Appendix F2 - CMO questionnaire - Motocross /SuperMoto

This questionnaire must be completed by the Chief Medical Officer (CMO) and returned to the FIM: cmi@fim.ch 2 months prior to the event

A copy of this form has to be handed over before the first track inspection to the FIM Medical Director, if present.

Included:

1) EVENT INFORMATION

2) CHIEF MEDICAL OFFICER

3) MEDICAL SERVICES

Rows	YES	NO
Are all medical services under the control of the Chief Medical Officer (CSM)

3a) NUMBER OF MEDICAL PERSONNEL

Rows	Friday	Saturday	Sunday
Doctor (CMO incl.)
Nurse
Paramedic or equivalent
Other medical personnel
Stretch bearer
Driver
Total medical personnel

4) VEHICLES TYPE A = MEDICAL INTERVENTION VEHICLES

Rows	Friday	Saturday	Sunday
Number

4a) TYPE OF VEHICLE

4b)

Rows	YES	NO
Do positions conform to map of circuit/posts?
Doctor as per Medical Code
Second doctor, nurses, paramedic or equivalent as per Medical Code
Driver as per Medical Code

4c) MEDICAL EQUIPMENT

Rows	YES	NO
Portable oxygen supply
Manual ventilator
Intubation equipment
Suction equipment
Intravenous infusion equipment
Equipment to immobilise limbs and spine (incl. cervical spine)
Sterile dressings
ECG monitor and defibrillator
Drugs for resuscitation and analgesia/IV fluids
Sphygmomanometer and stethoscope

4d) OTHER EQUIPMENT

Rows	YES	NO
Protective canvas/Tarpaulins

4e) TECHNICAL EQUIPMENT

Rows	YES	NO
Radio Communication
Visible and audible signals
Equipment to remove suits and helmets

5) VEHICLES TYPE B

Rows	Friday	Saturday	Sunday
Number

6a) TYPE OF VEHICLE

6b)

Rows	YES	NO
Do positions conform to map of circuit/post?
Doctor as per Merdical Code
Satff as per Medical Code

6c) MEDICAL EQUIPMENT

Rows	YES	NO
Portable oxygen supply
Manual and automatic ventilator
Intubation equipment
Suction equipment
Intravenous infusion equipment
Equipment to immobilise limbs and spine (incl. cervical spine)
Sterile dressings
Thoracic drainage equipment/chest decompression equipment
Tracheostomy equipment surgical airway equipment
Sphygmomanometer and strethoscope
Stretcher
ECG monitor and defibrillator
Pulse oximeter
Drugs for resuscitation and analgesia/IV fluids

6d) TECHNICAL EQUIPMENT

Rows	YES	NO
Radio Communication with Race Direction and CMO
Visible and audible signals
Equipment to remove suits and helmets

7) MEDICAL GROUND POSTS

Rows	Friday	Saturday	Sunday
Number

7a)

Rows	YES	NO
Do positions conform to map of circuit/post?
Doctor
First aiders or stretcher bearers
Paramedic or equivalent experienced in resuscitation and pre-hospital management trauma
Two first aiders or stretcher bearers

7b) MEDICAL EQUIPMENT

Rows	YES	NO
Equipment for initiating resuscitation and emergency treatment including initial airway
Ventilatory support
Haemorrhage control
Cervical collar
Extrication device - scoop stretcher or spinal board or equivalent

Devices such as "NATO" or other canvas stretchers that require the rider to be lifted are no longer acceptable.

7c) OTHER EQUIPMENT

Rows	YES	NO
Protective canvas/Tarpaulins

7d) TECHNICAL EQUIPMENT

Rows	YES	NO
Radio communication with CMO

8) MEDICAL CENTRE

Rows	YES	NO
Is it a permanent structure?
Secure enivronment from which media and public can be excluded
Area easily accessible by first aid vehicles
One or two rooms large enough to allow resuscitation of at least two severely injured riders simultaneously (resuscitation area)
Water supply, heating, air conditioning and sanitation appropriate to the country
Parking for ambulances

