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The harrowing tale of Kat Matthews surviving a collision when a vehicle steered into her path is every cyclist’s worst nightmare. Second on the list is witnessing such a horrific incident, especially if the person hit is your friend or training buddy. That was the case for Patrick Lange, who was shocked by what happened but also knew he needed to spring into action right away. Lange says Matthews “was unconscious and concussed at first” and that he “tried to hold her as stable as possible until an ambulance arrived.”
Luckily, Lange and his training partners were able to administer aid right away. In many cases, having someone another person step in to help could mean the difference between life and death: studies show that up to 59% of “pre-hospital” deaths from injury could potentially be prevented if more people stepped in with some simple first aid. In the multisport world, we’ve seen the importance of bystander assistance play out in many high-profile cases where drivers have hit triathletes on bikes—from Tim Don to Jordan Rapp.
You don’t have to be a medical professional to help a cyclist who has been hit, says Benjamin Briu, a paramedic with the New York City Fire Department and member of the FDNY triathlon team.
“It’s important for everyone to have some basic knowledge for first aid,” Briu says. “If you’re not in a big city, ambulances may take a very long time – like 30 minutes or even longer.” Being able to keep the cyclist safe and to administer first aid while waiting for an ambulance could very well save a life.
Get everyone to a safe place
If you come across a cyclist who has crashed or has been hit by a vehicle, the first thing you should do is make sure the scene is safe, Briu says. If the victim is conscious, did not hit their head, and you are able to help them out of the road safely, do so immediately. This will keep everyone out of the path of traffic.
If the incident involves the driver of a vehicle, and if that driver stopped, emotions may be high for all involved. Encouraging everyone to keep their cool until the authorities come is not only a wise legal move after a car-bike crash, it’s a smart medical play as well, since the victim should stay as still as possible until cleared by medics.
Report the incident immediately, even if the cyclist swears everything is fine. After a crash of any kind, the brain tries to protect the body from the trauma by releasing a sudden surge of adrenaline. This blunts pain so the body can survive – you probably know this as the “fight or flight” response, but most medical responders know it as the “I’m fine, really” response. Spoiler alert: They’re not always fine. When the adrenaline wears off, the pain sets in – and in the case of severe and critical injuries, waiting too long to seek treatment can lead to complications or even death.
Keep the victim stable
While on the line with 911, be prepared to answer the operator’s questions, which will include information about where you are, what happened, and what injuries you observe. Answer these questions to the best you can, and don’t worry if you don’t know the proper terminology for something – operators have heard it all and know how to get the clarification needed to best help you render aid. Pay close attention to the step-by-step instructions the operator gives for administering aid. This can include the following cases:
A spinal injury:
“If a spinal injury is suspected, you may be instructed to hold the head in a neutral position so there is no further injury to the spine,” Briu says. While kneeling or lying behind their head, place your elbows on the ground or your knees for stability. Gently hold each side of their head with your fingers on their temples or skull. Hold this position until medical help arrives.
First, check to make sure they are breathing, and if they are not, administer hands-only CPR by pushing hard and fast in the center of the chest (for more chest compressions, check out The Lifesaving Skill Every Triathlete Should Know). This action can help keep blood pumping around their body and to the vital organs (including the brain) until emergency medical responders can take over.
If the victim is breathing, check to ensure the airway is clear. “You want to manage the airway, make sure there’s no broken teeth or fluid blood impairing that person’s ability to breathe,” Briu says.
If the person is bleeding, the best thing to do is try to minimize the loss of blood. “There are many ways to stop the bleeding,” Briu says. “The most common way is to apply pressure to the site of bleeding.” A sterile dressing is obviously the most preferred item to apply to a bleeding wound, so if drivers have stopped, ask if they have a first-aid kid in their car. Ditto for anyone who comes out of nearby houses or businesses. But if one is not available, any cloth such as a towel, handkerchief, or shirt, will suffice. Avoid using your bare hands.
You can also slow bleeding by putting pressure on a major arterial point. If the bleeding is from the leg, identify the point in the groin (or the “bikini line”) where the leg bends at the hip, and press down – this cuts off circulation at the femoral artery. If the bleeding is from the arm, squeeze the brachial artery located on the inside of the upper arm, between the shoulder and elbow.
Using a tourniquet for cutting off blood flow to a limb should “only be used for a last resort” when other methods have failed, Briu says.
Few things are more jarring to look at than a limb with a severely broken bone or dislocated joint, but please leave the treatment of these injuries to the pros. “Unless you’re trained in this kind of thing, it’s better to leave these injuries the way you found them,” Briu says.
It seems like every dramatization of a medical emergency involves someone shouting, “They’re going into shock!” But few people actually understand what shock is, or what it looks like.
“Shock is when the blood pressure drops so low you can’t feel a pulse,” Briu explains. “The skin turns pale and cold, sometimes it will change in dryness or moisture. The patient will be very lethargic.”
When this happens, lay the victim down (if they aren’t already) and elevate the feet. Loosen or remove any tight or restrictive clothing, and if they complain of chills, loosely cover with a blanket or clothing. If vomiting begins (and if no spinal injury is suspected), help the victim roll onto their side to prevent choking. If breathing stops, begin chest compressions.
Give the medics a running start
The 911 operator will relay information from your call to the emergency medical services as they drive to you, but they may have more questions when you arrive. Bria says you might be asked things like:
- Was the person wearing a helmet?
- Have they lost consciousness at any point, and if so, were they confused when they woke up?
- How long have you been applying pressure to a bleeding wound or performing chest compressions?
Level up your first aid skills
One of the best things you can do to help others is to take courses that will allow you to render even more effective aid. Check to see if your workplace offers free or discounted first aid, CPR, and/or AED (Automatic External Defibrillators) training. If not, a variety of in-person and online courses are available from multiple agencies, including:
Those who spend a lot of time training outdoors might also find benefit in taking a wilderness first aid course. These first-responder trainings are more in-depth, designed to equip students with the skills to provide prolonged aid in areas where it may take emergency responders longer to respond (for example, rural roads popular with cyclists or on remote trail runs). Wilderness first aid courses are available at: