EMS Providers Care for ORV Racers in Mexico

Caring for racers south of the border

 

 
 
 

Adrian Cotton, MD | Ian Butler-Hall, MD | Jeff T. Grange, MD, FACEP | From the May 2011 Issue | Sunday, May 1, 2011


Imagine an EMS system that covers a distance of 1,000 miles with a response time of four to five hours (or up to 12 hours at night). Now imagine there isn’t any ALS monitoring equipment, and mutual aid might comprise a couple caballeros on horses. These are some of the challenges the Short Course Off-Road Enterprises (SCORE) medical team faces each year in a remote area in Mexico.

“This channel is code red. We’ve got an emergency at race mile 243. Checkpoint 2, go ahead,” says “the Weatherman” as he breaks into the airwaves.

“This is Checkpoint 2. We have a report of 18X rider down with a head injury and broken leg somewhere between race mile 240 and 255,” says a voice over the radio.

The Weatherman relays to all those listening, “OK. 18X rider down, head injury, broken leg, somewhere between race mile 240 and 255. Is there anyone in that area to respond?”

Background
This is the typical form of EMS dispatch and response four days out of the year in Baja Mexico during the SCORE Baja 1000 Peninsula Run, the longest continuous off-road race in the world. The race, which was started 40 years ago, was originally called the Mexican 1000. The first race had only a handful of entrants. Since then, it has grown to include a field of hundreds competing in one of about 30 different classes of vehicles, from motorcycles to off-road trucks, quad all-terrain vehicles and even classic Volkswagen bugs.

The race occurs every November on Mexico’s Baja Peninsula, a long, narrow piece of land that juts out more than 750 miles from Tijuana south to Cabo San Lucas. By comparison, this is roughly the same distance as the entire length of the state of California. The Baja 1000 crisscrosses the land to total more than 1,000 miles of racing, or approximately the distances between Portland, Ore., to San Diego, and New York City to Orlando.

Today the race is part of SCORE International’s Desert Championship Series, which consists of two races in Nevada and three in Baja (Baja 1000, Baja 500 and San Felipe 250). The Baja 1000 follows much of the same course as it has for 40 years, starting in Ensenada and ending in La Paz.

Some years it’s a “loop” race, meaning it starts and finishes in the same place—Ensenada. Regardless of where it finishes, it’s always approximately 1,000 miles of off-road racing over some of the roughest, dustiest, rockiest, most inhospitable and deserted land.

Although motor sports in the U.S. are tightly regulated, with volumes of guidelines for safety operations, the Baja 1000 doesn’t fall under such guidelines because of looser Mexican oversight. Additionally, because the race consists of off-road courses through miles of desert, mountains and fields, there’s no formal track or barriers to keep spectators away from the racing vehicles.

Most of the course has few, if any, spectators. But near the cities and towns, hundreds of people often line the course, some standing just feet away from 800-horsepower trophy trucks racing by at 60 mph. Occasionally, spectators are struck by vehicles while trying to reach out and touch them as they pass. Worse yet, dozens can be injured in seconds if trucks collide or veer off the course. Providing medical care for the racers and spectators is a unique challenge.

Ground Resources
Covering a thousand miles of mostly uninhabited, sparse desert with a limited number of EMS volunteers is a challenge faced every year by race organizers. EMTs and paramedics comprise the ground teams. The medical support includes American EMS providers and some local Mexican EMS ambulances organized into teams and spaced out about one every 100–200 miles or so across the 1,000-mile race course.

Monitors, defibrillators and medications are in short supply, and the Americans often bring their own medical gear from the U.S. They often have large trucks capable of travel on the rigorous off-road course. In the event of major trauma, the paramedics can start IVs or intubate at a minimum.

The Mexican ambulances are positioned on the main highways and are typically incapable of off-road travel. They often keep ALS monitors and medications in the ambulances and the vehicles to respond to incidents that occur on or near the highway, or they meet another paramedic truck and transport patients back to Ensenada or another appropriate facility in Baja.

Air Support
The other half of the medical support for the Baja 1000 comes in the form of helicopters. Two SCORE helicopters each carry a pilot, SCORE official and emergency physician. The kits the physicians carry include basic bandages, tools for laceration repair, IV supplies, rapid sequence intubation and pain medications, intubation equipment and supplies to establish a central line.

They also carry oxygen, a ventilator, backboards and splints. There’s no monitoring equipment besides a stethoscope and ones’ own senses. One helicopter also carries a hydraulic cutter and spreader unit used to help extricate drivers out of mangled metal frames.

Transporting patients in the helicopters (Astar AS 350 B2 or Bell Jet Rangers) can be tricky. If providers aren’t concerned about a C-spine fracture or feel the need for immobilization, patients are often transported in the back of the helicopter. When supine transport is necessary, the front left seat is removed and placed in back, and the patient positioned on the floor with their feet to the front of the aircraft.

