Dr Aruni Sen discusses the role of a Chief Medical Officer, from leading medical teams and preparing for race weekends to managing the clinical demands of circuit care.
There’s a crash, flags are waved, and the driver or rider is taken to the medical centre. For many spectators, that is their experience of motorsport medicine. Yet while attention stays on the racing and drama, medical teams prepare for moments that may unfold in seconds and demand calm, decisive action.
Dr Aruni Sen, a consultant in emergency medicine and Chief Medical Officer (CMO) at Oulton Park, has spent thirty years working in motorsport medicine. His role combines emergency medicine, pre-hospital care, logistics, and leadership. A CMO must be ready to coordinate the response, assess risk, and make decisions quickly, often with limited equipment and time.
MotorsportInsight spoke with Dr Sen about his role, how preparation changes between events, and why motorsport medicine continues to hold his interest.
Could you explain your route into motorsport medicine?
During my training, I worked with paramedics and joined a transfer team called the Shock Team, both of which deepened my interest in acute care outside hospital settings. My introduction to motorsport medicine came in the summer of 1996, when I was teaching on an Advanced Trauma Life Support course. Two candidates were the then CMO for Oulton Park and a doctor who was a prominent figure within the FIA. They asked whether I was interested in motorsport and invited me onto a rescue vehicle at Oulton Park.
Although I saw little trauma at that race, it sparked an interest. I asked to return and was put on the list for the following season, where I began as a junior medic. Motorsport and medical provision were different then, but the broad challenges were similar. From there, I expanded into motorbike racing at Anglesey. Thirty years later, I still go to Anglesey and Oulton Park, and I am now the CMO for Oulton Park.
What does the CMO role involve over a race weekend?
The role has two parts: ongoing administrative and supervisory responsibilities attached to the circuit, and operational responsibilities during a race weekend. At Oulton Park, the CMO provides medical oversight for paperwork, medicines, equipment, policies and governance. The circuit needs a named medical lead to advise on clinical matters, approve processes and ensure appropriate systems are in place. At the start of the year, we review the previous season, plan ahead and allocate the team.
During a race weekend, the role becomes much more immediate. The CMO is responsible for the race from a medical standpoint. If an incident occurs, I need to take charge, decide quickly, and coordinate the response. I can rely on the wider team, but the responsibility ultimately sits with me. A CMO therefore needs a broad, robust clinical skill set to handle whatever comes along, understand likely injury patterns, know the team’s strengths and limitations, and decide how best to deploy doctors, paramedics and rescue crews.
On a quiet day, the role can appear straightforward: checking a driver after a small collision, for example, and confirming there are no injuries. If a serious incident occurs and the race is red-flagged, I respond in the medical car with rescue vehicles staffed by crews trained in fire response, rescue and basic medical support. Those vehicles may also include a doctor or paramedic.
Once on scene, my role is to coordinate. If someone is trapped, the first question is how to extricate them safely. Sometimes judgement must override routine. A driver may be trapped in an overturned car, with the rescue team preparing for a textbook removal. But if the driver is conscious, stable and able to cooperate, righting the car and allowing them to climb out may be safer and faster. The question is how to avoid further harm while getting the patient out quickly enough to assess and treat them.
After that comes clinical assessment: deciding what treatment should happen trackside, what should be managed in the medical centre, who needs hospital transfer, whether that should be by land ambulance, and when an air ambulance may be required. The CMO may not perform every intervention, but they are responsible for oversight and for ensuring everything is done safely, appropriately and efficiently.
Although motorsport medicine is often associated with trauma, the role extends far beyond. Over my career, I have dealt with cardiac arrests, deaths, heart failure, asthma, among other medical emergencies at race meetings, involving marshals, competitors, support teams and spectators, as well as those on track.
What preparation takes place before racing begins?
On race day, the team usually meets 30 to 45 minutes before racing begins. If I haven’t worked with team members before, it is my responsibility to make contact, clarify roles and understand their experience and skill set. Equipment checks are also essential – knowing what is available in the medical car and ensuring the team is familiar with anything they may need to use.
Everyone signs on, and team members are reminded of their responsibilities and limits. The aim is to evacuate patients quickly and safely, avoid holding up the race unnecessarily, and avoid doing more treatment than is needed trackside. The priority is to keep the injured person safe, move them to the medical centre where appropriate, assess them quickly and decide on treatment or transfer.
I then deploy the team, deciding who will be based on rescue vehicles, who will work in the medical centre and who will cover other posts. The medical centre paramedic is a key contact, particularly in coordinating how the medical centre and trackside teams work together. Once the briefing is complete, the team moves into position. By that point, the medical team needs to be ready not only in terms of equipment, but also communication, confidence and clarity of role.
How does preparation change between events?
