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Quick action after a crash can save a life

The wet crump of a fellow rider hitting the road is one of the most horrifying sounds in cycling. What should you do if you or a riding companion crashes hard, or is hit by a motor vehicle?

This is the sort of knowledge you hope you'll never need to use, and you probably never will, but if the manure hits the air-conditioning, you'll be glad you know how to look after an injured rider.

Whether a cycling crash involves another vehicle or not, the priority has to be the welfare of the rider, so we’ll look at that first.

First aid

First aid training is invaluable when things go wrong because it gives you a simple set of steps to take control of a situation, stop things getting worse and perhaps even save a friend’s life.

The sooner a crashed rider gets help, the better. If there’s more than one person with your crashed friend, then someone should go or call for help while you look after the casualty. In these days of mobile phones that’s as simple as calling 999 or 112.

In theory, you should examine the casualty before deciding to call an ambulance, but you’ll often be able to tell instantly if one is needed. If the crash happened at any significant speed; if the casualty has any sort of obvious head injury; or if they don’t pick themselves up fairly quickly, then you need expert help.

If you’re on your own with a crashed rider then you should examine the casualty using the process St John’s Ambulance calls the Primary Survey.

DR ABC

There are five steps in this; it’s the first sequence of things you should do after someone has crashed. They fit the acronym DR ABC and go like this:

Danger — Assess the situation for danger both to yourself and the crashed rider and remove it. In a road crash this usually means controlling motor vehicle traffic around the area.

Response — Is the casualty responsive? Do they say anything when you ask them if they’re ok? If not, St John’s advises gently shaking their shoulders. However, if there’s any chance the rider has a neck or back injury, then it’s safest to just try talking and not risk any movement. If they’re unresponsive then you should assume they’re unconscious and make getting help for them a priority over the needs of other injured riders, if any.

The ideal response from a crashed cyclist is: “How’s my bike?”

Airway — Check the casualty’s airway is open and clear. If it’s not, but they’re conscious, clear the airway. If they’re unconscious, tilt their head and lift their chin to open their airway. It’s fairly unlikely a crashed cyclist will have an obstructed airway, but they might have been taking a bite of an energy bar at the time of the crash, so it’s still worth checking.

Breathing — See if the casualty is breathing. If they’re conscious and not breathing, fix whatever’s stopping them breathing, such as a blockage in the airway.

If they’re unconscious and not breathing, then you need to apply cardiopulmonary resuscitation aka CPR. This technique involves applying chest compressions and giving rescue breaths to keep the casualty alive until medical help arrives. If you’re the only person looking after the casualty and you’ve not yet called an ambulance, this is also the point at which you should do so.

Circulation — If the casualty is breathing, then check their circulation, or to be precise, whether their circulation is leaking. If they’re bleeding severely, then control the bleeding with your gloved fingers, dressing or clothing, and call for an ambulance if you haven’t yet.

Blood tends to freak people out, so it’s important to keep calm. Scalp wounds in particular often look much worse than they are because the area is very well supplied with blood vessels. A cut on the head also looks bad because the blood flows on to the casualty’s face, so even a small cut looks terrible. Stay calm; it almost certainly looks worse than it is.

St John Ambulance recommends you then go on to perform a Secondary Survey, which involves collecting as much medically useful detail as possible, so you can pass it on to the emergency services. If possible, make physical notes you can hand over.

Full details of the secondary survey are on the St John Ambulance website but points likely to be relevant to a cycling crash include:

Incident history: collect as many details as possible about how the crash occurred.

Signs and symptoms: get as much detail as possible about how the casualty feels. If they’re in pain, have them describe it. Then check the casualty over from head to toe.

Among the things you’re looking for are signs of serious head injury such as blood or fluid from the ears or nose, or differently dilated pupils. Feel along the arms from collarbone to finger tips looking for signs of fracture — a broken collar bone or broken wrist is a very common cycling injury.

Look for medical information such as a medallion or bracelet and be sure to point it out to the medics when they arrive.

Cardiac arrest

There have been a couple of deaths from heart problems in large sportives and two riders suffered cardiac arrest on the same day on Mt Ventoux in August 2016. Fortunately those two were saved by helpers using public defibrillators to restore their hearts to normal function.

According to the British Heart Foundation, the most common form of cardiac arrest is an abnormal heart rhythm called ventricular fibrillation. Instead of pumping normally, the heart quivers, or 'fibrillates' and therefore stops circulating blood round the body. 

