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Concussion, not conspiracies, keeping Fernando Alonso from racing

Is a Red Bull alliance with Honda on the cards? (AFP / Jorge Guerrero)
Expert
5th March, 2015
6

For all of Formula One’s communicative strengths – its huge potential audience reach and its many marketing dollars – it leaves much to be desired when it comes to speaking off-script.

Taken out of its element of the predictable rigours of a race weekend or pre-season test, it flounders as it searches for a form to best express some novel event.

The last 10 days in particular have proved challenging in light of the very human circumstances facing McLaren and Fernando Alonso, and the official message from the McLaren camp has flipped and flopped more than F1’s engine regulations.

Alonso was fine, then he had been knocked unconscious, then he was only lightly concussed, then he had to stay in hospital overnight, then for two days, and then for three. Then Alonso wouldn’t be at the final pre-season test, but if the test were the first race, he would definitely be racing. Then he wouldn’t be racing at the actual first race.

Ron Dennis did little to clarify the matter by saying Alonso was unconscious, not concussed, and then likening the situation to concussion cases in rugby.

This is not to blame McLaren, however. Head injuries are foremost in Formula One’s collective consciousness given the injuries to befall Jules Bianchi and Michael Schumacher in 2014, and sport as an international whole is still grappling with the implications of head injuries, research into which is being added frequently to paint an increasingly serious picture.

In McLaren’s response we see a team attempting balance Alonso’s right to medical privacy with the desire of the press and the fans to know what’s going on, all mixed with a still-developing discourse surrounding concussion.

This less-than-smooth blend has caused an unedifying wave of conspiracy and scepticism to roll through the sport’s fans and press alike.

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“There must be more to the story,” shout too many. Electrocution, the inhalation of toxic battery gasses, or even a spontaneous fit have been among the most popular theories, all riding on the back of a lack of widespread understanding of the seriousness of concussion.

While there may well be pieces of information missing from the exact sequence of events – facts likely lost in the messy communication – there is no reason to believe anything other than the official series of events.

Alonso’s car was unbalanced by a gust of wind. The angle of subsequent impact was sufficient to cause his head to bounce from one side of the cockpit to the other and develop a concussion.

It goes to our lack of general knowledge of concussion that sitting out a race doesn’t appear to agree with such a length time sidelined – but the evidence says otherwise.

Dr Gary Hartstein, former FIA medical delegate to Formula One and current anaesthesiologist and emergency physician at the University Hospital of Liège, says the more we learn about concussion, the more important it becomes to maximise precautions against it – particularly against multiple concussive events.

“There are two things going on and they’re concordant: multiple concussions are associated with (a) a higher risk of subsequent concussions, which implies that you’re not quite as sharp as you were because you’re avoiding things less well; and (b) an eventual poor neurocognitive response,” he explained.

“Multiple concussions are associated with loss of brain functions, more or less, but what’s frightening is what we’re learning about repetitive subconcussive blows. If you look at football players and review videos and interviews, and you roughly graph the number of times a player has headed the ball with some other markers of neurocognitive performance, overall there is a reverse correlation.

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“It’s looking like the threshold of what can be damaging is going down. What puts that together is that probably what’s going to hurt you long term is some load of force to the head. It’s going to be the number of hits times the severity of those hits.”

The so-called ‘second-impact syndrome’ is the extreme version of this and is receiving increasingly widespread media attention. Simply, it is the suffering of a second concussive impact before the first has healed, which leads to massive and sudden brain swelling. The next step is a coma, and the effects are fatal more often than not.

And so it is that Fernando’s doctors relayed to him, as he succinctly tweeted, “A second impact in less than 21 days ‘NO’ [sic]”.

Thankfully medical professionals in sport, including Formula One, are light-years ahead of public discourse in the field (as, frankly, you’d expect), and the result is, in situations such as these, drivers are protected from that corrupting competitive spirit that often spurs them to play on despite themselves.

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“We’ve been on it for a while,” confirmed Dr Hartstein. “We made contact with the American championships in the late 1990s and early 2000s, and one of the first things we did collaboratively was institute baseline neurocognitive testing.

“We also developed some return-to-competition criteria. We have had formal procedures for this probably since 2002. We’ve been on it and we don’t let anybody drive if we suspect they have a concussion. We follow them and don’t let them drive until they’re really back to normal. I’m very proud of that.”

So here we are, one week from the first round of competition in 2015, and Fernando Alonso will not be taking part – not because of an electric shock, battery fumes, a KGB plot, or any McLaren-authored conspiracy, but because medicine says so.

It’s a shame that it might take as high-profile a case as Fernando Alonso, but it’s about time the sport as a whole – in which I include fans and media – put faith in the medical facts of the matter.

It is not open to conjecture or debate: the safety of the sport’s competitors must be paramount.

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