One of the most important distinctions is between car racing and bike racing. In car racing, injury patterns are more predictable, and extrication is a major consideration. The precise type of car may vary, but the broad principles are familiar: the driver may be restrained within the vehicle, and rescue teams need to consider the safest way to access and remove them.
Bike racing presents different challenges. There is often no extrication: when a rider crashes, they are thrown from the bike and may land on the track or grass. That creates different injury patterns and can make decisions around movement, pain relief, medical centre assessment and hospital transfer more complex. For bike events, the focus is on immediate pain relief, which requires knowing what medication is available, ensuring there is enough, and confirming injectable pain relief is ready if required.
Team composition can also change day to day. While the CMO is present across a weekend, the doctors and paramedics around me may vary. This makes it important to understand each person’s experience and confidence. One day there may be an anaesthetist and gynaecologist; the next, a general surgeon, and it is up to the CMO to decide where people are best placed to maximise their skills. Equipment is generally consistent, but supplies must be monitored particularly across multi-day events to ensure essential drugs are not depleted.
Larger events bring further considerations. They often mean more drivers, bigger paddocks, more spectators and more family members. With more people on site, the likelihood of medical incidents beyond on-track trauma also increases.
What is the most challenging aspect of the work?
For me, the real draw is the clinical challenge. Trackside medicine demands fast, lateral thinking in an environment very different from hospital. There is no X-ray, ward, nurse, brightly lit treatment room or full range of equipment. Care may need to be delivered on grass, in mud or beside a damaged vehicle.
That environment forces rapid decision-making. There is rarely time to wait and observe. Race organisers will naturally want to resume the event as soon as it is safe, but the CMO must decide whether the medical team can release the track. Fundamentally, the race cannot restart if the medical team would be unavailable for another incident.
Speed is central. In hospital, there may be time to gather information, request imaging and involve specialists. At the trackside, key decisions may need to be made within minutes. Even when injuries appear similar, context changes everything. A limb fracture in hospital is managed differently from one beside a circuit. Trackside, the questions are practical: how should the limb be supported, how will the patient be moved, and what happens if they are admitted far from home?
One memorable case involved a biker with a femur fracture. A paramedic and I applied a splint to straighten and support the leg before transfer to hospital. The next day, feedback suggested the splint had worked almost too well, pulling the bone ends further apart than needed. Without X-ray, our priority had been to straighten the limb, manage pain and make the patient safe for transfer. It was exactly the kind of situation that illustrates how different trackside decision-making can be from hospital practice.
How has motorsport medicine changed?
The sport is safer now, thanks to improvements in car design and a greater understanding of how injuries occur, how to prevent them and how to treat them. Extrication has also changed dramatically. In the past, removing an injured driver could be complex and lengthy, sometimes taking hours, while modern approaches are often faster.
Equipment and drugs have improved too, with fast-acting pain relief more readily available and splints becoming more versatile, allowing trackside teams to support and stabilise injuries more effectively. Onward care has also evolved. Some patients still need immediate hospital treatment, but others can be managed with advice and follow-up. A suspected collarbone fracture, for example, may be managed with a sling, pain relief and advice to attend a local hospital on the way home, rather than automatic transfer from the circuit.
Do specific circuits require unique medical considerations?
Each circuit presents its own challenges, but Anglesey is one of the most demanding. Oulton Park is well established, with good tarmac and relatively accessible surroundings. Anglesey is set on a hillside by the sea. The circuit rises and falls, includes sharp corners, and is exposed to unpredictable weather, including wind and fog.
While Oulton Park has several hospitals relatively nearby, Anglesey is more isolated, with the major trauma centre potentially requiring helicopter transfer. That remoteness changes how patients are managed. It may be easy to advise someone to go to hospital, but much harder for that person to do so. At the same time, trackside care has limits, and as CMO, there comes a point when I must decide that treatment at the circuit has gone as far as it safely can.
Regardless of circuit, the start of a race is often one of the most dangerous points. Cars accelerate rapidly from a standing start, and the first corner may be only a few hundred metres away. Within seconds, drivers are accelerating, braking and fighting for position, creating the potential for pile-ups and high-energy incidents. Trackside medical teams may need to respond on foot before an ambulance can reach the scene, while managing damaged cars, debris, trapped drivers and increased risk to responders.
What keeps motorsport medicine interesting?
The continuing appeal lies in the clinical challenge: constant awareness, adaptability and judgement. Even on a quiet day, the potential for a serious incident remains. Motorsport medicine offers a view of injury that hospital clinicians rarely see, from concussion developing in real time to fractures that must be aligned, splinted and transported safely. It is a demanding branch of pre-hospital care, requiring rapid judgement, practical problem-solving and calm decision-making in unpredictable conditions. For medical professionals who want the challenge of trauma and acute care outside the hospital environment, motorsport remains one of the most testing and rewarding settings in which to work.