Just before Christmas I spoke with Dr. Gary Hartstein. Gary is an anaesthesiologist, working at the University of Liege Hospital in Belgium, but perhaps best known for his time as the FIA Medical Delegate in Formula One and the Chairperson of the FIA Medical Training Working Group. Here is my chat with him.
To hear the full audio, go here – http://www.gersweeney.net/2013/01/ben-sweeneys-f1-blog-chats-to-dr-gary-hartstein/
What do you make of the current level of Safety in Formula One?
Right now, Formula One has become an extremely safe sport. You have to temper that by saying we have 24 participants per race, so we don’t have a huge number of people participating as opposed to other sports but given the energies involved, it’s particularly safe. We’ve certainly gone a very long time without a severe injury and if you look really at the nature of the sport, a good many of the potentially severe or fatal injuries have been engineered out of the system. I’m not saying that bad things can’t happen, but if you look at the entire environment in which the sport takes place, we’re talking about the driver himself to the drivers personal protective equipment to the cockpit he sits in to the car that surrounds him to the circuits the car drives on, the deceleration areas the car goes through and then the barriers the car hits, If you look at the whole system, it’s just a remarkable system of energy management and in motorsport, that’s the area that you’re looking at to reduce risk and the level of safety is remarkably high.
You mentioned there about how safe the cockpit is but we saw this year in Belgium with Romain Grosjean’s crash, just how close he came to Fernando Alonso’s head, what would you make of cockpit canopies?
I think my view of that is that we need to look at how to prevent cars from getting airborne. I mean, that’s the essence of the problem there. I think if we can avoid cars getting launched, and I think the physics and mechanics of that are very close to being very well understood by the engineers who work for the FIA institute. That’s going to avoid a lot of things like the Fernando/Romain thing that happened. As for the canopies, I was the person responsible for pulling people out of cockpits, and the less I’d have to worry about to get them out, the better I like it. A car with a canopy on its roof poses potential problems. Basically, I think there are a fair number of solutions to the problem of cars flying over each other and there are a lot of smart guys looking at that, so as long as they have an input from people who are actually going to be doing the rescuing, then I think good solutions are going to be found. That being said, you’re never going to be able to engineer every single conceivable risk out of the system, because there’s always a risk that you haven’t thought of. A comets decides to shoot out of the sky and land on somebody as he’s driving around Monza, we’re not going to be able to design that out of the system, but in terms of the conceivable injury modality’s, getting airborne is the last tough nut to crack, and once that gets solved, a lot falls into place.
Onto a question from Twitter, what was the weirdest ailment you’ve ever had to treat on a driver on a race weekend?
Sid probably would’ve been able to answer these questions better because in the early days that he was around, as they used to say, racing was dangerous and sex was safe, so Sid treated all kinds of crazy stuff. But the guys are basically fairly calm, usually family men, who are extremely fit athletes so they are usually serious about that kind of thing. I’ve treated all the usual stuff though. There was a driver who came to me, who shall remain nameless obviously, complaining of hair loss and wondering what kind of pharmaceutical options were available for hair loss and that’s probably the oddest request that I’ve had. An unexpected injury, which was unusual because it was so unexpected was after one of the races and a driver came up to me and said that he had some pain in his butt, so I brought him to the FIA truck to check him out and the guy in question had a huge second degree burn on half of his butt and it was a massive burn. The guy had driven half the race with this huge burn, sitting on it and you know how painful burns are, and I was completely flabbergasted that the guy could drive like that. Turned out that one of the black boxes in the car was located right under his seat and got incredibly hot and didn’t have adequate cooling and just through the race, just burned the hell out of this guy. And I just couldn’t believe the stoicism of the driver to drive through the whole race with this massive race but I took care of that and he was ok for the next race.
Another twitter question now, If you had unlimited money to spend on the medical car, what features would you add to it?
If I had unlimited money to spend on AN F1 medical car, I’d probably try to find a mint condition original McLaren road car. The reason I’d find that is because it’s a three seater so I could sit in it with a driver and a local doctor and that would be good enough for us. If I had to spend unlimited money on the car we have now, I’d basically put the biggest engine, the biggest brakes and double wishbone suspension all around and a double clutch gearbox and I’d try and convince Mercedes and AMG that we should drive with slicks in the dry and we should use either inters or full wets in the wet. I wouldn’t really do a lot to it. The car is an amazing tool to get our job done and it’s really a lot of fun to go around in now and so it doesn’t need a whole lot. Give it a couple of hundred more horse power and big fat ceramic brakes and a double clutch gearbox and I think we’d be getting pretty close to everything a man could desire.
A final twitter question now; Did you ever have any rituals or superstitions before a session?