A jolt of electricity can restore normal heart function, because one of the causes of ventricular fibrillation is irregular electrical activity in the heart.

That jolt is delivered by a defibrillator, and publicly-accessible defibrillators are popping up in all sorts of places, including the observatory on Mt Ventoux. If you think your buddy is having a cardiac arrest, it's worth searching for a defibrillator nearby.

Public defibrillator locations are listed at Heartsafe among others. Using one is simply a matter of turning it on and following the instructions supplied.

Keep the rider warm

This isn’t often mentioned in first aid guides because most people aren’t silly enough to zoom around the countryside dressed only in half a millimetre of Nylon/Lycra, but a crashed cyclist will need keeping warm.

Wrap the rider in all the spare clothes you have to hand, and if they’re able to move, get them to somewhere sheltered, even if it’s just the lee side of a wall.

Concussion

Even if a crashed rider seems fine, they may have sustained a knock on the head that’s sufficient to cause a concussion. Any sign or suspicion of a head injury — however minor — is grounds for an ambulance ride to A&E. On no account should a rider with such an injury be allowed to carry on riding. People have died after apparently minor head injuries; don’t risk it.

Road rash

The most common cycling injury is to simply lose a chunk of skin as you slide down the road. It hurts like hell, but it's usually not serious. Usually. Our editor Tony once lost skin from his thigh and elbow in a crash. 

"The thigh graze hurt like hell and was weeping for days," he says, "but it turned out the elbow  —which I couldn't even feel — was worse. Reason I couldn't feel it was that road had scraped the nerve endings off pretty much back to the bone."

If the graze is, shall we say, normally painful, then you should clean and dress it. Wash and dry your hands thoroughly first, then clean the graze under a running tap. Don't use anti-septic as it can damage tissue and slow down healing. Pat the wound dry with a clean towel and then apply a sterile adhesive dressing.

If you need to carry on riding, a moist dressing like the combination of Spenco 2nd Skin and moist gel pads will stop the wound from crusting over so you can still move comfortably.

What to do if a motor vehicle is involved

If it’s not just a solo crash, then exchanging details with the other party is vital.

According to Citizens Advice, a driver is obliged to stop if anyone other than them is injured or if there has been any damage to property.

The driver must then remain near their vehicle “long enough for anyone who is involved directly or indirectly in the accident to ask for details”. The driver has to provide their name and address and, if it’s not their vehicle, the name and address of the owner. They must also give the registration of the vehicle.

Citizens Advice goes on to say: “If any personal injury is caused to another person, the driver must also produce a valid insurance certificate if asked to do so by a police officer, injured person, or anyone else directly or indirectly involved in the accident.”

If the driver can’t provide an insurance certificate at the time, they should report the crash to a police station within 24 hours, and present their insurance details within a week.

There's an app for that

SJA first aid for cyclists.jpg

SJA first aid for cyclists.jpg

If you don't have first aid training — or even if you do but want some reassurance — there are smartphone apps that will guide you through looking after a casualty or help you respond after a crash. Here are a a couple.

St John Ambulance First Aid for cyclists

This bike-specific first aid guide is available for iOS, and Android. It includes tips on how to turn your cycling equipment into first aid kit and covers the most common cycling injuries, including head injuries, cuts and grazes, and muscle injuries. St John also offers a more general first aid app.

CTC Crash Kit

This app is designed to help you gather the necessary information you need to make a claim if you're hit by a driver.

Our official grumpy Northerner, John has been riding bikes for over 30 years since discovering as an uncoordinated teen that a sport could be fun if it didn't require you to catch a ball or get in the way of a hulking prop forward.

Road touring was followed by mountain biking and a career racing in the mud that was as brief as it was unsuccessful.

Somewhere along the line came the discovery that he could string a few words together, followed by the even more remarkable discovery that people were mug enough to pay for this rather than expecting him to do an honest day's work. He's pretty certain he's worked for even more bike publications than Mat Brett.

The inevitable 30-something MAMIL transition saw him shift to skinny tyres and these days he lives in Cambridge where the lack of hills is more than made up for by the headwinds.

37 comments

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keirik [152 posts] 2 years ago
9 likes

you forgot the most important bit: laugh until you wet yourself (or is that just me)

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beanrtw [3 posts] 2 years ago
5 likes
keirik wrote:

you forgot the most important bit: laugh until you wet yourself (or is that just me)

I suppose that depends on just how dead the guy actually is.

