Elite Motorcycle Racing: Crash Types and Injury Patterns in the MotoGP Class.

BACKGROUND: Crashes are a small but regular feature of elite motorcycle racing. These crashes provide a novel opportunity to benchmark and analyze motorcycle crash mechanics, crash types, and associated injuries at high speeds in a cohort of riders who are well protected and in a controlled environment. PURPOSE: The purpose was to benchmark the prevalence of injuries, categorize crash subtypes, and determine associated injury patterns. METHODS: This was an institutional review board-approved, prospective observational cohort study of MotoGP riders for 1 racing season in 3 venues. Accident type was determined by race-marshal report and visual analysis of race footage for each crash. Accident types were defined as lowside (falling toward the inside of the turn), highside (falling over and toward the outside of the turn), and topside (going over the handlebars of the motorcycle). Specific injuries and hospital admission data were collected using a standardized data collection form. Basic descriptive statistics were performed on all categorical variables. We used the exact binomial test examine the association between accident type and retirement from race, transport to medical building, transport to hospital, and injuries sustained. RESULTS: Crash prevalence was 9.7 per hundred rider hours. There were 78 crashes: 58 lowsides, 13 highsides, 2 topsides, and 5 indeterminate. In the lowside group (n = 58), 19 (95% confidence interval [CI], 0.21-0.46) riders retired, 0 required emergent transportation to the track facility or to the hospital, and 1 (95% CI, <0.1-0.9) significant injury was noted. In the highside group (n = 13), 10 (95% CI, 0.46-0.95) retired, 9 (95% CI, 0.39-0.91) were transported to the track medical facility, and 3 (95% CI, 0.05-0.54) were admitted to the hospital. In the highside group, there were 7 (95% CI, 0.25-0.81) significant injuries. In the topside group, both riders were retired with 1 hospital admission. Lowside crashes had a lower rate of retirement from race, emergent transport, and significant injuries compared with highside crashes. CONCLUSIONS: Lowside crashes are lower risk than highside crashes. Most highside crashes are caused by oversteering to prevent an impending lowside crash. Strategies to reduce oversteering to prevent a lowside crash may reduce highside crashes, enhance the safety for riders in MotoGP racing, and be applicable to recreational motorcycle riding.

Medical support at a large-scale motorsports mass-gathering event: the inaugural Formula One United States Grand Prix in Austin, Texas.

INTRODUCTION: Formula One returned to the United States on November 16-18, 2012, with the inaugural United States Grand Prix in Austin, Texas. Medical preparedness for motorsports events represents a unique challenge due to the potential for a high number of spectators seeking medical attention, and the possibility for a mass-casualty situation. Adequate preparation requires close collaboration across public safety agencies and hospital networks to minimize impact on Emergency Medical Services (EMS) resources. HYPOTHESIS/PROBLEM: To report the details of preparation for an inaugural mass-gathering motorsports event, and to describe the details of the medical care rendered during the 3-day event. METHODS: A retrospective analysis was completed utilizing postevent summaries, provided by the medical planning committee, by the Federation Internationale de L'Automobile (FIA), and Austin Travis County Emergency Medical Services (ATCEMS). Patient data were collected from standardized patient care records for descriptive analysis. Medical usage rates (MURs) are reported as a rate of patients per 10,000 (PPTT) participants. RESULTS: A total of 566 patients received medical care over the 3-day period with the on-site care rate of 95%. Overall, MUR was 21.3 PPTT attendees. Most patients had minor problems, and there were no driver injuries or deaths. CONCLUSION: This mass-gathering motorsport event had a moderate number of patients requiring medical attention. The preparedness plan was implemented successfully with minimal impact on EMS resources and local medical facilities. This medical preparedness plan may serve as a model to other cities preparing for an inaugural motorsports event.

Care plan program reduces the number of visits for challenging psychiatric patients in the ED.

BACKGROUND: A small number of patients representing a significant demand on emergency department (ED) services present regularly for a variety of reasons, including psychiatric or behavioral complaints and lack of access to other services. A care plan program was created as a database of ED high users and patients of concern, as identified by ED staff and approved by program administrators to improve care and mitigate ED strain. METHODS: A list of medical record numbers was assembled by searching the care plan program database for adult patients initially enrolled between the dates of November 1, 2006, and October 21, 2007. Inclusion criteria were the occurrence of a psychiatric International Classification Diseases, Ninth Revision, code in their medical record and a care plan level implying a serious psychiatric disorder causing harmful behavior. Additional data about these patients were acquired using an indigent care tracking database and electronic medical records. Variables collected from these sources were analyzed for changes before and after program enrollment. RESULTS: Of 501 patients in the database in the period studied, 48 patients fulfilled the criteria for the cohort. There was a significant reduction in the number of visits to the ED from the year before program enrollment to the year after enrollment (8.9, before; 5.9, after; P < .05). There was also an increase in psychiatric hospital visits (2%, before; 25%, after; P < .05). CONCLUSION: An alert program that identifies challenging ED patients with psychiatric conditions and creates a care plan appears to reduce visits and lead to more appropriate use of other resources.