When I would notice myself getting into ritualistic behaviour, I would always try to change it after a couple of races, just to see if it’d change anything, you know? Eh, I put my gloves on right – left now I’ll put them on left – right! I tend to get very ritualistic about things but not because I think it’s going to bring any outcome or avoid any outcome, it’s just I tend to do things the same way all the time. It’s more OCD than superstitious behaviour! So yeah, I don’t really have any rituals. Like I said, there are thing we try to do pretty much all the time in the same way, but not because we believe it’s going to avoid any problems. We joke around about it a little bit. When we drive down the pitlane before a session, usually about five minutes before the session starts to get to our standby position, Dickie Stanford, the race team manager for Williams is always on the pitwall and he always turns around and waves at us as we go by and says ‘hi guys’ and if for some reason Dickie is busy or talking to somebody or we don’t see Dickie and we get to our standby position, Alan and I look at each other and go ‘Oh dear, something bad is going to happen’. It’s more joking around than anything else. I don’t even think that Dickie is aware that it’s become a big thing for us, you know us saying ‘ok, we need to talk to Dickie now’, and we’ve joked to each other on occasions that we should just back up the pitlane and say hello to him!
On that subject, you’ve spent a lot of time sitting in a Mercedes with Alan Van Der Merde so, what do you do all day?
It winds up being a fair mix of things but usually P1, Friday morning for about half an hour of the first session, I’d probably have my eyes shut! There’s something about first thing on Friday morning… You’d think it’d be like ‘Ah here we are after two weeks’ but in fact, there’s something about the green light in the pitlane going on and the cars going out on track on many occasions was the most powerful sleeping pill you could imagine! European season after FP1, GP2 would usually go out and basically I pay a lot of attention to what happens because it’s usually a good track and those guys are pretty good for an accident so you know, you have to stay awake and pay attention! Apart from that, we talk a lot, we joke a lot and we comment a lot on what’s going on around us. We watch the screens in the car and that provokes gales of laughter occasionally and there are various personalities in the paddock that you might zoom in on and we usually have something to say about pretty much everybody. On occasion if I’ve brought work along with me then I’ll have some reading to do. Between watching the race action and joking around with Alan, Killing time, meditative exercises i.e. Sleep, and talking to the tower which we don’t do a whole lot of, and of course, watching what’s going on out on track, that pretty much takes care of everything.
Talking about the medical car, you spent about 15 years sitting beside Sid Watkins. After all that time, how would you describe him?
Sid was certainly one of the most extra-ordinary people I’ve ever met. There’s just something about him. The first thing that grabs you is his charisma. He just has this extra-ordinary charisma and he could just draw you in. And, I don’t know anybody whose stories were as good as his were and just an amazing guy. When I first met him, the legend was just starting to form and I rode with him from 1990 at the Belgium Grand Prix and then pretty much once a year until 1997 and we got to be fairly good friends but I think he fairly crystallises and solidified the work he did after Imola 1994, that’s where everything really came to a head and the true brilliance of the guy came out. He just put it all together. He had an incredible sense of humour as dirty as anybody could want and yet he could turn on a level of poshness that royalty could be and was quite at home with. He knew how to get problems solved, he had an innate sense of what needed to be done and what attitude needed to be adopted to get something done, be it bullying, threatening, cajoling, kowtowing, which he didn’t do much of but he just had an innate sense of how to get stuff done. Extra-ordinary stubbornness, in a good sense, just relentlessly pursuing his goals. An amazing guy. Just sitting with Sid for hours and hours in the medical car are really some of the best memories I’ve got.
Speaking of Sid, he was known for his relationship with Ayrton Senna. Have you ever felt a similar relationship between you and another driver?
Not really, no. I get along fine with most of the drivers but I think that that was something that was meant to happen between Sid and Ayrton. I think things have changed now. You don’t have a lot of guys like Ayrton around anymore. I think Ayrton was a guy who had an intensively developed and developing spiritual side and I think while some of the drivers may or may not have that now; I’m not privy to that. These guys now are very busy on a race weekend and extremely focused on the task in hand and I never wanted to feel in any way that I was making a demand on their time or taking them away from something that needed to be done. I was there to do a job, they were there to do a job and I thought that unless they need me for something specific, I need to stay out of their hair, and that’s always been my way of dealing with them. I’ve felt fairly paternalistic about a fair amount of the drivers and quite concerned about them but I haven’t developed a relationship with them. They’re a lot younger than I am, we don’t really have a whole lot in common, so while I respect what they do and it brings me a huge amount of pleasure, I can’t really say that I’ve developed a close relationship with them. Although, their reactions when I announced that I wouldn’t be back next year did surprise me by its intensity, I still wouldn’t say that I’ve got friendships with them.
