Dr Muiris Houston, Medical Correspondent, spends a day at the races with the Turf Club's medical officer
As the pounding of the horses' hooves comes close, the ambulance starts up and follows the 15 or so animals and their riders as they approach the first hurdle.
Sitting in the Health Service Executive (HSE) West ambulance along with the crew and Dr Walter Halley, the Turf Club medical officer, as a first- time racegoer, I am struck by both the speed and the ferocity with which the horses take the hurdles in the wind and rain.
It isn't long before we have our first "customer" in the form of a fallen jockey. Even as we pull up alongside and Halley ducks under the rails, the rider already walking towards us indicates that he is okay.
But the Turf Club medical officer recommends that he join us in the back of the ambulance. Barry Geraghty is winded from the fall, but otherwise uninjured.
The mud-spattered jockey was more annoyed at losing a promising position in the race than he was about a possible injury. By the time we complete the circuit and arrive back at the stand, it is clear there is no need to bring Geraghty into the modern medical centre at Ballinrobe racecourse for further medical attention.
Medically involved in racing since 1974 and Turf Club medical officer for the past 20 years, Halley has seen many changes in his 31 years in the job. Until this year, he was the only medical official in Irish racing, which necessitated his personal attendance at every race meeting on the island. Now there are five Turf Club medical officers (TCMOs) who each take responsibility for a certain number of the 340 race days held in Ireland every year.
As well as a TCMO, each race meeting is also attended by racecourse medical officers (RMOs) - usually local general practitioners - who share the racing medical duties and are also available to deal with medical emergencies among the public.
Today's RMO is Ballinrobe GP Kieran O'Reilly. Both he and Halley carry radios with direct communication to the ambulance personnel and the clerk of the course.
They have agreed a "divvy-up" of the race ambulance duties for the seven races on the card.
Halley has earlier checked the medical centre and the ambulance to ensure resuscitation equipment, such as oxygen, artificial airways, suction, and spinal boards are in place and in working order.
It is obvious as we walk into the jockeys' room between races that the riders and Halley have a close relationship.
Every now and again he is pulled aside for a whispered chat and he himself initiates conversations with other riders, usually checking on how the person is doing following their comeback from injury.
There is a sense of entering a sacred inner sanctum, with these small framed, wiry but determined looking men quietly changing colours and repositioning helmets and body protectors. A similar, but less busy scene is enacted next door in the women jockeys' room.
The wearing of personal protective equipment is a must for the modern jockey. Body protectors offer specific protection against injury to internal organs such as the liver, spleen, heart and lungs. They also protect the spinal column and are manufactured to a specific European standard CN13158.
"Body protectors have revolutionised racing injuries," Halley says as we examine one in detail.
"Before they were introduced there were between 20 and 30 rib fractures annually. Now I might see two a year."
The commonest racing injury among jockeys is a fractured collar bone.
According to Halley, dehydration is the biggest medical problem in international racing. In an effort to meet weight restrictions, some jockeys are overusing saunas.
The resulting dehydration can cause confusion and aggression. Racecourse doctors watch out for "the staggers," where dehydration and intracranial blood thickening lead to an abnormal gait.
There is also evidence of an increased incidence of osteoporosis among jockeys as a result of constant dieting which can also lead to eating disorders.
Weight loss and dehydration in riders is the subject of a research project nearing completion at the National Coaching and Training Centre (NCTC) in Limerick University.
According to Dr Giles Harrington of the NCTC, preliminary results show jockeys have body fat as low as 5 per cent, compared with a rate of 10 per cent in other athletes.
Halley is also involved in research into helmet safety with Prof Michael Gilchrist, professor of mechanical engineering at UCD. The two-year project, which started in July, will look at helmets damaged following a fall.
They will be examined using ultrasound and MRI scans, with the results used to build a computerised prototype for a new safety helmet. Jockeys will also be asked to wear helmets fitted with measuring instruments, in order to measure impact forces during falls.
Apart from the tragic deaths of Sean Cleary and Kieran Kelly as a result of racing accidents in 2003, Halley says his worst experience was attending Shane Broderick after his fall at Fairyhouse which left the rider with quadriplegia. "I can still see the accident in my mind," he says, shaking his head with regret.
On a positive note he says he has never had "less than 110 per cent support from the stewards of the Turf Club. They gave me a lot of freedom when I started."
Halley says he was lucky to meet up early in his career with Dr Michael Allen, the former UK Jockey Club medical officer, who became his mentor.
He credits improvements in jockey equipment, such as footwear, stirrups, body protectors and helmets, as well as the introduction of plastic rather than metal rails as significant factors in the reduction of both the number and severity of injuries in racing.
"I love this sport and have enjoyed my career in racing," he says with enthusiasm. "Any day I go home from a racetrack with no injuries is the best day."
Safety Review
Report of the Horseracing Safety Review Group:
Following the tragic death of jockeys Sean Cleary and Kieran Kelly in 2003, both of whom died from head injuries, the Turf Club set up a Safety Review Group to examine in detail health and safety issues in the sport.
Chaired by Ivo O'Sullivan, the group included Walter Halley, the Turf Club medical officer, and Jack Phillips, consultant neurosurgeon at Beaumont Hospital, Dublin.
The group's report, published last year, contained key recommendations on improving safety design in helmets and reducing dehydration among jockeys.
It recommended that body protection be improved to strengthen the panel covering the spine. And it put in place an increase in the minimum weight of national hunt jockeys to nine stone 10lbs.
This was an acknowledgment that as the body weight of the general population is increasing steadily, jockeys are having severe difficulty meeting median weights without subjecting themselves to long periods in the sauna with a consequent risk of dehydration.
Among the safety group's medical recommendations were:
• A Turf Club medical officer to attend all race meetings in Ireland.
• The standing-down period for a dehydrated rider to be a minimum of 48 hours from the diagnosis of dehydration.
• Twenty riders to form a research group at the National Coaching and Training Centre, Limerick University, to determine reasonable body weight goals for jockeys.
• The use of high caffeine drinks by riders to be vigorously discouraged.
• Injured riders must be formally declared medically fit before resuming riding.
• Jockeys not to chew gum, sweets or tobacco while riding.