The injury motorsport can’t ignore

Dr Paul Trafford is in a jovial mood - he's rarely anything else - and his cheery tone belies the serious nature of his words. AUTOSPORT has a request, and he's happy to help. The topic is concussion, a grey area (at best) for the majority and a serious one for TOCA medical officer 'Traff' and his fellow professionals.

"Really we didn't used to see it a lot," he admits. "I don't know if it's because we didn't look for it, or that people were getting other injuries they were hospitalised from. But it's better understood now."

We're together to talk about concussion in motorsport, a topic brought into the limelight earlier this year when Fernando Alonso missed Formula 1's season-opening Australian Grand Prix due to a concussion suffered in a Barcelona testing crash. Misinformation was rife, with a big part of that down to a lack of understanding from team personnel to the media to the fans.

Edd Straw's column at the time was appropriately titled 'Why F1 takes concussion so seriously'. It was right, particularly with regard to the championship's medical personnel and practices. But the wider motorsport world doesn't recognise concussion for what it is, which given it's a brain injury is shocking to fathom. But Trafford has a theory why.

"We weren't really looking for concussion because they'd hurt their arm or broke their back," he reckons of motorsport in decades past. "Injuries were much worse then, because the safety features weren't as good so people were getting other injuries they were hospitalised from."

We've digressed slightly. A world away from F1, the British Touring Car Championship - which sparked this Sunday-morning conversation with Trafford in the Snetterton medical centre thanks to Aiden Moffat's concussion-inducing crash in second practice - was the scene of the good doctor's first experience of such an injury in motorsport.

The aftermath of Alonso's Barcelona accident highlighted the lack of understanding © LAT

Kelvin Burt's huge shunt at Oulton Park in 1996 left the Briton out of action for a long time as he recovered. Moffat's was substantially less dramatic, and his time on the sidelines is expected to be equally so, and yet the injury suffered was the same.

AUTOSPORT was disappointed with how Moffat's injury was reported. The race to be 'first' was prioritised ahead of clarifying the facts (perhaps the BTCC paddock isn't so far removed from F1 after all). So why is motorsport so behind the times - and are things changing?

Thanks, largely, to what Traff calls the "industry" being built out of head injuries suffered by American football players over in the United States, the wider public is becoming more aware of the severity of concussions. And yet a prevalent attitude is 'why should a bump to the head stop anyone?' - and that was especially so post-Alonso's crash in February.

Something that is becoming more apparent in the NFL is 'second-impact syndrome' - which can be fatal. AUTOSPORT can't state this with complete authority, but it's likely this was one of the factors in Alonso not being cleared to race in Australia. What we can be sure of, says Trafford, is that it is a real issue.

"It exists," he attests, "but it's questionable whether it's a big problem. If you have an episode of concussion and before you've recovered you have another accident that would give you concussion, you can get a massive swelling of the brain and drop dead.

"They've seen a few cases in the States in American football. It's not brilliantly understood and some people aren't sure it's that common, but the risk is there and if you're going to go back out in a car and race you might have some sort of impact. We've got to think of that."

That threat of second-impact syndrome is the most severe when it comes to a driver racing while not fully recovered from concussion. And, of course, it's one that exists across the motorsport spectrum - "and the younger you are, the more prone you are with SIS," Trafford points out, "which is a worry because as new formulas come in with younger people driving, we've got to be more cautious".

Moffat's accident at Snetterton put concussion back on the BTCC agenda © LAT

The disparity between the worst-case scenario and the wider world's opinion of concussion points to more overwhelming evidence that suggests concussion is not something being taken seriously enough by the masses, which is exactly the sort of attitude British motorsport now looks set to attempt to combat.

As revealed by AUTOSPORT, UK racing's governing body the Motor Sports Association is evaluating introducing a formal protocol regarding concussions.

If you're an Alonso, racing in F1, or a World Rally Championship driver, concussion is significantly easier to monitor. F1 and WRC drivers undergo what is called an ImPACT test at the start of each season that establishes a baseline level of brain performance, which becomes the standard by which that person is then measured in the event of a concussion.