In your opinion, what has been the most important development in Safety since you began?
I might disappoint you a little but I’ll answer the question in two parts. By far the most important development in safety in motorsport has been not so much this or that invention or this or that bit that they’ve put on the cars or the fact that now they use TecPro in a lot of places instead of tires, or the fact that they use asphalt run offs instead of Gravel, I think the overriding advance in safety is that now, when they are developing safety tools, the scientific method is being used. Hypothesis are being created then they’re being tested objectively and data is being generated that either verify the hypotheses that leads it to either being refined or thrown out and based on the result of that experimentation that is done by our engineers, thing are pushed forwards into the regulations. Three examples that we know have been lifesaving in at least ten to fifteen accidents are the new spec helmets, which clearly saved Felipe’s life in Hungary, the HANS device which has repeatedly managed energy such that drivers are avoiding head and neck injuries in a lot of frontal and angled frontal collisions, and the headrests that we take out of the car. Those head rests are safe because they are both higher than they were obviously before Imola 1994 and also because of their crushability parameters which have been studied and they are protecting the drivers in the case of lateral or rearward impacts. That’s just an example but those three elements have been tested; we had all the numbers before the regulations put them into effect. It wasn’t done empirically, it was done very scientifically, and that’s been applied to creating tire barriers now, they aren’t done randomly. We have the date to know that on a corner where cornering speeds are going to be ‘x’ then you know you need five or six rows of tires, you need them staggered, you need them bolted together vertically and horizontally and so on and so forth. There’s a whole set of criteria to create barriers under circumstances and then there’s TecPro, but all of those things, every one of the rear and lateral impact structures on the car, the front impact structures, they’re all tested, we know the data and that’s what Sid and the advisory group did in 1994. When Max said to Sid, ‘look Sid, you put together an advisory expert group and you do what has to be done,’ they were flooded with ‘we could do this’ or ‘we could do that’, from people all over the world and what they said was, ‘we are going to do this as scientists and engineers. We are going to test the hypothesis and what works we’ll do and what doesn’t work we’re not going to do.
On a similar line, when you look back at what you’ve done in 20 years, will you be happy with what you have achieved, up to 2012 at least?
If you think about it, the engineers with input from the docs and led by Sid as sort of an intellectual locomotive, I think the main advances in safety and the main reductions in bad accidents have been down to engineering. If you think about it, the doctors and nurses and paramedics on track are there for when something goes wrong. What I mean to say is, when the protective measures have failed, that’s when we get called in. And at that point, all you can do is count on high quality medical care and that’s an on-going thing at the moment. Some places we work in, the medical crews take part in a huge amount of racing, but in others, they don’t participate in a lot. And in both scenarios, the people involved are or are not involved in pre-hospital medicine in the real world and so you have a tremendous mix of skill levels and that’s the big challenge. The big challenge is to get everyone up to the same level of ‘comfort’ and you really need a lot of experience and situational awareness in a situation like that. People tend to lose that because of the stress and that’s the next step. So I can’t say that I’m satisfied. We’ve had a lot of obstacles thrown up, a lot of difficulties but we’re getting there. There’s a ton of guys out there really want to get the job done but it’s a slow slog. Sid knows that; it took him from 1978 right up until last year to get the work he got done, done. So I can’t say I’m satisfied, but I’m not too dis-satisfied.
You were saying there about how some tracks are better than others in terms of safety personal so what would your thoughts be on a permanent group of, however many, fifty medical people dotted across the circuit. Obviously you’ve got people like yourself going to every race but would you be happy with a highly skilled group of people at every race, or is what’s there suitable?
I think there are advantages to the way we do it now and clearly if you pick a team of five, ten guys and you train together and you work together and you go to every race together, then you wind up in a situation where people work together without even speaking and everybody knows what everybody is doing and it works very seamlessly. Since we’re travelling all over the world, we could work very well, very efficiently at an accident trackside, but ultimately the casualty is going to have to go to a local hospital for his initial management and at that point, we would lose control anyways. And we would lose control to a team of hospital based physicians who would be dealing with people who told them in not so many words, ‘we don’t really trust you trackside, but could you take care of our casualty now?’ and so beside the fact of being registered as doctors in all these countries, which we wouldn’t be, we would be practicing medicine in a country where we’re not licensed to practice medicine. Very, very difficult. So what was elected to be done when Sid first started doing this, and for obvious diplomatic, political and medical legal reasons, was that the whole system was based on a minimum FIA presence but a certified local team who was certified to be up to spec in a certain number of categories; enough people, enough equipment and so on. And that’s the current situation. I think it makes sense, but obviously at that point the difficulty is getting them up to the level of quality that you want them at.
