A rally car is a piece of high-performance machinery, but what makes world-class rallying into a dynamic sport is the human element - the driver, who’s job it is to control this machinery. The man and machine element become one unit, the success of which is determined by their joint efficiency and, while the technical factor is controlled by a team of expert engineers, it is the job of the driver and team’s medical personnel to ensure the human part of this combination is performing at its peak.

Marlboro Mitsubishi Ralliart now has a team of four medical personnel responsible for doing just that. With the extremes of environment encountered in the FIA World Rally Championship - which can range from minus 20 in Sweden to plus 40 degrees Centigrade in Kenya - having personnel expert in all areas of physical and mental well-being is critical to the success of the partnership, such is the current level of competition.

Dr. Paul Trafford heads the medical team at Marlboro Mitsubishi Ralliart, the 44-year-old Englishman qualified in general practice, anaesthetics and intensive care. A keen interest in motorsport is always a bonus, being that Paul regularly travels with the team as it moves around 14 different countries in the world, but his dedication not only to various manufacturers, teams, governing bodies, venues and promoters within the sport is underlined by a keenness to ’keep his feet on the ground’ and maintain his clinical expertise in the national health service.

"In order to maintain the skills needed and keep up to date with developments it’s vital that doctors are involved clinically with medicine, this way everyone benefits", he comments. "At Mitsubishi we have a team of people who are all able to provide a mix of the skills required to look after a World Rally Championship team, while at the same time we all have the opportunity to maintain our clinical skills, and that’s vitally important".

In rallying a number of external factors combine to make the driver’s task harder than it might otherwise be. These stresses, and the efficiency with which the body deals with them, is dependent on individual reactions and reducing the potentially detrimental effects. Man has evolved a thermostat that keeps the body at a steady temperature, but stray outside these boundaries and efficiency suffers. "If the body’s core temperature rises above 39 degrees Centigrade, performance can slip and this is where we, the driver and the team have to do as much as possible to minimise the affects. Even the large white number sticker on the roof of the rally car can make the car cooler inside, and it’s been shown that temperature in a light-coloured helmet is measurably lower than in a darker one. All these small things add up when you consider the prolonged period of intense concentration and stamina required in motorsport", comments Paul.

Maintaining fluid levels is a critical element of optimising peak performance in hot countries, and when you consider ambient temperatures in the high 30’s and cockpit temperatures topping nearly 60 degrees Centigrade in Cyprus, Greece and Kenya in particular, hydration can be a significant issue. As the driver works, his metabolic rate of internal heat production increases and, hampered by clothing and in a confined cockpit, he must lose heat through sweating. But, when the body can tolerate no more fluid loss, due to insufficient liquid being injected, the body’s most efficient means of heat reduction fails and heat exhaustion follows, hence the hydration balance is constantly monitored.

Another factor that contributes to fatigue is the vibrations constantly generated from speed and the repeated pounding suffered over rough roads. Visual sharpness can also therefore be impaired - such is the sensitive tissue in the eye - and while there is very little that can be done to overcome this, the more skilled and physically prepared the driver is, the better his body will cope with the stresses.

"The drivers are only one element though", adds Paul. "Keeping the team of engineers and mechanics at full strength is a significant issue in rallying because, without them, the crew can quite easily be out of an event. Whether it’s organising vaccinations, advising on nutrition, training, medical or health issues, each and every member is treated with the same degree of importance.

"On events I also liase with the local organising medical services and the FIA to ensure the welfare of the competitors, and also go through the evacuation procedures and major incident plans. We carry all the medical equipment we need to ensure we are self-sufficient though".

And that equipment certainly puts Marlboro Mitsubishi Ralliart in a position to deal with nearly every eventuality. Heart start machines, monitors, pulse oximeters, resuscitation, cutting, rescue, immobilisation and extrication equipment, drugs and operating implements add up to a travelling medical kit worth over £25,000.