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Bobbinogs [268 posts] 2 years ago
1 like

Don't feed the troll

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Mungecrundle [977 posts] 2 years ago
8 likes

And this of course is the main difference between road cycling and mtb. Whereas a road cyclist is full of concern and assistance for their fallen comrade, a mountain biker will see the fallen rider as potential traction in slippery conditions.

But seriously. Remembering A, B, C and being able to put an unconscious casualty into the recovery position whilst everyone else stands around arguing about neck injuries as the casualty suffocates on their tongue can save a life.

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themartincox [553 posts] 2 years ago
0 likes

Pinkbike have this from a few years ago.

An MTB rider fell pretty innocuously and tore his femoral artery, the video is not pretty, but it's certainly worth a watch to learn what to do if something that bad happens to you.

 

the guy lived, despite it taking 30 minutes for an ambulance to arrive!

 

http://www.pinkbike.com/news/Video-CGs-Bloody-Crash.html

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localsurfer [202 posts] 2 years ago
2 likes

DRSABC - The 'S' is for shout.  Call for help from any bystanders if you get no Response, and get them to call an ambulance while you work on the rest.

Always assume a spinal injury with a head injury.

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Richard D [129 posts] 2 years ago
9 likes

45 minutes of lying in the gutter, in the rain, with a broken femur taught me two things - firstly the critical importance of not only summoning the ambulance fast, but with accurate details about where the casualty is; we do a lot of riding on relatively small roads in out-of-the-way places, after all.  And secondly, keeping the casualty warm; pretty impossible when wearing wet Lycra, but I'll be packing a couple of "space blankets" in my saddlebag when I finally head back out there later this summer.

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kwi [293 posts] 2 years ago
1 like
Richard D wrote:

but I'll be packing a couple of "space blankets" in my saddlebag when I finally head back out there later this summer.

I've long said that a 'space blanket' should be a bare minimum for every cyclist, not only for after accidents, found a shivering cyclist on top of a mountain one day after they had a mechanical (Brake caliper was missing at this point, and he didn't fancy the descent.), I was driving and offered him a lift but he assured me help was on its way.

Hope your recovery goes OK Richard, must of been a sore one.

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keirik [152 posts] 2 years ago
10 likes
Bobbinogs wrote:

Don't feed the troll

 

it wasn't a troll, it was a joke, you guys need to chill.

yes if it's a serious accident of course you look after the victims, but most crashes are minor and do involve taking the piss out of your mates.

 

you lot must be great fun to ride with

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kil0ran [924 posts] 2 years ago
2 likes
localsurfer wrote:

DRSABC - The 'S' is for shout.  Call for help from any bystanders if you get no Response, and get them to call an ambulance while you work on the rest.

Always assume a spinal injury with a head injury.

Mega important as once you've started CPR you mustn't stop and a weedy-armed road cyclist is gonna get knackered bloody quickly doing chest compressions  1 Kneeling on Tarmac in Lycra shorts won't be fun either  1 if you're in a group, designate someone to handle the comms, and ideally someone else to make the scene safe (e.g. stop traffic)

As to spinals, St Johns will tell you to carry on with ABC even if you suspect one - because if they're not breathing they won't be alive to experience potentially being paralysed. 

The St Johns app also has a location-aware list of community defibrillators. If in a group, pick your fastest rider to go get it as chance of survival drops by 10% every minute you're flatlined and then get cracking (literally as you'll break ribs doing it properly) with CPR.

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macrophotofly [316 posts] 2 years ago
0 likes

Somewhat surprised by the "Don't use anti-septic as it can damage tissue and slow down healing "

Is there any certified medical advice you can point to for that? Our club here always carry (sealed singular medical, not open packs of) anti-septic alcohol wipes and the feeling is they are the best way to get dirt/germs out of a road wound. Better anyway than spraying the wound with a mates water bottle. We are not usually near a tap when climbing in the mountains so need something with us to use if a man/woman goes down.

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kwi [293 posts] 2 years ago
0 likes
kil0ran wrote:

Mega important as once you've started CPR you mustn't stop

 

Used to be the case, unfortunately people decided not to start if they deemed help too far off, but that has changed to you can stop when unable to continue.  And it is exhausting, though when doing it for real the adrenaline helps a bit.

And ambulance control will send a community 1st responder with a defib if there is any in the area and you're a bit far from an ambulance station.  A few lives saved locally by the 1st responders recently and I would urge anyone to volunteer for any local scheme.  Training is free, regulary updated, and you may make a difference.  And the time impact on your everyday life is negligable.

