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by Dr Carl Le
September 7, 2015
Photography by Kristof Ramon & Dr Carl Le
As cyclists, we all accept that there is a risk of injury when we ride. Nobody wants to get injured, of course, and by the same token, no one wants to see a fellow cyclist get injured while out riding. But chances are you’ll be first on the scene during a cycling accident at some point in which case it makes sense to be prepared.
So, what should you do if you come across a fellow rider (or someone else) that’s been injured? Emergency doctor and cyclist Dr Carl Le has put together the following guide. Please note that the following constitutes Dr Carl’s personal thoughts on the subject and may not be applicable to your situation. All advice should be considered as general advice only.
Whether it’s climbing a 12% gradient at 9km/h, descending at 90km/h, or cruising along in a peloton at 50km/h there is always that unfortunate risk of a rider falling off their bike. With learned experience, we all constantly assess the risks and scan for hazards as we ride. Sometimes, however, accidents can and do happen.
So what should you do if you come across an injured rider or riders? It may sound very simplistic, but my approach to this question is the good old DR ABC. I use this all the time when I’m working on a race track (as the lead doctor for the V8 Supercars Championship) and this is what I still teach regarding first intervention to any racing incident.
As simple as it sounds, there’s a good reason why DR ABC has stood the test of time when it comes to first aid.
Of course, if there is someone else present at the scene of an accident who has first aid or medical training, you should let them lead and assist where and when possible. But assuming you’re the only one there, here’s how to proceed.
Lets go through the steps:
If the scenario is dangerous to either the injured person(s) or yourself, you need to make it safe before doing anything else. For example, if the injured person (e.g. rider, pedestrian) is on a road with traffic, your priority should be to ensure traffic isn’t an issue. This may involve:
This final point should also answer the common question of whether or not you should move an injured person. Quite simply, you should move an injured person if there is danger to them or yourself. Importantly, if you’re going to move an injured person, try to immobilise the spine from head to bottom as much as possible.
Image: Mike Renland/Flickr
Next you should decide whether or not to call 000 (or the relevant emergency number if you’re outside Australia). Ask yourself:
Lastly, consideration of ‘Danger’ may also involve avoiding the hazard yourself – i.e. don’t become a patient as well! For example, was there debris or oil on the road that caused the initial crash, that you (and/or other riders) need to avoid?
There was an incident in 2013 in the Otways National Park where a rider was electrocuted by a fallen power line across a track. One of the riders who found him reportedly also received an electric shock. Don’t let that happen to you! In general, don’t put yourself in danger in trying to help someone else.
Check to see if the injured person is conscious. An unconscious person implies a more serious incident and someone that is at risk of further injuries. An unconscious person should not be moved unless the ‘Danger’ imperative overrides the risk of further injury. Again, the spine from head to bottom should be immobilised as much as possible when moving such an injured person.
A conscious person can be more safely moved away from danger as they can help splint any injured parts themselves. Clearly it is better to move away from a road when possible.
Check that there is nothing obstructing the person’s airway (e.g. chewing gum, energy bars or broken dentures). Remove anything that is causing or may cause an obstruction. Consider placing the patient into the ‘Recovery position’: facing downwards and slightly to the side, supported by their bent limbs.
This will help keep an unconscious patient’s airway open.
B (Breathing) and C (Circulation)
Check that the person is breathing and that they have a pulse. If they do not, then you should start Cardio-Pulmonary Resuscitation (CPR). This may involve chest compressions and ‘mouth to mouth’ resuscitation.
To learn more about CPR and more, I highly recommend doing a first aid course (see below).
Multiple injured persons
Bear in mind that if you’re faced with a situation where you’ve got multiple injured persons, the person(s) making the most noise may not need the most urgent attention. It is the silent, unconscious injured person(s) that should be attended to first.
As well as knowing how to react when someone’s been injured, there are also a handful of preventative measures you can take.
First aid training is offered by many different providers around Australia (and around the world) with the most commonly known organisation being St John Ambulance Australia. A Certified First Aid course cost starts at about $200 for a one-day course and can go up from there depending on the focus. A (non-certificated) Basic First Aid course will cost less than $100 and only takes a few hours.
ICE (In Case of Emergency)
Imagine that you are the unconscious person that is found. How would the rescuer know who you are, who your emergency contact is, and what medical conditions you may have? You should have all of this information easily available.
Some commonly-used ICE solutions include bracelets or cards in a wallet/jersey pocket. iPhone users (or if you find a person with an iPhone) should check out the Medical ID function that is accessible on devices with iOS 8 even when the phone is locked.
Do you carry a first aid kit with you on your bike? Should you? My answer is that you should plan to have access to a first aid kit when you head out for a ride. Whilst a serious injury may necessitate calling for an ambulance, you should be able to deal with cuts and grazes yourself.
You should consider where you are riding, whether it is in a suburban area (where pharmacies and doctors are accessible) or up in the mountains (far away from medical assistance). I always ride with a small first-aid kit in my jersey pocket. This is simply a small sandwich bag with adhesive dressings of various sizes and a three-inch bandage.
If riding in a group in the mountains, it may be worth taking more supplies (e.g. triangular bandages, space blankets, different sized crepe bandages, more adhesive dressings, and even some antiseptic, spread amongst the group.
As a doctor, I also feel that if I came across an injured rider, I would want to be able to offer some medical assistance. This is another reason I carry a first aid kit with me and I’ve had to use it for this very purpose.
In 2014, I came up with an idea that evolved to become “Cycling Karma”. It was a simple idea to give back to the cycling community for the joy that I get from cycling. With the support of some companies and friends, I have put out over 200 inner tubes, and four first aid kits along the Kew Boulevard, the “1 in 20 climb” on Mt. Dandenong, and on the Arthurs Seat climb. These are for anyone to use as needed.
The white crosses indicate that a firstaid kit is taped behind the sign.
If you have a regular climb or ride, an option for you might be to leave your own first-aid kit somewhere that you and friends know and can access should the need arise.
It might sound obvious, but you should always let someone know where and when you are riding, and when you should be back. And if you’re riding in a remote area, do some research to find out if mobile phone coverage is available.
I hope that the above information is helpful. Let me know if you have any questions in the comments and I will try and answer them.
Dr Carl Le is a Melbourne-based emergency doctor who is also a cyclist and Ironman level triathlete. He is the Permanent Medical Delegate for the V8 Supercars Championship series.