Inquest into the Death of Anita Jade BOARD
Deceased
Anita Jade BOARD
Demographics
8y, female
Coroner
Coroner Linton
Date of death
2017-11-12
Finding date
2019-08-14
Cause of death
complications of multiple injuries sustained in motor vehicle crash
AI-generated summary
Eight-year-old Anita Board died from catastrophic brain injury sustained in a motor vehicle crash at Perth Motorplex on her first junior drag racing licensing attempt. Her dragster failed to slow adequately after the finish line and crashed into a concrete barrier while attempting to exit through a side gate at excessive speed. Contributing factors included: inadequate training for a first-time driver; vehicle defects affecting brake function requiring excessive pressure beyond the child's capacity; unclear finish line markers; conflicting signals from a track official; and limited speed control mechanisms. The coroner identified systemic safety gaps in junior dragster racing including inconsistent track official practices, absence of formal driver training programmes, and lack of infrastructure improvements. Recommendations focus on graduated training, enhanced vehicle scrutineering, improved finish line visibility, consideration of alternative exit procedures, mandatory head restraints, remote cut-off devices, and enhanced emergency coordination protocols.
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Specialties
Error types
Clinical conditions
Procedures
Contributing factors
- inexperience as a first-time driver
- inadequate formal training prior to first racing attempt
- failure to decelerate and brake adequately after finish line
- vehicle brake system defect requiring excessive pressure
- vehicle weighed only 29 kg limiting ability to apply sufficient brake pressure
- poor visibility from dragster confining vision
- unclear/hard to see finish line markers
- conflicting instruction from track official signalling turn while child unable to safely execute it
- absence of graduated speed introduction programme
- rapid acceleration of dragster surprising inexperienced driver
- dragster capable of speeds exceeding class limits for young drivers
- impact with rigid concrete barrier at corner
- resulting tension pneumothorax and subarachnoid haemorrhage
Coroner's recommendations
- ANDRA give consideration to requiring all junior drag racing participants to continue all the way down the track rather than through the exit gate. In the alternative, if junior drag racers exit through a side gate, all must come to a complete stop before executing the turn and VenuesWest should consider installing a form of barrier to the corners of the exit gates similar to those at Sydney Dragway.
- VenuesWest give consideration to replacing white flags at Perth Motorplex with fixed and highly visible finish markers swung into position on the safety barrier wall to mark the end of the junior track.
- VenuesWest and ANDRA work together in consultation with the Junior Drag Racing Association in WA to create and implement a training programme for new junior drag racers similar to Sydney Dragway's programme. Children should not commence training until at least eight years old. The programme should involve theoretical and practical tests assessed by a person other than the parent or guardian before driving at more than idling speed. Speed should be gradually increased. Training should include on-track orientation at Perth Motorplex so the child is familiar with landmarks before their first licence pass attempt.
- ANDRA introduce a mandatory requirement that all junior racers must include a frontal head restraint device in their personal safety gear.
- VenuesWest in conjunction with ANDRA require scrutineering of 25% of vehicles participating in the junior dragster bracket at all junior drag racing events at Perth Motorplex and complete full scrutineering of all vehicles once every two years including driver safety equipment.
- VenuesWest in conjunction with ANDRA explore the feasibility of requiring a remote cut-off device to be installed on all junior dragsters.
- If junior racers continue to exit through the side exit gate, a CCTV camera or cameras should be installed at Perth Motorplex to capture junior dragsters leaving the gate.
Full text
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