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To Flag Or Not To Flag – Motorcycle Racers Deserve Basic Medical Assessment, Too

I want to make two things clear before you read the remainder of this article. First, I am acting as a journalist, and I have no medical training. The medical procedures described below are simply summarized from basic trauma care described by medical experts writing for the web site TRAUMA.ORG, as well as the assistance of reader (and club racer) Barry R. Ellman, MD FACS (thanks, Barry). Dr. Ellman is an Assistant Professor of Surgery who has actually trained Emergency Medical Technicians (“EMTs”) and paramedics in the trauma assessment techniques described in this article. Second, this article is not intended as an analysis of the Kato incident, nor as speculation as to the cause of his death, but merely to focus on a general rider safety issue.

The circumstances surrounding the fatal crash of Daijiro Kato have brought focus to an important issue of rider safety that (as far as we know) has not been fully addressed by any sanctioning body to date. This being the inconsistent use of the red flag to stop a race when an injured rider is down on the racing surface or in an impact zone. This article will attempt to illustrate the necessity of employing the red flag ANY time such circumstances occur. Meaning that if the rider appears immobilized the race must be stopped immediately to allow him to be properly treated by emergency personnel.

When an EMT arrives to treat an injured rider, his assessment of the rider’s condition follows the “ABCs” – airway, breathing, and circulation. If the rider is conscious, the EMT can talk to the rider as part of this assessment. However, if the rider is unconscious (frequently the case in motorcycle crashes), the EMT must assess any possible injuries resulting from the crash circumstances and assume that all these injuries are present when implementing his treatment of the rider. This assumption of injuries will remain until proven incorrect.

Assessment by a trained emergency medical technician is particularly important in cases where the possibility exists of neck/spinal cord injury. In researching this article, I have referenced a medical paper on TRAUMA.ORG entitled “Initial Assessment of Spinal Trauma”. According to this paper, “all patients with sufficient mechanism of injury [blunt trauma] to lead to a spinal injury should be considered to have a spinal injury until proven otherwise”. The document goes on to outline the technique for handling a patient who might have a spinal injury, stressing the importance of immobilizing and protecting the spine to prevent further aggravation of spinal injuries already present. Throughout these instructions there is emphasis on inducing as little movement as possible in the patient’s neck/spinal cord region.

The severity of a spinal cord injury can be increased by improper handling of the patient. Because the vertebrae surround the spinal cord like the sheath of an electrical wire, a broken vertebrae can sever the spinal cord if the spine is shifted in a certain direction. Partially or completely severing the spinal cord can cause paralysis.

It seems obvious that the observation of correct treatment procedure for an injured rider is made infinitely more difficult if both the rider and medical personnel themselves are in the midst of a continuing race. Besides the fact that an EMT working in a racing environment must consider the ongoing threat to him and his patient, imagine the difficulty of talking to an injured rider (or listening for breathing in an unconscious rider wearing a helmet) over the roar of race bikes.

Red-flagging the race after a crash where the rider does not immediately stand up and walk away (or otherwise objectively indicate he is not in need of immediate trauma assessment) appears to be the only way to afford that rider the medical assessment and care he needs, and is entitled to.