Many fans were distressed to see the video of Chris Horner from Friday. He crashed late in the stage, the same move that took out FDJ’s Rémi Pauriol and Sky’s Bradley Wiggins but whilst these two were holding their arms in the tell-tale sign of a broken collarbone, the Radioshack rider was apparently unconcious in the roadside ditch. He came to and finished the stage but crossed the finish line unaware of where he was and what was going on around him, seemingly riding the last part of the race on instinct alone.
There was a related story with Tom Boonen. He crashed hard on Stage 5, sustaining head injuries but carrying on. Boonen quit on Stage 7, telling cyclingnews.com:
“I’ve got a huge headache… Every kilometre was one too many. I was wondering, ‘who am I pleasing by continuing?’ Not myself, that’s for sure. I was a danger for the other riders, too. I think I suffered a concussion. Noise, colours… I couldn’t stand them. A honking car that passed was echoing a thousand times in my head. Yesterday was a dark day – due to the rain – and maybe that’s why it went better.”
Now I’m no medic but it sounds like he was in bad way since the crash, the symptoms Boonen describes sound just like brain trauma, also known as concussion. Whether he should have stayed in the race is beyond my knowledge, concussion supposedly passes with time but often bed rest is recommended; but riders often do things that others don’t.
But this raises the question of who decides on a rider’s health? Do they have the final say? Is it the team doctor in charge? What about the race doctor? Here are the relevant UCI rules:
13.1.008 The Team shall not oblige or allow any cyclist to participate in cycling events if he has been judged unfit by the Team doctor or if it learns in any other way that he is unfit.
13.1.011 In the event that the Team doctor learns of any facts that in his view render the cyclist (even temporarily) unfit to participate in cycling events, he shall declare the cyclist unfit and shall inform the Team Manager. The duration of the period for which a rider shall be deemed unfit shall be determined by the Team doctor. This decision and the declaration of unfitness shall be made in writing and added to the rider’s medical file.
In other words the team has a duty of care to the rider and the buck stops with the team doctor. It’d be interesting to see what went into Tom Boonen’s medical file last week. For me 13.1.008 isn’t worded quite right as “oblige or allow” is a little contradictory, if a rider is not allowed to start they cannot be obliged! But it makes clear that the team should not let a rider start if it learns that the rider is “unfit”.
I don’t want to make this about individuals although obviously the tales of Boonen and Horner have made me ask aloud what’s involved. It’s worth noting that these two riders are influential riders and valuable riders on their teams. It’s more the lesser rider I might worry about, the one who is worried about their contract coming to an end and “soldiering on” for the sake of the team but at the risk of their health.
The role of the “race doctor” has retreated. In the 1950s Doctor Pierre Dumas was the Tour de France doctor and was involved every day in treating the riders, whether at the roadside or in their hotel. Dumas was an early crusader against doping, calling a press conference to denounce the actions of some in the entourage of French rider Jean Malléjac as “attempted murder” after the rider almost died in the race.
More recently Dr Gérard Porte was the “Tour doctor” until ASO ended his contract but in recent times this role has meant heading up a staff of fellow medics, including a nurse and an osteopath. But the visible role of the race doctor is primarily concerned with first aid during the course of a stage. They will intervene if there’s an accident or if a rider requests help and they note any rider visiting hospital after the race. But they can’t give every rider a check-up before each stage.
The teams and in particular the their appointed doctor are in charge of monitoring a rider’s health. This can include declaring them unfit to race. Note the potential for a conflict of interest here, a doctor is paid by the team and the team’s interest are not always those of the rider.
The official “race doctor” you see in the Tour de France and other race is more available for first aid and to help riders cope with incidents during the stage.