In Tour de Crash, Doctors Are Fastest of All; 2 Minutes and It's Too Late.

http://www.bloomberg.com/news/2014-07-25/tour-de-france-cyclists-need-quick-aid-to-reach-finish.html

The Tour de France is all about speed, and that goes for the doctors too.

The 101st edition of cycling’s biggest race ends tomorrow in Paris, where Italy’s Vincezo Nibali is expected to win. Former champions Chris Froome andAlberto Contador crashed out during the 3,664-kilometer (2,276-mile) ride, with other riders completing the course with broken bones and shoulder separations. Doctors don’t have long to diagnosis and treat athletes after a pile-up before race leaders are out of sight.

“If you wait for 2 minutes they are already a mile ahead of you,” Max Testa, medical director for BMC Racing Team, said in a telephone interview.

The drive to finish all 21 grueling stages despite crashes during the three-week event makes cycling different from many sports. In football and basketball, play can be stopped while an injury is evaluated and the player can be benched. In cycling, the race goes on.

There are only moments to check the rider’s condition and symptoms of a concussion might not be immediate, so the medical team will stay next to the rider and talk with him for a few kilometers, Testa said.

BMC’s American rider Tejay Van Garderen continued on but lost a minute on the leaders after a crash in stage 7, the same day teammate John Darwin Atapuma withdrew with a broken leg.

Tinkoff-Saxo’s Contador dropped out with a fractured tibia during stage 10, while last year’s champion Froome of Team Sky didn’t finish stage 5 after breaking his left wrist and right hand. Omega Pharma-Quick Step sprinter Mark Cavendish tore shoulder ligaments during the opening stage.

Even with the pain, Cavendish wanted to continue, team doctor Helge Riepenhof said.

Follow That Rider

A standard neurological exam is performed for head injuries, race doctor Florence Pommerie said by phone. The medical team includes 10 physicians with emergency training and five nurses, with three ambulances and two cars to follow the race, and more ambulances and an X-ray and ultrasound van waiting at the finish line.

“Most of the head injuries are nothing,” she said, saying there’s more concern if the rider lost consciousness or if they were going at high speeds. In those cases, the ambulance will follow closely and a race or team doctor will typically keep talking with the rider as he continues, she said. If there are signs of a brain injury, a scan will be done, she said.

Testa said awareness of the risk of concussions, which can lead to long-term brain damage and have been linked to neurological disorders, has increased over the 20 years he’s been involved. The Union Cycliste Internationale, cycling’s governing body, made helmets mandatory in 2003.

“We’re much more aware of the risk of a second concussion so definitely we do more prevention,” Testa said. “We know more now about how we can push the envelope with some types of injuries rather than others.”

Spain's Benat Intxausti, left, and Czech Republic's Leopold Konig after a fall during the 208.5 km nineteenth stage of the 101st edition of the Tour de France cycling race on July 25, 2014 between Maubourguet Pays du Val d'Adour and Bergerac, southwestern France.