By Kerri Cebula
The history of motorsport in the United States is filled with stories of drivers racing with serious injuries, including concussions, and being celebrated for doing so. In 1984, NASCAR driver Ricky Rudd famously ran the Daytona 500 with his eyelids duct taped open after suffering a concussion and broken ribs a week before in an all-star style race. In the 1992 The Winston, as NASCAR’s all-star race was known, Davy Allison and Kyle Petty wrecked after taking the checkered flag. Allison won the race, but hit the wall hard and was knocked unconscious. He eventually had to be cut out of the race car and spent the night in the hospital with a concussion and a bruised lung. The next week, he finished fourth in the Coca-Cola 600, NASCAR’s most grueling race (Fowler, 2017). To this day, fans and commentators alike celebrate the wrecks and the hard hits, much like they do in football.
With the recent focus on concussions in sports and on concussion litigation in sports, and given the history of motorsports, some wonder if NASCAR and IndyCar could be the next stop on the concussion litigation train. Both NASCAR and IndyCar have concussion protocols in place and take care to update the protocols. However, there are issues with their protocols.
Concussion Protocol
Studies from the Centers for Disease Control show that motor vehicle crashes are the leading cause of traumatic brain injuries that result in hospitalization for adolescents and adults from 15 to 44 (TBI: get the facts, n.d.). Those statistics are for regular motor vehicle crashes. For race car drivers, studies show that, controlling for national sports participation, drivers have a greater risk of concussions, measured at 181 per 100,000 participants (Deakin & Hutchinson, 2017). Yet concussions have rarely been discussed in motorsport. In his book Racing to the Finish, Dale Earnhardt Jr. tells that he was not at Daytona in 1998 for his father’s only win in NASCAR’s most prestigious race, the Daytona 500. Instead, he was back home in North Carolina with a washcloth over his eyes, suffering from the effects of the concussion he received the day before in the now Xfinity Series race (Earnhardt, Jr & McGee, 2018).
But things began to change in the early 2000s. Prior to the 2003 season, the doctor in the infield care center, where all drivers are taken if they cannot drive their car back to the garage, did a quick examination to determine if the driver needed to go to the hospital. If he did not need to go to the hospital, he was considered cleared to resume racing. In September 2002, Earnhardt Jr. shocked the motorsports world, and angered NASCAR officials, when he confessed in an interview that he had driven in several races while “feeling a little loopy” after a wreck in California. In 2003, the protocol changed that if the infield care doctor had suspicion of a concussion, the doctor was to call for further scans and tests and not clear the driver to return to racing that day (Earnhardt Jr & McGee, 2018).
Now both NASCAR and IndyCar require their drivers to undergo baseline testing using validated concussion testing. IndyCar requires its drivers to undergo baseline testing every two years using two different tests, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the I-Portal Neuro Otologic Test, which measures eye movement. In addition, IndyCar drivers are given the Sideline Concussion Assessment Tool (SCAT) so that they have a baseline report. Following an on-track incident, if the on-track safety team suspects that a driver has a concussion, he is to be brought to the infield care center where an approved sideline concussion test will be given and compared to his baseline results (IndyCar Concussion Protocol, n.d.). IndyCar drivers are required to wear an earpiece called an accelerometer that measures the G-force impact on the head in an accident. If the accelerometer measures an impact of 80g, the driver is required to undergo concussion testing, even if he does not have concussion symptoms (Lawrence, 2016). NASCAR has a similar accelerometer, known as the Incident Data Recorder, that is placed in the car and measures the acceleration and deceleration of the car. In stock car racing, an impact of 25g to 30g is considered a big hit (Earnhardt Jr & McGee, 2018).
A concern in stick-and-ball sports is returning to play immediately after a suspected concussion. In 2017, Houston Texans quarterback Tom Savage was hit hard during a play. He was evaluated for a concussion and passed the sideline concussion test and returned to the game without missing an offensive play. After one series, he was removed from the game with a suspected concussion (Wagner-McGough, 2017). This is not necessarily an issue in motorsport. In IndyCar, if a driver has been hit hard enough that he must go through the sideline testing, his car is most likely too damaged to return to the race, alleviating the need to immediately clear a driver to return to racing. NASCAR has implemented a rule that if a car has to return to the garage due to crash damage (not mechanical failures), even if the driver can drive the car back to the garage, he is out of the race, again alleviating the need to immediately clear a driver to return to the race.
If a driver does have a concussion, he will not be permitted to return to racing until he is asymptomatic. In IndyCar, a driver rests until all symptoms have resolved. He is then instructed to begin an exercise program, increasing in intensity until up to his pre-concussion intensity and remains asymptomatic. He then begins driving and will not be cleared to race until he can drive at competitive speeds for 30 minutes and remain asymptomatic (IndyCar Concussion Protocol, n.d.). NASCAR has a similar return to racing policy where the driver needs to be cleared by an independent physician after a similar progression (Earnhardt Jr & McGee, 2018). These concussion protocols are constantly changing as the science and understanding of concussions continues to evolve.
