A friend crashed deep into a hard corner a while back. After checking that there were no bones broken and that his head hadn’t impacted the ground- I played the incident down and encouraged  him to get back on his bike and keep moving. The same guy had crashed hard in a race last season and it had taken a toll, leaving him a bit nervous in a bunch- a perfectly normal reaction. My actions to get him back on his bike quickly were simply to distract him from the incident- to pass it off as nothing and hopefully prevent further nervousness.

After a crash and we are more aware of obstacles and problems that could cause another crash.  Where riders have subsequent crashes, this increased anxiety is a trauma driven by the fear of further injury and is often referred to as hypervigilance.

The prospect of crashing again is an elevated state of constantly assessing potential threats around you and within a bunch of riders where all must flow and accelerate and brake together. One rider overreacting- can often cause further incidents.  

After this incident I was wondering  if it was the proper procedure to encourage the rider to get back on their bike … so I asked local legend Michael Henry, who is a paramedic and a seasoned biker, and who is used to dealing with lots of road traffic incidents: What was the correct plan of action when a riding partner crashes?

I’m going to assume there are two or more cyclists and I am looking at this from injury  to the rider and not the bike:

There has been a touch of wheels and several riders have come down in front of you, now what?!?! 

1. Safety. Secure the scene. Stop traffic or other cyclists (single track). Try to warn others to slow down, avoid, or stop. This is of utmost importance, you do not want a driver to plough into rescuers or the injured. Do this, either yourself, other cyclists and/or the motorists themselves, before helping the injured. 

2. Assess. Go to the cyclists and make sure they are conscious and breathing. If they are groaning, moaning and crying out in pain this is “good”. Major bleeding must be stopped immediately. Compress the wound area with your hand in the first instance and with pads and bandages in the succeeding instances. Apply pressure to stop the bleeding. Involve others in securing the cessation of bleeding for you to assess the other riders. Reassure that rider, tell them not to move (hence the reason to secure the scene) and go to the next rider. Repeat this until you have assessed all riders. If this is a serious crash, the rider does not move or is unusually quiet despite you talking loudly to them, get medical help. Immediately ring 999 (112) and request ambulance and police attendance. Do this yourself or get bystanders to ring while you attend to the rider. Involve others in helping the unusually quiet rider. Otherwise, concentrate on the most seriously injured and work your way back to those who are self assistng, that is, from the most injured to the least injured. Do not be distracted by others telling you their mate feels worse. Tell them to stay still and you will be over to them presently, you have already assessed them. 

3. Treat. In the unconscious/not alert rider, secure an open airway by placing a thumb either side of the jawbone at the angle of the jaw and push forward, an open mouth is usually an open airway. Place the rider in the recovery positon with the help of as many others as possible, trying to minimise body movement. Turn the pelvis and legs together with the head and shoulders at the same time. Hopefully the rider is breathing and safe, and awaitng the arrival of the ambulance so go to the next rider. With each rider in turn, allow them to remain on the ground until they feel able to get up and move safely to the side of the road. A crash will leave riders stunned and shocked, so allow time for the rider to realise what has happened to them and to get over the shock. Ask the rider where they have the most pain. If it is the easily visible road rash this rider is not too seriously injured and can safely be allowed to self mobilise to the side of the road, where you will return to for further assessment when the time allows. If the rider complains of pain to the limbs assess for shortening, rotation or gross deformity of the limbs. If there is any major deformity in the lower limbs, allow the rider to remain on the ground until the paramedics arrive. If the rider complains of back pain and is adamant that he/she does not want to move, assume this rider knows they have a serious injury and allow them to remain in position until the paramedics arrive. Cover with coats to maintain heat. If the rider has deformity to the upper limbs but can safely move, either by themselves or with help, allow that movement to the side of the road, for both comfort and heat, it can get cold lying in one spot on the cold ground. 

4. Reassess. Your riders are up and sitting at the side of the road. Check each rider for cuts, bruises, skin rash and breaks in bones. The most common break is the clavicle bone and any rider that holds one arm with the other for support and guards the shoulder can safely be assumed to have a clavicle break. A large lump usually mid-shoulder with shortening of the clavicle bone will confirm without the need for X-ray eyes. Remove the riders helmet and check it for damage. Any break or impact damage to the helmet is a good indicator that this has been a significant crash which can result in concussion at the minimum and head injury/ death at the most. Do not let this rider continue to ride even if the symptoms have eased or resolved, nor leave him/her alone. Any potential head injury or concussion needs medical assessment and time at the E.D. Advise (strongly) the rider and any relatives/ friends that are with the rider, that they MUST go to the E.D. Signs of head injury and concussion include glazed eyes, lack of attention, confusion, disorientation and repeating the same questions. Make sure someone stays in the company of this rider. Chest injuries are uncommon and are usually associated with and accompanied by head injury, so this rider needs medical attention. Other injuries will include contusions (bruising), abrasions and lacerations and, while these appear dramatic they are not usually life threatening. Any injury or bruising that gets significantly worse in the following few hours will need hospital assistance. Any rider that feels they need medical attention should be advised to go accompanied to their local E.D. Time spent in the waitng room or the emergency department should be considered time spent in a medical facility with medical personnel and thus time well spent, regardless of any treatment received. A minor injuries department can also be a good choice if they are accustomed to the type of injury riders may have and can advise and treat as well as arrange x-rays. 

5. Treating any wounds. Clean any wounds, abrasions, and road rash with plenty of clean water and sanitise the wound area with hygienic ‘wet wipes’. Ask motorists, especially those with child seats if they have any. In the days following COVID lots of bystanders may have alcohol wipes or gels, use these to clean and sanitise. Get the wound area as clean as possible, apply an antiseptic cream such as Germolene, Savlon or Sudocream and cover with a dry pad/bandage. Any deep wound or wound that is aggressively bleeding will probably need stitches in the first instance and followup treatment of wet wound dressings and antiseptics as well as a possible tetanus injection. Mild abrasions of the epidermis respond well to deep cleaning, antiseptic creams and sunshine while deeper abrasions respond well to thin layers of antiseptic creams, wet to dry dressings such as Tegaderm or Melolin and gauze. 

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