It’s illegal to fly in Mexico after dark. And with limited ground lights and infinite hills, peaks and other obstacles, it isn’t safe either. This limits the effective use of helicopters and forces racers to rely on only the sparse ground medics for any injuries that befall them after sundown.

Communications
During the race, the radio traffic on the SCORE race channel is relayed and moderated by a person called “the Weatherman,” who sits atop Devil’s Peak—a 10,000-foot mountain, the highest point in northern Baja. The Weatherman keeps track of all vehicle locations and progress via radio, satellite Internet and satellite-phone contact with the providers stationed at the checkpoints and with race operations staff in Ensenada.

The same radio frequency is also used to announce emergencies and call for medical help. Pinpointing the location of the injured, and which medic team is closest, is a challenge without an enhanced 9-1-1 or computer-aided dispatching system.

Reports of injured drivers are much like the game of telephone: The actual location and injuries can be very different from what’s finally reported over the radio after the information is passed on from one driver to another, to a pit location then on to a checkpoint and finally to the Weatherman.

Logistics
Many calls are responded to prior to the Weatherman’s intervention because the telephone game-style communications reach the nearest medic team first. Obstacles to transporting to the hospital, which may be hundreds of miles away, come from the isolated terrain and the riders themselves.

In many cases, the team evaluates and treats the rider, often releasing them to continue the race. (Imagine releasing your patient with broken ribs or even a pneumothorax to continue another 800 miles of a race.)

Given the distant separation of medic teams and the vastness of the course, one of the two helicopters often has the shortest response time. If the helicopter can land on scene, the patients are assessed there. Then, based on injury severity, time of day and location of the accident, the physician and crew must determine whether transport is necessary and what the best course of transport is.

Because the helicopter is a limited resource, prioritizing its use is important. The helicopter crew may transport directly to the Velmar Hospital in Ensenada or another appropriate facility if they’re farther south on the peninsula.

The crews may call and rendezvous with a ground crew or ambulance for transport to the hospital, or can call for use of the fixed-wing operated by Aeromedevac, which sits at the airport in Ensenada at the ready to transport the sickest American patients back to the U.S.

American racers are asked to have their U.S. passports with them on race day and keep them tucked away somewhere on their person. If they should need emergent air evacuation back to the U.S., it’s imperative they have their passport.

The race medical teams are there to provide medical care for racers and race team members. However, each year, providers see inevitable traffic accidents on the surface highways that involve spectators—both American and Mexican. These incidents are primarily managed by local Mexican EMS systems.

In 2009, the Baja races started requiring participant vehicles to carry a satellite tracking device made by International Racing Consultants (IRC). Inside the instrument is a global positioning system module, an Inclinometer, a G-Force Meter, an Iridium satellite voice/data modem and a microcomputer.

The IRC device records data every five seconds and transfers it every two minutes to the IRC communications center. Racers can press a button if they’re injured, and some models allow for voice communications similar to OnStar. This device has not only revolutionized vehicle tracking, but also allows for more rapid location and assessment of injured racers.

Conclusion
The Baja 1000 is a rugged endurance challenge—for the drivers who race it as well as for those who provide medical care for the event. The expansive and desolate landscape provides a unique setting for an EMS system, and it forces interesting constraints on those who provide care.

For more information about volunteering or providing medical care at SCORE Baja races, e-mail SCORE Medical Director Jeff T. Grange, MD, FACEP, an emergency physician at California’s Loma Linda University Medical Center, at jgrange@symonsambulance.com. JEMS

This article originally appeared in May 2011 JEMS as “Off-Road EMS: Caring for racers south of the border.”

Baja Tales #1
A Class 10 buggy crashed and high centered on a large rock in a pine forest at the 5,000-foot level, and one of the drivers couldn’t get himself out of the car. The rugged terrain in that area prevented helicopters from landing in the immediate area, so the SCORE crew was forced to land in a meadow about a mile away.

The physician and SCORE official first hitchhiked with their medical equipment, riding on the hood of another racing car halfway to the scene. They were then carried on horseback by a group of local caballeros to the scene.

Once on scene, the physician applied a Kendrick extrication device and extricated the driver from the car, lifting him out through the roof. The patient was kept in full spinal immobilization because he had severe back pain and tingling in his legs. The driver had to be carried back down the course, against traffic, one mile to the helicopter.

Amazingly, the caballeros roped the buggy and pulled it off the rock. The co-driver continued the race. The injured driver was flown back to Ensenada airport, where the Aeromedevac plane flew him to San Diego.

Baja Tales #2
A motorcycle rider who had flown over the handlebars had a head injury and broken arm. Fortunately, his accident occurred close to a checkpoint and popular viewing spot for spectators and support crews. An off-duty paramedic from Arizona, who was part of a race support team and not officially with the SCORE medical crew, was standing nearby when the accident happened. He had some medical supplies with him and promptly put the patient in a C-collar and splinted his arm.

