INDYCAR Concussion Protocol
INDYCAR drivers are among the many athletes who can sustain a head injury while participating in their chosen sport. For the health and safety of our drivers, INDYCAR has a multipronged approach to concussions.
INDYCAR has invested significantly in the effort to reduce the risk of injuries, particularly Traumatic Brain Injuries (TBI), in crashes. INDYCAR is the recognized leader in the development of safer race courses with the invention of the energy-absorbing SAFER Barrier walls for all high-speed oval tracks, and developing energy-absorbing, high-density foam barriers to shield fixed hazards such as pit walls at the pit entrance. These innovations have significantly reduced the decelerations (G-loads) that the driver experiences when making contact with walls or barriers during competition and have decreased the frequency of driver injuries and concussions.
Historically, many concussions have occurred when the car spins while entering a high-speed turn and backs into the wall. Data demonstrates that the G-forces a driver’s head experiences in these rear-impact collisions are three to four times greater than the G-forces the car chassis experiences. This has resulted in a series of car design changes to decrease the decelerations a driver’s head experiences with the impact. The first was the installation of a honey-combed attenuator on the gearbox. By specification, these are required to absorb a minimum of 63 kilojoules (4,700 foot pounds) of energy. Next, the rear wheel assembly and suspension were moved to the aft, so that as the car backs into the wall, the first impact is with the tire/wheel assembly and the suspension absorbs more of the energy from the impact. There was extensive work completed on the design of the head-surround; making it more energy-absorbent, thus decreasing the deceleration the driver’s head experiences during rear-and side-impact incidents. The head surround also serves to keep the driver’s head facing forward, preventing rotational accelerations that have a much higher propensity for causing concussions than linear accelerations.
The symptoms of a concussion are subjective and notoriously nonspecific (blurred vision, confusion, dizziness, feeling hazy/foggy/groggy, headache, difficulty concentrating/staying focused, nausea, sensitivity to light or sound, or just not feeling right). Any of these conditions following a crash may be symptoms of a concussion, and since they are subjective, there is no way that a physician evaluating the driver can know if the driver is experiencing the symptoms of a concussion unless it is disclosed. Each year, during the annual physical examination, the INDYCAR medical director meets with each driver and reviews the symptoms of a concussion and emphasizes the importance of informing the medical team if any of these symptoms are experienced following a crash. The drivers are also reminded of the risk of a second concussion if they have not fully recovered from a concussion and the long-term consequences of repeated concussions.
INDYCAR requires baseline testing of each driver using the ImPACT test, a computerized, neurocognitive exam. All drivers also participate in a I-Portal Neuro Otologic Test, in which they are fitted with goggles that track eye movement. In addition, INDYCAR has adopted the strategy of using a validated sideline concussion detection tool. Currently the INDYCAR medical team uses the SCAT3 (Sideline Concussion Assessment Tool version 3) as an assessment tool to be used at the venue to evaluate drivers for potential concussions. All drivers have a baseline SCAT3 test in their medical records and data acquired using I-Portal can be used for comparison following a crash.
If, following an on-track incident, a member of either the AMR INDYCAR Safety Team or medical team observes signs of a possible concussion (transient loss of consciousness; delayed or slowed spoken or physical response; slurred/unclear speech; blank stare/dazed look; loss of balance/coordination; behavior/personality changes; disorientation; loss of memory of events preceding, during or following the incident) in an involved driver or if the driver experiences symptoms of a concussion, the driver will be transported to the infield care center where the INDYCAR medical director will administer a validated concussion detection tool, currently, the Sideline Concussion Assessment Tool version 3 (SCAT3). If the driver remains symptomatic, has any signs of a concussion or fails the concussion detection tool, the INDYCAR medical director will declare the driver medically unfit to drive and notify appropriate officials. The driver will remain medically unfit to drive until such time as he/she has completed INDYCAR’s Return to Racing Protocol.
INDYCAR Return to Racing Protocol
Each concussion and each driver is unique and it is not possible to set a finite time frame for return to participation or for the progression through the steps of the graduated exercise program (described below). Recovery time will vary from driver to driver. The decision to return a driver to participation ultimately remains with the INDYCAR president of competion and operations. The INDYCAR medical director will make recommendations to league officials based upon his professional opinion as to the driver’s medical fitness to participate in racing activities.
The concussed driver is instructed to rest until all symptoms have resolved. Once concussive symptoms have been resolved, the driver is to begin light exercises and to progressively increase the intensity of workouts until exercising at the pre-concussion maximum intensity. If the driver has a return of symptoms with exercise, he/she is to return to the level of activity where symptoms of a concussion do not occur and gradually increase the intensity and duration of exercise until able to exercise at the level of a preconcussion maximum intensity workout without symptoms. Depending on the driver and the seriousness of the concussion, this process may take days to several weeks to complete.
When the driver has returned to baseline exercise ability and remains asymptomatic, he/she will notify the INDYCAR medical director. The medical director will arrange for the driver to take the ImPACT Test. If the driver’s test results demonstrate no significant loss of neurocognitive function, as compared to baseline test results, the medical director will notify INDYCAR officials that the driver is medically cleared to resume driving.
The driver should start by driving during practice sessions and gradually increasing speed and intensity of driving until driving at a competitive level without concussive symptoms prior to returning to competition. Since the symptoms of a concussion are subjective, it is important for team owners and trainers to work with the driver to assure that symptoms do not reoccur, and that if they do, the driver feels comfortable in reporting these symptoms to the team or medical staff. If symptoms or signs of concussion reappear after testing at competitive speeds, the driver will be declared medically unfit to compete until such time as he/she is asymptomatic and capable of practicing at competitive speeds for at least 30 minutes without symptoms or signs of a concussion.