's what he did through the DMSB in Germany.

I caught up with him after his talk at the FIA Institute's chief medical officers seminar last week in Vienna. This stuff has been evolving rapidly over the last few years in critical care medicine (ED, ICU, anaesthetics and prehospital medicine) and there is every reason to put it to use in motorsport medicine as well.

Keep an eye on this site as I should have a summary of the two day CMO seminar ready to publish very soon. It's quite lengthy (You'll find out why) so I will probably split it up over a couple of posts.

Here is the podcast:

Here are some additional resources for simulation training, human factors training and crisis resource management:

The EM Mindset by Chris Hicks (@HumanFact0rz) on emDocs

The Fog of War: Training the Resuscitationist Mind also by Chris Hicks on the EM Crit podcast

The Flow Model: Balancing challenge and skills on

Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments. Jesse Spurr, Jonathan Gatward, Nikita Joshi, Simon D Carley. Emerg Med J. 11 March 2016.

MobileSim - An excellent in-situ sim resource blog by critical care physician Jon Gatward (@jgatward)

Simulcast - An evolving simulation-based educational blog and podcast resource by Jesse Spur (@Inject_Orange) and Victoria Brazil (@SocraticEM)

Podcast 14 – Dan Marin, the ICMS and PRI_2015

Motorsport medicine is a lot of fun. There are fast cars, (mostly) good drivers and you get to work with a small group of similarly aligned individuals in a fairly challenging environment. Often it's the social aspect and the things that you learn along the way that keeps you coming back.

And medical conferences play on that socialising/networking/learing framework. So thankfully there are a handful of motorsport medicine conferences at various times of the year. Last year I went to my second FIA Medicine in Motorsport Summit and at the begining of this year I was at Trauma and Extrication Management (TEM2015) meeting at Mondello Park in Ireland.

In a bit over a week, the International Council for Motorsport Science are hosting their annual medical conference in partnership with the Performance Racing Industries trade show (PRI2015). It's a North American conference I've heard a lot about but I can't go this year. So I tracked down the conveynor, Dr Dan Marin, and recorded a podcast, asking him about the work of the ICMS and the medical program at the PRI2015 event, which includes a practical day out on the Indianapolis race track (I'm a little bit jealous). You can listen to the podcast here:

Feel free to leave comments or questions below.

Podcast 13 – The medical communicator role with Don DiGiglio

I've been chasing this podcast for a while now. My guest for this one is Mr Don DiGiglio, who has been the medical communications operator for the Formula 1 GP since it started in Adelaide. At the recent WRC Rally Australia in Coff's harbour I finally managed to convince Don to sit down over a cup of tea and a choccy bickie and chat about this often under appreciated role.

It can be a tricky job, balancing the communication demands of the medical and rescue teams as well as what is going on in race control. And there are additional aspects that Don brings up that many people may not be aware of.

Here's a picture of the Formula 1 race control room from 2014:

This is the race control at the V8 Supercar event from August of this year:

And here is the rally base control room at the 2011 WRC Rally Australia:

So sit back and enjoy Don's velvety tones.