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- Road rash is a friction burn. Clean it with mild soap and running water within 30 minutes, debribe embedded grit, and keep it moist — scabs scar.
- Suspect a fracture when there is deformity, point tenderness, or inability to bear load. Splint in position and do not attempt to realign.
- Any helmet impact with loss of consciousness, nausea, vision changes, or persistent headache is an emergency-room visit. Second-impact syndrome kills.
- Carry the basics: gloves, sterile gauze, antiseptic, tape, and a credit card for bee stingers. It fits in a saddlebag.
/ 01
Scene safety first
Before you do anything else, get yourself and the injured rider off the road. Move out of the traffic lane. Do not move a rider who may have a spinal injury unless they are in immediate danger from traffic or fire.
If the rider is unconscious, do not remove their helmet unless it is obstructing the airway. Call emergency services and monitor breathing. Most fatal cycling injuries involve the head or the chest — not the obvious road rash everyone rushes to photograph.
/ 02
Road rash — treat it like a burn
Road rash is a friction burn, and the burn model is the right one. The skin is gone, dirt is ground into the underlying tissue, and the wound will be wet for days.
The correct sequence is clean, debride, dress, keep moist. Clean under running water with mild soap — not alcohol, not hydrogen peroxide, both of which damage the new tissue. Pick out embedded grit with tweezers or a damp gauze pad; a credit-card edge works for the deeper bits. Cover with a non-adherent dressing and an absorbent top layer. Re-dress daily until the skin has re-epithelialised.
Road rash severity and treatment
| Severity | Appearance | Treatment | Follow-up |
|---|---|---|---|
| Minor | Top layer of skin, mild weeping | Clean, moisturise, leave open | Heals 3-5 days |
| Moderate | Raw dermis, embedded grit | Clean, debride, non-adherent dressing | Re-dress daily, 7-14 days |
| Severe | Deep, fat or muscle visible | Do not clean aggressively | ER — may need grafting |
/ 03
Fractures — recognise, splint, do not realign
The signs of a fracture are deformity, point tenderness, swelling, crepitus (a grinding felt through the skin), and inability to bear load. The classic cycling fractures are the collarbone, the scaphoid (from an outstretched hand), and the hip or pelvis in high-speed impacts.
Splint in the position found. Pad with clothing, immobilise above and below the suspected break, and do not attempt to realign — you can convert a closed fracture into an open one with the best intentions.
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Head injuries and the helmet check
If your helmet took an impact, you are Concussion Suspect Number One. Any loss of consciousness, any gap in memory of the crash, any nausea, vomiting, vision changes, balance issues, or a headache that worsens over hours is an emergency-room visit.
The danger is second-impact syndrome: a second, smaller hit to a brain that has not healed can cause catastrophic swelling. If you have had a concussion, you are off the bike for at least a week, often longer. Replace any helmet that has taken an impact, even if the shell looks intact — the foam is single-use.
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The saddlebag first-aid kit
A useful kit fits in a saddlebag and weighs under 100 g: two pairs of nitrile gloves, a sterile gauze pad, a small roll of paper tape, an antiseptic wipe, a credit-card-sized debribe tool, a triangular bandage, and a small emergency blanket.
Ride with it every ride. The one time you need it is the one time you left it at home.
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