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iso2000 [88 posts] 2 years ago
0 likes
macrophotofly wrote:

Somewhat surprised by the "Don't use anti-septic as it can damage tissue and slow down healing "

Is there any certified medical advice you can point to for that? Our club here always carry (sealed singular medical, not open packs of) anti-septic alcohol wipes and the feeling is they are the best way to get dirt/germs out of a road wound. 

Interesting, I always knew that a big dollop of antiseptic cream shouldn't be applied to a wound dressing, but not using any antiseptic in the washing process is a surprise. Looking through a few Google results shows that opinion is divided on the use of antiseptic for cleaning but the NHS Direct site clearly states that the wound should be washed with running water.

 

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WashoutWheeler [113 posts] 2 years ago
1 like

I imagine there will be some that do nothing and keep going,  got to keep those strava figures up there.

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WashoutWheeler [113 posts] 2 years ago
0 likes
Richard D wrote:

45 minutes of lying in the gutter, in the rain, with a broken femur taught me two things - firstly the critical importance of not only summoning the ambulance fast, but with accurate details about where the casualty is; we do a lot of riding on relatively small roads in out-of-the-way places, after all.  And secondly, keeping the casualty warm; pretty impossible when wearing wet Lycra, but I'll be packing a couple of "space blankets" in my saddlebag when I finally head back out there later this summer.

I hope you are OK, A mobile phone idealy with data and gps is also a must have I see a lot of riders now going for absolute minimum carry its ok on Le Tour but on public roads? Nah  your idea about space blankets is great I am getting one this week.

I cycled up to watch the stage on La Planche des Belles in 2014 BTW I am no racer but I plod along quite nicley for an old fatty, I found I  had forgotten to pack a fleece in my day bag, so only had a jersy and rain jacket on, after 4 hours in the rain up there I was really cold and actualy getting worried,  me and another guy had to keep running up and down just to keep warm a space blanket would have been really helpfull.

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muppetteer [95 posts] 2 years ago
1 like

And I'd like to add that if you're riding alone, please have something on you with your emergency contact details.

There's things like the Road ID, or its easy to fabricate something yourself. But, if you're alone, its really important that you're identifyable especially if you have any specific medical issues or if you need to let family and friends be contacted in the event of an issue. 

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J90 [424 posts] 2 years ago
0 likes
Mungecrundle wrote:

But seriously. Remembering A, B, C and being able to put an unconscious casualty into the recovery position whilst everyone else stands around arguing about neck injuries as the casualty suffocates on their tongue can save a life.

 

Exactly, so many people say don't move them, but if you've checked their airways and they're not breathing then that becomes the priority.

 

I was shocked when Pozzovivo had that bad crash in the Giro last year and the spectator started moving him before checking anything else, so ignorant.

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SteppenHerring [378 posts] 2 years ago
0 likes

Having had a mate break a wrist on an MTB ride, I was amazed that the ambulance people wanted a road name and couldn't cope with GPS (WGS 84) or grid references (OSGB36). Being in a field, I had no idea of the nearest road.

A while ago, I knocked up a little Android app that tells you the nearest postcode/address along with road name. I would release it into the wild, but it doesn't work if you don't have a data connection.

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Luv2ride [111 posts] 2 years ago
0 likes

This is all thought provoking stuff, especially the bit about space blankets.  As a MTBer I always had one or two in my pack, but as a roadie (for the past 5 years) I've never taken one out with me.  Given the ones I have are flat and jersey-pocket shaped, and wouldn't take up any room, I can't think why not!  Will take one out with me from now on...

 

 

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WolfieSmith [1396 posts] 2 years ago
4 likes

If a car is involved the Motorist Only Highway Code states that in the event of motor collision between vehicle and cyclist, pedestrian, horse or lollipop person 'the driver is obliged will stop, get out of the car, check the other party hasn't damaged the car and then either drive away or start scolding the other party for being on the road and disrupting their journey.' 

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ch [188 posts] 2 years ago
0 likes
macrophotofly wrote:

Somewhat surprised by the "Don't use anti-septic as it can damage tissue and slow down healing "  Is there any certified medical advice you can point to for that? 

 

In 2014 I crashed on a downhill due to a sudden flat front, and suffered severe road rash over a several large areas.  Wasted a few days and suffered a lot of pain and swelling from using anti-septic, which all went away within a day of stopping anti-septic.  

I had used anti-septic all my life (54 years) for smaller cut type wounds and never had a problem.