An additional step that IndyCar takes is to have its own traveling medical crew. The safety team consists of approximately 30 people, with 18 traveling to each race. This crew is made up of a trauma physician, an orthopedic physician, two paramedics, two registered nurses, and 12 firefighters/EMTs. This traveling crew gets to know the drivers and can tell when a driver is “off,” helping in the recognition of concussion symptoms (AMR IndyCar Safety Team, n.d.). NASCAR has also begun to implement a traveling safety team, but it is unclear if it is as robust as IndyCar’s.
Issues
While NASCAR and IndyCar have good concussion protocols in place, there are still several issues that arise.
The first issue is with testing; not concussion testing, but the testing of the race cars and the tire compounds. Testing in racing is similar to practice in stick-and-ball sports, but done more infrequently and only at the behest of the sanctioning body or the tire manufacturer. Both NASCAR and IndyCar and their tire manufacturers run tests in which teams and drivers are required to participate. They may be testing a new feature for the car or a tire compound for a particular race track. The sanctioning body or tire manufacturer rents the race track and pays for the fire and ambulance personnel to be at the track. But this does not mean that the series’ concussion protocol will be in place. In 2012, Earnhardt Jr. crashed while running in a tire test at Kansas Speedway after a tire blew while he was running at 205 miles per hour. His Incident Data Recorder recorded the hit at 40g. While fire and medical personnel were at the track, they were slow to respond, and Earnhardt Jr. ended up being driven back to the infield in driver Brad Keselowski’s rental car before the ambulance crew even made it to the site of Earnhardt Jr.’s wreck. He was not seen by medical personnel at the track nor was he seen by medical personnel back in North Carolina. He raced for almost two months before a crash at Talladega Superspeedway aggravated his concussion symptoms and forced him out of the car for two races (Earnhardt Jr & McGee, 2018). While an almost full complement of fire and ambulance personnel are at each test session, it is unclear if the infield care center is also staffed or if in IndyCar, the safety team travels to tests. If not, any driver who crashes may not be subject to concussion testing before the next race. Any driver who crashes during testing needs to undergo concussion testing prior to getting back into the race car to ensure both driver and competitor safety.
A second issue with the concussion protocol is that it relies on drivers to report concussion symptoms outside of the event. For example, if a driver is racing in a race sanctioned by a different sanctioning body and crashes, he will not have to go through the concussion protocol for his main sanctioning body unless the driver reports concussion symptoms. Or if a driver is in a crash on Sunday but does not experience concussion symptoms until Monday. It is up to the driver to report that. One of the benefits of the IndyCar safety team is that the physicians have a relationship with the drivers and can follow up with them after a crash (Lawrence, 2016). But it is still dependent on a driver reporting concussion symptoms. Which as shown by Earnhardt, Jr., they can still be reluctant to do so.
A third issue with the concussion protocol is related to the second issue and is the need for a continuous driver education piece. IndyCar drivers receive an education in concussion symptoms at least once a season and it is unknown how often NASCAR drivers are educated on concussion symptoms. It is important because concussion symptoms are similar to sinus and allergy symptoms and have been mistaken for them. In 2016, despite his concussion history and a crash the week before, Earnhardt Jr. wrote off his concussion as allergies and took allergy medicine instead of reporting the symptoms (Earnhardt Jr. & McGee, 2018). Drivers, and their crews, need to be constantly reminded about what the concussion symptoms are and to get tested if they are unsure.
The final issue is not with concussion protocols, but with the nature of the sport itself. While concussions are important, the biggest safety concern is death. As a reporter put it “[t]hat disconnect in concussion perception, between stick-and-ball sports and racing might be because a racer – between his Hans device, the “soft” track walls and that carbon fiber shell he calls an office – seems so well protected. Or it could be because getting your bell rung is the least of his concerns. Recall: This is a sport where people die in competition. (The uniform is called a fire suit for chrissakes.)” (Lawrence, 2016). This risk is especially great in IndyCar. In May 2015, James Hinchcliffe was seriously injured during a practice session for the Indianapolis 500. He hit the wall at over 200 miles per hour. In his words, he suffered “a massive concussion” and does not remember the accident. However, he was also pinned to the car by a metal rod which had broken off his race car and had struck an artery in his leg. Blood loss was the much more immediate concern and he was taken to the hospital without stopping at the infield care center and was rushed into emergency surgery to repair the artery (Hinchcliffe, 2015). His concussion was treated after the doctors saved his life. Later that same season, Justin Wilson died after being struck in the head by debris off another race car. In August 2018, Robert Wickens was severely injured in an accident at Pocono Raceway. His car was hit in the wheel by another car, sending Wickens’ car into the catch fence, where it careened back on to the race track. Wickens’ suffered several severe injuries include a thoracic fracture, a spinal cord injury, a neck fracture, fractures in both arms, both legs, and four ribs, and a pulmonary contusion. As a result, he was paralyzed from the waist down. A concussion was not even listed on his initial injury list. When IndyCar and NASCAR make safety changes to the car, the driver’s uniform, or the race tracks, it is to prevent death, not concussions, as it should be.