It's no surprise that, at the very top level, discretion is very much the better part of valour. Subjective though it may be, it's the most accurate test thus far to determine if someone is still concussed. But it's also expensive and time-consuming.

So while F1 or WRC drivers can be tested at the start of a season, the 10,000+ race-licence holders in the UK competing in a variety of club and national championships presents a different challenge entirely. This, Traffords tells AUTOSPORT, is what is trying to be addressed.

One option on the table is to confiscate a driver's licence for three weeks in the event of a concussion. If they are a professional, and this just won't do, they will have the wherewithal to go and get scanned and professionally evaluated (£600 for the scan plus the doctor's time). Then they can get cleared earlier.

If, like the average club racer, that's not a realistic option, the three-week grace period acts as a protective buffer. OK, not everybody recovers after three weeks - but the majority of people do. So it's a good safety net.

Trafford has spotted a trend of head injuries being reported more in recent years

And kudos to those at the heart of it - the Motor Sports Association's Motor Sports Council and Dr Phil Rayner's Medical Advisory Panel - for pushing for that.

Head injuries are underestimated on a wide scale and it's all-too-easy for people to take a binary approach: either a driver's fine and needs to get on with it, or they have suffered irreparable brain damage. Similarly, it's easy for drivers to have a massive crash and walk away unscathed - thereby assuming anything less than a huge hit should not result in a serious injury.

British Touring Car champion Andrew Jordan knows all about the significance of a concussion now he's suffered one - it went some way to ruining his title defence last season. When he crashed in FP1 at Snetterton in 2014, it was an incident the man himself admits was not a biggie - "I wasn't heading into the barriers thinking 'shit, this is going to hurt'"- and one he didn't fully appreciate the after-effects of until the Sunday afternoon.

Jordan missed FP2 and qualifying that Saturday but was given the all-clear to race on Sunday on the proviso he pulled out if he started to feel ill. He battled through the first two races, but that's where his weekend ended.

"Traff took one look at me after race two last year and said I was done for the day, and I was glad he said it," Jordan admits. "I was absolutely gone. The thing that surprised me was the shunt wasn't big, and it opened my eyes to the potential risks."

Educating drivers so they understand concussion is one of the biggest battles medical staff are facing. Trafford says the misconception over how you can suffer one, like Jordan before Snetterton, is a common one: "You don't have to have been knocked out and you don't need to have had a big impact, you need to have shaken your brain."

When it comes to misunderstanding though, it's not just about how concussion occurs - it extends to recognising you have it in the first place. And this is particularly significant in motorsport, because concussion is not a common injury - or, at least, is not one that's recognised by most circuit medical staff because it's not something that's being looked out for. The knock-on effect is it's not easily recognised.

The impact of Jordan's 2014 Snetterton accident didn't hit home immediately © LAT

Symptoms of concussion range from being a bit dizzy, having distorted vision, not being able to sleep properly, being aggressive or weeping, headaches, feeling sick - "emotional things that are really very nebulous," says Trafford.

"It's very hard to identify. If you have concussion you'll only see the symptoms when you're having to think hard. If you broke your leg you wouldn't walk on it. If you have concussion, people feel fine until they go to do something."

Therein lies the danger. But times are changing as understanding improves, and Trafford said the TOCA medics - operating in the most professional paddock in Britain - have a process that is becoming more thorough, but without proper protocol that can still be blurred.

"There are no hard and fast rules," he admits with frustration. "That is why it's hard to say 'you're out'. There are more guidelines elsewhere and what we're trying to do is get some more in motorsport."

If a concussion protocol is introduced in Britain, national motorsport will take a big step in catching up to the wider world. But it's playing catch-up nonetheless.

Fans of football - both gridiron and Premier League - or rugby will know the seriousness with which the topic of concussion is taken. It's high time motorsport joined in as well.