Of course, the paramedic wasn’t carrying a backboard with him, so he improvised, using duct tape to fasten the patient to a lined tailgate from a truck. The shorter length of the tailgate allowed the patient to easily fit across the back seat of the B2, rather than having to switch out the front seat, and he was flown to the Ensenada airport. Unfortunately, the door to the Aeromedevac plane wouldn’t accommodate the width of the tailgate, so the patient was transferred to a regular backboard prior to the flight to San Diego. It would’ve been a sight had this patient arrived in the emergency department of the trauma center strapped to the tailgate of a truck.

Baja Tales #3
Tragedy befell the 2007 Baja 1000 when a helicopter carrying four people crashed after striking some power lines. Two passengers were killed instantly. Luckily, a ground rescue crew was a few hundred yards from the crash and saw the copter go down. They quickly cared for the other two occupants, both of whom were critically injured. The crew had immobilized the patients and started IVs on them by the time helicopters arrived.

One patient was flown with a physician back to Ensenada in the SCORE helicopter while the second was cared for by an off-duty paramedic who had been in a camera helicopter that was filming in the area. That patient was also flown back to Ensenada via helicopter.

Mojave Desert Racing
On Aug. 14, an off-road rally race was just about to get underway. Starting at 7:30 p.m., the California 200 was a 200-mile, off-road rally race in the Lucerne Valley of the Mojave Desert in Southern California. The start/finish line was located approximately 125 miles from Los Angeles (225 miles from Las Vegas) by ground. The race was scheduled to be four 50-mile loops with a 7.5-hour time limit.

The race was part of the Mojave Desert Racing (MDR) series, an off-road racing body that organizes a series of rally-style, off-road races in Southern California. Although organizationally unrelated to SCORE, the vehicles in the races are similar to those that race in the Baja 1000. This race had around 100 entries.

On-site medical support was provided by Symons Event Safety, a regional provider of medical care for large spectator events ranging from concerts, arena sports and races, including NASCAR. One ALS ambulance, staffed by two paramedics, was positioned at the start/finish line. The nearest community hospital was 34 miles from the starting line, or about 45 minutes by ground, and the nearest trauma centers were 30 minutes away by helicopter.

The Incident
Unique to these off-road races is the lack of barriers along the course. Although spectator instructions had specified that bystanders should stay beyond 100 feet from the course, there was no effective enforcement, and people were able to come within feet of speeding vehicles.

Approximately 10 minutes after the first vehicle left the starting line, a modified Ford Ranger competing in the race hit a popular rise called “The Rock Pile.”

As it hit, the truck appeared to lose control and drifted to the side so that when it landed askew, it quickly rolled off to the side and into spectators along the barrier-less, off-road course.

The ALS ambulance immediately called for support from nearby ground fire and EMS. The event ambulance arrived on scene about seven minutes after the crash. They found four patients dead on arrival, including one spectator who had been decapitated. They called for 14 medical helicopters and began triaging more than 20 patients.

Paramedics began treating two of the most critically injured patients, who unfortunately died prior to the arrival of any transport units. Off-duty medics watching the race assisted with placing patients on backboards and treating them. This bystander assistance proved to be a help and a hindrance. More patients were able to be treated, but there was no organization. The only ambulance was quickly pillaged of supplies. Ground support arrived about 30 minutes after the initial call.

Helicopters from three states—California, Nevada and Arizona—responded, including a military crew from Fort Irwin. They arrived on scene about 40 minutes after the accident occurred. Ten patients were transported by air to trauma centers. Two of those patients later died from injuries. Other unknown patients self-triaged to hospitals by private vehicle. In total, eight spectators died.

The race took place on Bureau of Land Management (BLM) property, and California Highway Patrol and BLM investigations of the accident continues. Further Mojave Desert Races have currently been suspended pending these investigations.

Safety remains the unquestioned focus of MDR and BLM, as evidenced by the event’s 15-year history. MDR has already begun strict enforcement of speed and distance regulations, as well as prominent designation of safety fencing. BLM will grant permits only to events that can adhere to strict criteria, as well as improving pre-event coordination and on-scene presence.

Logistically, having dual paramedic teams or two mixed EMT-B/paramedic units for the event allows for simultaneous triage and treatment, and initiation of the incident command system (ICS) system with resource allocation. Most importantly, this incident underscores the importance of incorporating MCI training into continuing education programs.

Joshua Bobko, MD, EMT-T, is the current EMS fellow at Loma Linda University Medical Center. He responded to this incident.




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Related Topics: Major Incidents, Mass Casualty Incidents, SCORE Baja 1000 Peninsula Run, orv trauma, EMS special operations, Jems Features

 

Adrian Cotton, MD, is an attending physician in the Department of Internal Medicine at Loma Linda University Medical Center and has been involved in off-road racing for many years.

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Ian Butler-Hall, MD, is an emergency physician in Boise, Idaho, medical director for the Meridian Fire Department, and a former EMS Fellow at Loma Linda University Medical Center.

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Jeff T. Grange, MD, FACEP, is the SCORE medical director, attending physician and EMS fellowship director in the Department of Emergency Medicine at Loma Linda University Medical Center.

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