8a) ROOMS

8b) EQUIPMENT FOR RESUSCITATION AREAS

Rows	YES	NO
Equipment for endotracheal intubation, tracheostomy and ventilaton support including suction, oxygen and anaesthetic agents?
Equipment for intravenous access including cut down and central venous cannulation and fluids including colloid plasma expanders and crystalloid solutions
Intercostal drainage equipment
Equipment for cardiac monitoring and resuscitation, including ECG monitoring, defibrillation and blood pressure measurement
Equipment for immobilising the spine at all levels
Equipment for the splinting of limb fractures
Drugs/IV fluids including analgesia, sedating agents, anticonvulsants, paralysing and aneasthetic agents, cardiac resuscitation drugs/IV fluids
Digital X-ray (recommended) provided it is not prohibited by national legislation)

8c) STAFF

Rows	YES	NO
Staff are appropriately trained and skilled

8d) OTHER FACILITY

Rows	YES	NO
Centre Medical Mobile
Is there another facility (e.g., room, container or tent, etc.) for treatment of injured riders?

8e) PLEASE DESCRIBE/SPECIFY - only if there is no medical centre

8f) NUMBER OF MEDICAL CENTRE PERSONNEL

Rows	Friday	Saturday	Sunday
Doctor
Nurse
Paramedic or equivalent
First aider
Other medical personnel
Stretch bearer
Driver
Total medical personnel

8g) SPECIALITY AT MEDICAL CENTRE

Rows	YES	NO
1. Surgeon experienced in trauma
2. Trauma resuscitation specialist

8h) OTHER SPECIALISTS

Rows	SPECIALITY
3.
4.
5.
6.
7.

9) RACES WITH CHILDREN (15 years and under) - Art. 09.8

Rows	YES	NO
Doctor expert in paediatric trauma
Equipment, monitoring devices and medications suitable for children

10) VEHICLES FOR TRANSPORT TO HOSPITAL

Rows	Friday	Saturday	Sunday
Number

11) TUNNELS and BRIDGES

Rows	YES	NO
Tunnel
Bridge

12) HELICOPTERS with MEDICAL EQUIPMENT

Rows	Friday	Saturday	Sunday
Number

12a)

Rows	YES	NO
Helicopter on call
Helicopter on the track

12b) MEDICAL EQUIPMENT

Rows	YES	NO
Fluids and drugs
Respirator
Oxygen
ECG/defibrillator

12c) NUMBER OF MEDICAL CENTRE PERSONNEL

Rows	Friday	Saturday	Sunday
Doctor
Paramedic or equivalent
Pilot

13) CLOTHING OF MEDICAL PERSONNEL

Rows	YES	NO
Doctor
Nurses and paramedics or equivalent

14) MEDICAL SERVICE FOR SPECTATORS

Rows	YES	NO
Is there separate medical personnel for spectators?

14a) NUMBER OF MEDICAL PERSONNEL

Rows	Friday	Saturday	Sunday
Doctor
Nurse
Paramedic or equivalent
First aider
Stretcher bearer
Driver
Other
Medical personnel in total

15) ANTI-DOPING

Rows	YES	NO
Are thre anti-doping facilities

15a) PLEASE DESCRIBE THE LOCATION OF THE DOPING CONTROL STATION

15b)

Rows	YES	NO
Are chaperones available on site for the doping control officers?
Is a waiting area with seating available for riders?
Are sealed bottles of still water available for the riders?

16) HOSPITALS

Rows	Name	Tel N°	Contact person	GPS coordinates/Google map link	Address	Time to hospital by road (min.)	Time to hospital by air (min.)	Distance in km
Local hospital
General surgery
Orthopaedic/trauma surgery
Neurosurgery
Spinal injuries
Cardio/thoraci surgery
Burns/plastic surgery
Vascular surgery
Micro surgery

17) MAPS

Rows	YES	NO
A route map is enclosed

18) CIRCUIT CMO QUESTIONNAIRE

Rows	YES	NO
This questionnaire has been completed by the CMO

19) REMARKS

20) FILE UPLOADS (maps, etc.)

21) DATE

Date

22) SIGNATURE OF THE CMO