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 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.
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 (link is external). 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 (link is external) 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.
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 (link is external) 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.
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.
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 (link is external) 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 (link is external), 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.
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.