Conclusion
Motorsport is a dangerous activity. Every time a driver straps into the race car, he runs the risk of serious injury and even death. And drivers understand the risk they take. Less than five months after his Indianapolis 500 practice crash, Hinchcliffe returned to racing. Why? “It’s because we’re wired wrong. This is our passion, and we accept the risks that come along with it. I don’t expect anybody who’s not a driver to understand it. It’s just what we do. We get back in the car. ” (Hinchcliffe, 2015)
That same year, IndyCar driver Justin Wilson died from injuries suffered in a crash at Pocono Raceway. Writing after Wilson’s death, driver Tony Kanaan explained why drivers still race, knowing the risks:
“… But we can’t make it 100 percent safe, and we’re okay with that. If you made it 100 percent safe, then anybody could drive a race car. And if anybody could do my job, I wouldn’t want that job. To take away risk in car racing would take away what it means to be a race car driver. Nobody wants that. We should always be looking for new ways to evolve and minimize the risk, but no matter what we do, there will always be accidents that we can’t prevent. There will always be risk. There will always be danger.” (Kanaan, 2015)
If for no other reason, this is why drivers will not sue over concussions.
Professor Cebula is a sports management professor at Kutztown University. She earned her Juris Doctor from Marquette University Law School and the Certificate in Sports Law from the National Sports Law Institute of Marquette University Law School (MULS). While at MULS, she was a member of the Marquette Sports Law Review and served as a research assistant to Professor Paul Anderson, Director of the NSLI. Upon graduation, she spent several years in college athletics, including a stint in the compliance office at the University of Delaware, before arriving at Kutztown in 2012. Professor Cebula can be reached at cebula@kutztown.edu.
References
AMR IndyCar Safety Team (n.d.). IndyCar. Retrieved from: https://www.indycar.com/Fan-Info/INDYCAR-101/Safety/Holmatro-Safety-Team
TBI: Get the Facts (n.d.). Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
Deakin, N. & Hutchinson, P. (2017). Concussion in motorsport: incidence, awareness and future directions. Concussion (2017)2(3)43. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094153/pdf/cnc-02-43.pdf
DeGroot, N (2017, Feb. 17). NASCAR announces updates to concussion protocol. Motorsport. Retrieved from: https://www.motorsport.com/nascar-cup/news/nascar-announces-updates-to-concussion-protocol-874642/874642/
Earnhardt Jr., D. & McGee, R. (2018). Racing to the finish: my story. Nashville: W Publishing.
Fowler, S. (2017, May 18). 25 years later, finish of first night race at Charlotte still among NASCAR’s greatest. The Charlotte Observer. Retrieved from: https://www.charlotteobserver.com/sports/spt-columns-blogs/scott-fowler/article151282617.html
Hinchcliffe, J. (2015, Oct. 14). Getting back in the car. The Players’ Tribune. Retrieved from: https://www.theplayerstribune.com/en-us/articles/james-hinchcliffe-indycar-crash-return
IndyCar (2019). NTT Indy Car Series official rule book. Indianapolis, IN: Indy Car. Available at: http://epaddock.indycar.com/LinkClick.aspx?fileticket=k8xdi-l5zaU%3d&portalid=0
IndyCar Concussion Protocol (n.d.). IndyCar. Retrieved from: https://www.indycar.com/Fan-Info/INDYCAR-101/Safety/Concussion-Protocol
Kanaan, T. (2015, Sept. 8). Why we race. The Players’ Tribune. Retrieved from: https://www.theplayerstribune.com/en-us/articles/tony-kanaan-justin-wilson-indycar
Lawrence, A. (2016, March 18). IndyCar steadily coming to grips with concussions. Sports Illustrated. Retrieved from: https://www.si.com/racing/2016/03/18/indycar-will-power-concussion-policy-cte
Martin, B (2016, March 13). Power misses St Petersburg IndyCar race, diagnosed with concussion. Autosport. Retrieved from: https://www.autosport.com/indycar/news/123238/power-diagnosed-with-mild-concussion
Pockrass, B (2018, May 18). NASCAR and IndyCar adapt new tests for concussion screenings. ESPN. Retrieved from: http://www.espn.com/racing/nascar/story/_/id/23541155/nascar-indycar-implementing-new-tests-screen-concussions
Taking a closer look inside NASCAR’s concussion protocol (2016, July 16). FOX Sports. Retrieved from: https://www.foxsports.com/nascar/story/dale-earnhardt-jr-alex-bowman-sprint-cup-nascar-concussion-protocol-hendrick-motorsports-071616
Wagner-McGough, S (2017, Dec. 10). Texans’ Tom Savage briefly returns despite suffering scary-looking concussion. CBS Sports. Retrieved from: https://www.cbssports.com/nfl/news/texans-tom-savage-briefly-returns-despite-suffering-scary-looking-concussion/
