What if your friend got injured in a crash, laying on the ground, not breathing? A member of the mountain rescue service sums up the principles of giving first aid in case of a bicycle accident.

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Marek Frys is a member of the mountain rescue service in the Czech resort Spindleruv Mlyn. A keen mountain biker, he has treated hundreds of bikers during his thirty-year career. What should you do if your friend gets hurt? Let’s go through some basic guidelines, as time might be running short in case of an emergency.

Make warning signs around the accident zone

Especially in an area with increased cycling traffic, such as bike parks or single trails, secure the accident site to prevent further injuries. Mark the zone before a turn, jump or drop, so that it is visible from a safe distance. While one of you secures the place, the rest should attend to the injured.

MTB Trail
Always make sure to mark the accident zone.

Be aware of massive bleeding

What to do if you find your friend wounded on the road? Try to talk to them to find out if they’re conscious. Immediately upon your arrival to the injured person, it is highly important to exclude severe arterial or venous bleeding, which could lead to rapid loss of blood to a degree sufficient to cause death. If a wound is bleeding massively or if blood is spurting from it in periodical intervals, try to stop the bleeding by pressing whatever comes to hand deep into the wound, be it your bare palm, a glove or even a stone. Stopping the bleeding with one hand, try to bandage the wound as tightly as possible with the other one. If a tourniquet is available, use it to limit the flow of blood. You can make a simple tourniquet using a stick and a rope or a belt, for example. The state of things is not always apparent at first glance, as the patient may complain, for example, about a broken limb, which may hurt more than a wounded artery.

Carry out further examination

If there’s no apparent bleeding, or you just stopped it, but the patient is not responding even to a gentle shake, get them to what is called supine position by putting them on the ground the way they lie on their back. If there’s the slightest suspicion that the injured biker might have suffered vertebrae trauma due to the crash, rescuers should manipulate them cautiously. To prevent an irreversible spinal cord injury, which could be caused by pressing the cord with loose bone fragments, when you move the wounded person, always rotate their whole body as if it were one solid cylinder. Always turn the pelvis and legs together with the head and shoulders at the same time. That is why it is so important to ride in groups of three or more people – only then can you help each other safely and sufficiently.

To control the breathing of the injured person, don’t tilt their head, just gently stick their chin forward to clear their airways. Bring your face closer to their mouth so that you can feel their breathing, and at the same time, monitor their chest with your eyes to see if they’re breathing or not. This elementary examination should take up about 10 seconds. If the wounded is unconscious and not breathing, one member of the group should begin cardiopulmonary resuscitation, while another one calls the mountain rescue service or an ambulance. This way, the chain of emergency steps is about to be released. From that moment on, it is up to you to keep the patient alive until medical professionals arrive. In some cases, every minute matters.

First Aid for Cyclists
If the wounded is unconscious and not breathing, one member of the group should begin cardiopulmonary resuscitation, while another one calls the mountain rescue service or an ambulance. © Profimedia

How to perform cardiopulmonary resuscitation (CPR)

The cardiopulmonary resuscitation is a technique to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. Current recommendations emphasise intense chest compressions over artificial ventilation. That is a simplified method involving chest compressions recommended to be performed by untrained rescuers. The particular steps are as follows. Kneel to the side of the injured person, and place the lower edge of one hand right to their breastbone – which is found in the middle of their chest. Lace your fingers together and stretch your arms, so that your shoulders are right over the patient’s chest. Start rhythmically compressing the breastbone to a depth of about 5 cm. After each press, release the pressure completely, so that the chest can return to its natural position. Thus, the pressure on the heart is relieved, creating a vacuum that sucks blood from the veins back into the heart. The frequency should be 100 to 120 compressions per minute. Don’t worry about hurting the patient. Even though you’re likely to break them a few ribs, the wounded person is probably in the state of clinical death, so any treatment can only help. If you stop resuscitating, the patient will probably die. If there are more of you, take turns. Continue until the patient’s blood circulation and respiration are restored, or until the arrival of the professional rescue team.

Penetrating objects

If a solid object like handlebars or a tree branch got stuck in the patient’s body without causing significant bleeding, do not pull it out of the wound under any circumstances, as it could trigger arterial bleeding with a high risk of bleeding into the abdomen or chest. Such a patient should be transported to the doctor with the intruding object still in.

Brain concussion

Despite wearing a helmet, concussions with unconsciousness are common when the head hits the ground or some other object. Confusion about a person’s current whereabouts or most recent activities is a common consequence of a concussion. Even after becoming conscious, the patient usually asks the same questions over and over again. When looking closely, you’ll notice that their eyes look as if they were floating on water. Concussion requires hospital admission and at least 24-hour observation to rule out serious brain injury that might lead to fatal consequences. In any case, call an ambulance or the mountain rescue service to transport the patient to the hospital. Never let the biker carry on unattended cycling after suffering brain concussion, even if the original symptoms have relieved.

First Aid for Cyclists
Concussion requires hospital admission and at least 24-hour observation to rule out serious brain injury that might lead to fatal consequences. © Profimedia

Risk of internal bleeding

At first glance, injuries to internal organs may not be apparent. It is important to stay alert to complaints of pain in the abdominal area. The patient’s stomach may feel hard and they may not let someone else touch it. If the injured biker fell on their abdomen, back or side, there is a high risk of liver or spleen injury. Pain shooting up their shoulders may be a sing of internal bleeding. Never underestimate a hard crash, and even if the patient feels healthy, it is necessary to observe them. In case of nausea, deterioration, malaise or when you suspect that everything is not in perfect order, call for help immediately. No one has X-ray eyes, so it is better to call for help than to regret your negligence later.

Fractures

Broken collarbones are a typical injury of mountain bikers. Broken legs or pelvic fractures are also quite common. It is advisable to fix fractured arms or legs by using a splint. Splints hold a displaced or moving part of a limb in place, which prevents remarkable pain caused when the displaced part moves. Splints are also useful for severe strain or sprain injuries in the limbs. A broken arm can be slung in a scarf, which will relieve the injured person from pain. If you are in a hard-to-reach area, call the mountain rescue team for safe transport to the hospital.

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