 

 

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kil0ran [924 posts] 2 years ago
0 likes
J90 wrote:
Mungecrundle wrote:

But seriously. Remembering A, B, C and being able to put an unconscious casualty into the recovery position whilst everyone else stands around arguing about neck injuries as the casualty suffocates on their tongue can save a life.

 

Exactly, so many people say don't move them, but if you've checked their airways and they're not breathing then that becomes the priority.

 

I was shocked when Pozzovivo had that bad crash in the Giro last year and the spectator started moving him before checking anything else, so ignorant.

From years of watching motorsport I do wonder if they have decent first aid training in Italy & Spain - seen so many motorcycle racers picked up and plonked on a stretcher rather than be treated where they fell. Has improved in recent years.

In comparison I know in Germany you get trained in school and have to pass a first aid test as part of the driving test.

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Aussie Rider [8 posts] 2 years ago
5 likes

Very good information here and correct action could make a difference

 

I'm surprised that no one has mentioned

 

PAUSE THE GUYS GARMIN !!  3 

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bornslippy [19 posts] 2 years ago
0 likes

The CTC crash kit doesn't appear to work on iPhone...

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Cantab [102 posts] 2 years ago
0 likes
muppetteer wrote:

And I'd like to add that if you're riding alone, please have something on you with your emergency contact details.

There's things like the Road ID, or its easy to fabricate something yourself. But, if you're alone, its really important that you're identifyable especially if you have any specific medical issues or if you need to let family and friends be contacted in the event of an issue. 

Good advice, iPhone users can set a 'medical ID' via the iOS Health app. This puts a few vital details and allows you to set emergency contacts which can be activated from the emergency mode from the lock screen (swipe to bring up the passcode screen, press emergency). Worth setting up if you're an iPhone user and checking if the casualty is one!

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Bike Science [11 posts] 2 years ago
0 likes

We were unlucky enough to have a member of our group suffer a really nasty crash out riding yesterday. A broken stay on his mudguard got jammed in his front brake resulting in him going straight over the bars and landing on his head at around about 25mph. Turns out he has broken two vertebrae.

My advice would always be - keep them warm, still and get an ambulance there if there's even the slightest chance of any head, neck or spinal injury. Fortunately in this case, no additonal damage was done after the accident. Even if the rider is insistent on getting up, keep them still until the paramedics have done their thing.

 

 

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imajez [107 posts] 2 years ago
0 likes
Cantab wrote:
muppetteer wrote:

And I'd like to add that if you're riding alone, please have something on you with your emergency contact details.

There's things like the Road ID, or its easy to fabricate something yourself. But, if you're alone, its really important that you're identifyable especially if you have any specific medical issues or if you need to let family and friends be contacted in the event of an issue. 

Good advice, iPhone users can set a 'medical ID' via the iOS Health app. This puts a few vital details and allows you to set emergency contacts which can be activated from the emergency mode from the lock screen (swipe to bring up the passcode screen, press emergency). Worth setting up if you're an iPhone user and checking if the casualty is one!

You can set up ICE on any phone. ICE - In case of emergency.
Here are how to links for Andoid, the iPhone and for a Windows phone.

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kwi [293 posts] 2 years ago
1 like
Aussie Rider wrote:

PAUSE THE GUYS GARMIN !!  3 

Funnily enough, I did ask for someone to do this as I was strapped down to a spinal board.

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nniff [247 posts] 2 years ago
0 likes
kwi wrote:
Aussie Rider wrote:

PAUSE THE GUYS GARMIN !!  3 

Funnily enough, I did ask for someone to do this as I was strapped down to a spinal board.

Funny that - I picked up some nice KOM scalps in Lincoln from the back of an ambulance. My conscience got the better of me though - 20 minute leg turner, 90 minute stationary propped up against a wall , arrow-fast to the hospital was a bit of a give-away.

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Richard D [129 posts] 2 years ago
0 likes

My Garmin crashed when the battery ran out.  No ambulance-edited KOMs (which realistically was the only chance I ever stood), and worse I didn't even get to see how fast I was going when I hit the deck.   2

As as for moving the casualty, I was told that I couldn't just lie in the middle of the road, so they scooped me up and as they did so, asked if I could put any weight on my leg.

That's when I felt the broken bits of femur moving against one another.  Never felt it before, but instantly recognisable for what it was.  "Put me down and call me an ambulance!"  I wasn't going to risk a femoral artery tear by mucking about at that point.

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