State coroner Graeme Johnstone has released his findings following the inquest into the death of race marshal Graham Beveridge at the Australian GP last year. Johnstone said the Australian Grand Prix Corporation (AGPC) did not manage the risk...
State coroner Graeme Johnstone has released his findings following the inquest into the death of race marshal Graham Beveridge at the Australian GP last year.
Johnstone said the Australian Grand Prix Corporation (AGPC) did not manage the risk to their track officials, and stated that they should have been aware that gaps in the fencing designed to stop debris spinning into the crowd could prove dangerous to officials and spectators at the event.
"The eventual solution (a partial cage around the openings) was not only obvious, it was practical, and should have been in place before the racing incident at Albert Park. Mr Beveridge's death was avoidable. The issue of the potential for debris to go through the gap had been identified by CAMS years prior to the running of the 2001 event at Albert Park," he was quoted as saying in the The Age newspaper.
Beveridge was standing near an access gap in the fencing on crowd control duty when a stray wheel, ripped from Jacques Villeneuve's car after a high-speed collision with Ralf Schumacher, flew through the hole causing fatal injuries.
Johnstone found that Beveridge died of a ruptured heart shortly after being struck by the wheel, despite efforts by medical staff at the race track to resuscitate him.
He also criticised the Alfred Hospital, where the 52-year-old volunteer was taken. Johnstone said he found it difficult to understand why the hospital altered Beveridge's medical record after he had been declared dead.
"The patient's record should be a true and correct record of medical management. It should not be altered for contractual, procedural or any other reason of self interest," he said.
Johnstone also went on to say it was vital that the teams and the FIA develop better methods of roping wheels to the chassis in the event of an accident. Tyre tethers have only been introduced over the past few seasons, but have so far proved only reasonably ineffective in the event of a big accident.
"Continuing development of technical systems like tethers is not only desirable but it is essential considering the acknowledged dangerous nature of the sport of motor racing," he said.
Johnstone absolved both drivers from blame, saying it was the nature of formula1 racers to push their vehicles to the extreme. Any minor error could have disastrous consequence.
He also handed down 13 recommendations in his findings, among which he requested the FIA to provide more information to future GP hosts and suggested race organisers should consider appointing safety officers and independent safety audits.
The coroner did have some praise for the AGPC, saying they had taken some positive and proactive steps to reduce the risk. "Whilst some of the comments in this inquest have been critical of the management of this particular risk by agencies such as AGPC and CAMS, it also needs to be said, in very positive light, that these agencies also have taken many pro-active and innovative steps in relation to safety in the past and appear to be engaged in a process aimed at continual safety improvement," he said.
"Processes aimed at continual safety improvement are essential if the risks are to be appropriately managed. It is noted that the FIA also appears to have taken a significant number of steps on safety in the area of international Grand Prix motor racing."
The AGPC have now raised fence heights around 40 per cent of the circuit from 2.5 to at least 3.5 metres.
After the inquest's findings were announced, Sergeant Ron Perrett of the police major collision and investigation squad, who conducted the investigation into Mr Beveridge's death, told The Age:
"(I am) pleased with the recommendations, I believe as a result of that we will have a lot safer Grand Prix in this state and that will flow on to other car races around Australia.
"Also with the recommendations as far as wheel tethering (affixing wheels to vehicles) on formula1 cars, it will flow on internationally as well."
This year's Australian Grand Prix will take place on March 3rd.