You were talking about how essentially, a casualty goes as quickly as possible to a hospital so on that topic, you’re a very qualified doctor, without meaning to sound bad, why pick F1 over a hospital?
Well that’s an interesting question because what you probably don’t realise is that I’m a full time University hospital based doctor. I’m the professor of anaesthesiology at the University hospital here in Liege so when I get home from a race on Sunday night or Monday afternoon, Tuesday I’m back in the hospital. The job that pays my rent is my hospital job. F1 in its way is a very demanding and obvious hobby, but that’s not been my main job, my main job is in the hospital. Really, you can’t stay clinically credible in F1. There are so few accidents in F1 that you don’t build and maintain your skills just sitting in a medical car so I work in the operating theatre and the A&E department here at the hospital all week and that’s how I stay sharp.
That’d be some shock for some lad to walk in with a broken arm and see you treating him!
It happens on occasion. It does happen that the patients go ‘aren’t you the guy who does F1’ because inevitably the local newspapers run articles from time to time about the guy who works in Liege and goes to Formula One races so on occasion patients do recognise me, but it doesn’t change the way that they get treated, or the way I do my job.
Now on a completely different subject, what’s the best piece of advice you’ve ever been given, and why?
That’s a good question. The best piece of advice I’ve been given might not be one that I followed but more and more I think that the most useful advice if you’re getting into a politically hostile area, is to pick the battles you’re going to fight. You can’t fight every battle that you want to fight; you’ve got to pick them properly. Sid did a good job inculcating that into me and I think that Bernie is the perfect demonstration of that; Bernie picks his fights and he picks the ones that he needs to win and has a good chance of doing so. And the other ones he does damage control, and that’s something I try to apply, especially now!
It’s been a hot topic recently; do you think that Michael Schumacher was right to come back to Formula One?
I was really glad when Michael came back and I’m not a sports physician, I’m more of a trauma anaesthesiologist but I thought that whatever Michael would have lost in pure racing physiology; reaction time, visual processing etc. I thought he would have made up for with his extreme intelligence and I thought he would really be in for a shot of giving Nico a run for his money and ultimately, your first job is to beat your team-mate, so I was pretty happy to see how things would turn out.
Turns out it was an interesting experiment and I’ve spoken with a lot of very eminent sports physicians and you can’t do Formula One when you’re forty years old. Not in 2012. And in fact, these guys told me that, to their credit, in Malaysia of 2010. I remember having a conversation with them and I remember saying to them ‘This is really great, I’m really excited’ and they said, forget it, it’s not going to happen. Turns out it kind of didn’t happen. But I’m glad he came back. I think it was good for Michael, the guys in the best shape he’s ever been in. He had a rough time of it but I think it did him some good to get this out of his system and I think it did the fans a whole lot of good, it did the sport a whole lot of good, and it was cool. It’s a pity that he didn’t do better but I think Michael understands that that’s just the way it is.
If you were a team boss, which two drivers would you want, and why?
That’s a good question to ask. I guess if I was a team boss, I’d want Sebastian and Fernando on my team, just because I think they are such hardworking guys and they’re so focused and they’re so brilliant and so talented. And if you could deal with having two geniuses like that on your team, you’re going to win Championship’s year after year. That’s not to say that I don’t love Jenson, don’t love Mark, don’t love Lewis, I really do like a good deal of the drivers on the grid, but if I was a team principal, Seb and Fernando would be my pick.
A final question now, if you could change one thing about your twenty two years in Formula One, what would it be?
If I could change on thing about my time in Formula One…. I suppose I’d make the bottom of my seat a little more padded and angle it back just a little bit more. Over twenty two years, that would have provided me with several weeks’ worth of more comfort. I don’t think I’d change a whole lot to be honest, I mean it worked out a little bit funny at the end there but I’m pretty happy with most of the stuff I did, I don’t have any regrets. It’s been a long run and it’s been a lot of fun and I’ve learned a lot, met a lot of cool people and made friends all over the world and drive around all the circuits in a really hot car with some really cool drivers, so it’s been pretty good.
So after twenty two years, the only thing you’d change is you’d put an armchair in a car!
Put an armchair in a car, yeah. When Sid was riding in the front, AMG put a humidor and a little whiskey flask with a couple of shots built into the car, and I don’t really smoke a lot, I barely smoke cigars anymore anyways, but the armchair and the humidor in the car were quite nice touches. They’re probably the only things I’d like to go back and get sorted, yeah.
So that’s it, the word according to Gary!
I’d like to thank Dr. Gary Hartstein for taking time to give us his thoughts and valuable insights based on his time in f1. I’d like to wish him all the best in the future, and I look forward to hearing from him soon.