from the Experts at the Norman Parathyroid Center
Interesting stories of hyperparathyroidism we see every day. Parathyroid blog published bi-weekly.
Today (October 9, 2014) I update this article because of Jules Bianchi terrible accident at the 2014 Japanese Grand Prix. Although Jules has not died of his injuries (he is in very serious condition with severe brain injury), like the injuries of many others drivers discussed here, his accident was avoidable and preventable. The mechanism of Jules injury is discussed below in the appropriate section: Deceleration Injuries.
Previous updates were prompted by the death of another young racer, Sean Edwards. Sean’s death, like that of Allan Simonsen 4 months prior, was predictable, avoidable and preventable. Sean died of a sudden deceleration injury just like Allen, Cause of Death number 4 below. It is imperative to understand that deaths due to sudden deceleration injuries are usually preventable with simple changes to track design to allow for a more gradual deceleration instead of a near instantaneous deceleration. A close look at the track design flaws that allowed for the death of Sean and Allen is included below in the section on Sudden Deceleration Injuries.
The death of race car driver Allan Simonsen in the early minutes of the 2013 24 Hours of Le Mans, and now the terrible tragedy of Sean Edwards (10/15/13) and the near catastrophe of Dario Franchitti’s crash at the Houston Grand Prix (10/6/13) has caused many fans and racers to question the safety of the sport, and to call into question whether the sanctioning bodies are doing enough to keep race car drivers safe. This article will take a close look at what happens to the human body that causes a racer’s death, and just how far race car safety has come. In Section 4 (Sudden Deceleration Injuries) we will look at the death of Allen and Sean more closely and conclude that these were foreseeable and predictable crashes that resulted in deaths that were preventable and avoidable.
Blunt force trauma is the medical term for a blunt object hitting the body with minimal or no penetration of the skin (in contrast to penetrating injuries discussed below). Blunt force trauma can cause injury to many parts of the body, and most frequently this results in broken bones and various soft tissue injuries and not death. This was not always the case, however, as blunt force injuries were extremely common in all forms of racing prior to the implementation of seat belts. The universal use of seat belts, and the improvements in seat-belt design over the past 5 decades has saved the lives of countless racers. The seat belts keep the racers tightly attached to their racecars, preventing them from flying out of the car and hitting stationary objects. Blunt force trauma still is one of the most common causes of racer deaths, but since it requires that some stationary object hit the driver, deaths by blunt force trauma are far more common in open-cockpit racecars where parts of the driver are exposed.
Jim Clark. On 7 April 1968, Clark died in a racing accident at the Hockenheimring in Germany. Clark’s Lotus 48 veered off the track and crashed into the trees. He suffered a broken neck, skull fracture and a number of other chest and abdominal injuries. Clark died before reaching the hospital. As you will learn from reading further, these types of injuries are much more common for “open wheel” and more-specifically, “open cockpit” type race cars. The head, neck, and shoulders are exposed outside of the protective roll cage and bodywork of the car. As discussed later, all sanctioning bodies have required higher and higher side pods on open-cockpit cars over the years so that the driver’s bodies are exposed much less than in years past. In fact, the past few years has seen the fastest of the prototype sports cars going away from open cockpit designs to those that are completely covered. The most obvious examples are the latest Audi R-18s that won the 2013 24 Hours of Le Mans, compared to the “same” car that won the race 10 years ago–the new one has the driver completely enclosed. Allan McNish’s spectacular crash during the 2011 Le Mans is a great example of how modern race car design (including a completely enclosed cockpit) saved his life. There is simply no comparison in the overall safety between the Formula cars of the 1960’s and modern “open cockpit” Formula cars. However, open cockpit cars by their very nature leave part of the human body exposed and therefore more vulnerable to certain types of injuries.
Jason Leffler. Jason Leffler was a popular NASCAR driver who died only 1 week prior to Allan Simonsen (June 12, 2013). Jason was running in second place in a heat race at a 0.625-mile, high-banked dirt oval when his car flipped several times on the front straightaway, hitting the wall twice and rolling. His autopsy showed the cause of death to be “blunt force trauma to the neck” (no other specifics are available at this time). Again note that Jason was driving an “open” car, a car without doors and windows that left his upper body exposed to outside objects. An important aspect of this accident that the car Jason was driving did not have the most modern type of seat that prevented lateral (side to side) movement of the head. This type of seat also protects the neck from blunt and penetrating trauma. The modern racing seat has “walls” along the bottom and sides of the seats which extend to the side of the helmets. These seats are the result of progressive improvements over many years with the purpose of supporting the body from flexing movements and torsional rotation. They also provide protection from blunt and penetration injuries (see below).
Penetrating trauma is the medical term for an injury sustained when a projectile (such as a bullet) or stationary object (such as a tree limb) penetrates the body. Penetrating trauma (lethal and non-lethal) is also less common for race car drivers who are racing sedan-type race cars where they are protected by the body of the car from objects which could potentially penetrate their body. Just like blunt force trauma, the universal use of seatbelts has dramatically decreased the number of injuries and deaths from penetrating trauma compared to the early years of racing. The design of the interior of the car also reflects safety measures taken to eliminate sharp objects, or items that are not well secured within the cockpit of all race cars. Penetrating trauma to an extremity is a non-lethal injury, but penetrating trauma to the abdomen, chest, neck and head can often be fatal.
Injuries to the cervical (neck) spine and, most commonly, where the spine attaches to the skull are rarer than they ever have been, primarily because of the mandatory use of “head and neck restraining” devices. The authors of this article, like virtually all of our fellow racers use a HANS device which quite simply prevents our head from flexing forward during the deceleration that comes with a forward crash / deceleration. Since our shoulder harnesses cover both shoulders holding them firmly back into our seats, a sudden deceleration injury would allow our head to flex rapidly forward and down, thereby causing fractures to the base of the skull and/or the upper cervical vertebrae. This typically causes death by several means, including damage to the upper spinal cord and/or lower part of the brain resulting in the inability to move and breath.
Adam Petty. On May 12, 2000, Petty was practicing for the Busch 200 NASCAR Nationwide Series (then Busch Grand National Series) race at the New Hampshire International Speedway in Loudon, New Hampshire. While entering turn three, Petty’s throttle stuck wide open, causing the car to hit the outside wall virtually head on. Petty was killed instantly due to a basilar skull fracture. It is highly likely that Adam would have survived this crash had he been wearing a mondern HANS device.
Sudden deceleration injuries can occur in any person subjected to rapid slowing of their body such as during an head-on car crash. The mechanism of injury is that the body is forcibly stopped but the contents of the body cavities remain in motion due to inertia; the brain is particularly vulnerable to such trauma as is the aorta (the large artery that exits the heart). For this discussion, we will give examples of both types (brain and aorta). Deceleration injuries to the brain typically result in a sub-dural hematoma, while deceleration injuries to the aorta typically result in an “aortic transection”.
Mark Donohue was killed during a practice session for the 1975 Austrian Grand Prix. On his second lap, while at about 260 km/h a rear tire of his March 751 – Ford suddenly blew, the out of control car went through the fence for about 180 feet, over a guard-rail and into a ravine. Donohue was hit in the head by a fence post and knocked unconscious. Several minutes later Donohue regained consciousness. There is film of him speaking to his rescuers and looking quite un-injured. He was taken to the hospital for observation. During the day he became confused and slipped into a coma, classic signs of a sub-dural hematoma that every nurse and doctor knows today. He was operated on later that night by a neurosurgeon but he died of his injuries two days later. This type of death is extremely unlikely today with much more knowledge of closed head injuries and better training of track medical staff that can recognize the early signs of brain injuries and blood clots. The universal use of CAT scans for any racing driver who is even suspected of having a closed head injury is another reason why racecar driver’s deaths from this cause are rare and should probably never happen. If you complain of a headache or a loss of consciousness after a crash, my fellow racers, you can expect a trip to the local hospital for a CAT scan of your brain. You can thank Mr Donohue for helping save many future racers. Mark Donohue Crash Video.
The real tragedy for both Allan’s and Sean’s death is that they died of sudden deceleration injuries that were avoidable with relatively simply changes in track design. In Allan’s case, the armco (guard rail) is immediately adjacent to a large mature tree. Guard rails have an inherent “give” to them that is part of the design, making them much more “forgiving” and accepting of imparted forces than a brick wall (or large tree). The reason to have guard rails instead of brick walls and cement barriers is because the design of the guard rail is such that it is fixed to the ground at 3-4 meter (6-10 foot) intervals. The intervening “railing” can dent and be depressed inwards thereby absorbing some of the impact that otherwise would be imparted onto the driver. Having the armco guard railing next to the tree is not much different than having no guard rail whatsoever, or having the guard rail bolted to a cement wall. The picture on the right shows the armco at this turn is immediately adjacent to a large, mature tree, and therefore, Allan’s death is due to his car hitting a tree at some 110 or so MPH. (Note: entry to Tetre Rouge in a GT car is approximately 129 MPH, 103 at the apex, and 121 at the exit).
Fire is an obvious cause of race car driver deaths, but this is extremely uncommon. One of the most horrific fire deaths was that of Roger Williamson who died in the 1973 Dutch Grand Prix when his March Formula 1 car flipped and caught fire after a tire failure. Williamson was uninjured from the physical crash of the car, but succumbed to fire/smoke inhalation. This gripping and very sad video shows his friend and fellow driver David Purley try in vain to flip the car back on its wheels to free Williams, and then try to extinguish the fire. Sadly, no safety team arrives within any reasonable period of time and other observers fail to help. IndyCar and NASCAR travel with their own safety teams who are highly trained and can respond to accidents very quickly. Other forms of racing are sorely lacking in this department and need considerable work, including Grand-Am and ALMS (soon to be USCAR).
Modern fuels, fueling equipment, race car fuel cells, and car designs have seen deaths from fire become quite rare. Fires do injure persons in the pits and occasionally fans, but regulations are frequently updated and safety measures increased regularly to decrease the incidence of all fires in and around race cars and the race track. Formula 1 has gone so far as to eliminate (ban) refueling during the race beginning in 2012 after numerous fueling accidents over the years.
The same day that Allan Simonsen died at the 2013 running of the 24 Hours of Le Mans, two-time German VLN Endurance Racing Champion Wolf Silvester died because of a heart attack suffered during the VLN race at the Nurburgring. Safety marshalls at Saturday’s race said Silvester apparently lost control of his Opel Astra OPC, and when they approached the stopped car on the track they found him sitting motionless in the seat. Race car drivers are under considerable stress during these races. All sanctioning bodies require EKG’s of their drivers every 2 years, with annual EKG’s required for us older guys over 50. It may seem like a pain in the butt to my fellow drivers (and myself), but the reasons for having our tickers checked out is clear. Several times per year a driver dies while driving a race car without ever hitting a wall or crashing. Racing is stressful on our hearts!
In the days following the tragedy at the 2013 Le Mans, we heard from dozens of racers who are concerned about their own safety and the safety of those around them. Four months later my fellow drivers are asking what we have accomplish now that another friend, Sean Edwards has died. They are questioning whether the sanctioning bodies who run these races are doing enough. They are waking up to the fact that many tracks still have one or two turns that are far too risky that must be addressed.
Race car drivers are safer than ever before, but there is still work to do — and some of that work is for the drivers themselves to do. The cars are safer, the pit stalls are safer, the helmets and suits are safer. Race tracks are being made safer every year, but unfortunately, these changes seem to occur only after a serious–if not lethal–crash. There is no greater example of the changes to race tracks to make them safer than the addition of the two chicanes along the Mulsanne straight within the Circuit de la Sarthe (home of the 24 Hours of Le Mans), however it took a number of high-speed crashes before this obvious change was made. In NASCAR, the addition of SAFER barriers at most tracks adds a degree of “flexibility” to the outside wall which serves to decrease the G-forces imparted on a race car driver–obviously to decrease the impact of deceleration-type injuries. However, it appears that Allan and Sean would still be alive today had several very simple things been done differently at their respective tracks. Track officials, owners, and race promoters / organizers evaluate tracks on a regular basis. Unfortunately, this is often because of insistence of the racers themselves, or by the track’s insurer. When these tracks change, the reason they do is so that we have less of a chance of hitting something head-on or at an angle that could put a driver or even the fans at risk of injury. Removing immovable objects from the potential trajectory of a race car seems amazingly intuitive–so much that there is no surprise that many drivers are frustrated and angry. Each individual racer’s active involvement, consistent with the standards first demanded by Jackie Stewart, is the way to proceed, rather that expecting a regional, federal or even global standard to accomplish something that represents an actual improvement for the sport. Often the best way to accomplish necessary change is through education (the primary purpose of this article). Has the time come for a universal driver’s group to come forward to provide a louder and unified voice advocating change in the name of safety?
In Summary: Ultimately, as in any type of accident with severe results, the required elements are the deadly combination of extreme forces applied at a critical time with the inability of the body and/or the equipment (usually both) to protect against severe damage. In other words, driving a race car at 200 mph is inherently more dangerous, because of that inability to control all amplified factors of risk perfectly, than other low-speed, low risk activities. We can work to improve the courses we race upon, the cars we race in, and the gear we wear while racing, but at the end of the day, we still require a dose of good fortune to survive a big crash. Our bodies remain the most fragile part of the race car, and excessive forces absorbed by the human brain, spine and torso ultimately will cause deadly harm if the wrong combination of factors occurs at impact. For sure, there’s reason to continue to strive to make all aspects of our sport as safe as possible, but the human element can never be strengthened to the point of invincibility. Because human flesh is so vulnerable, all efforts must be made to prevent the 6 distinctly different external forces from being applied. No effort should be overlooked.
Race hard, enjoy the thrill of our sport, but give a thought to those who have made our lives and careers safer and longer by what we have learned, and continue to learn, with each tragic loss. Let’s work together to improve the sport we so dearly love. Additional References:
Note that this article was published within the Parathyroid Blog of Dr Norman’s website parathyroid.com. Please feel free to link, copy, and otherwise distribute this article as you see fit, provided a link back to this site is maintained.
James (Jim) Norman, MD, FACS, FACE, is recognized as one of the world's foremost expert on parathyroid disease and hyperparathyroidism and has treated far more parathyroid patients than any other doctor in the world. He is the founder of the Norman Parathyroid Center in Tampa, Florida, the world's leading center for the diagnosis and treatment of hyperparathyroidism. Dr Norman has made numerous contributions to to the understanding of parathyroid disease and is credited with dramatically changing the way parathyroid surgery is performed. He is a fellow of the American College of Surgeons (FACS) and also a Fellow of the American College of Endocrinology (FACE). He is recognized in the top 1% of all surgeons by US News and World Reports in addition to dozens of other awards and Best Surgeon accolades. He has published over 250 peer-reviewed journal articles. Dr Norman and his partners perform more than 3,600 parathyroid operations annually on patients from all over the world.