10 Most Common Bicycling Injuries

Deep Cuts/Internal Injuries

If the PT is bleeding – put on your gloves. The most common and effective way to control external bleeding is to apply direct pressure. PUT ON YOUR GLOVES. It is always best if you apply the pressure with a sterile dressing. This is not always possible but you should be carrying some 3X3 or 4X4 dressings that are wrapped and sterile. If it is a serious cut ¼ inch deep or more and 1 inch or more in length – you MAY want to not irrigate with water. It is a judgment call. If the wound is bleeding a lot – apply the direct pressure and KEEP THE PRESSURE ON until the wound stops bleeding. WEAR GLOVES – keep the pressure on – apply dressing and wrap with a roller bandages. If it continues bleeding – DO NOT TAKE THE dressings/bandages off – apply NEW dressings on top of the old ones and more roller bandages. KEEP APPLYING DIRECT PRESSURE. Continue new dressings/bandages and direct pressure until the wound stops bleeding.

If you have a wound serious enough that you cannot afford to irrigate the wound because it is bleeding too much – make arrangements to get the PT to an ER or call 911. The PT may be upset about 911/ER but if the wound is bleeding so bad that you had to skip the step of irrigating the wound – they are going to need stitches anyway – plus – at some point the wound needs to be irrigated and cleaned. They can do that in an ER. The point is to get the PT to a higher level of medical care where they can properly clean and stich up the wound.

Back at the wound site – usually the blood will be dripping out – if it is periodically squirting out of the wound – that is an arterial bleed – an artery has been severed – do not hesitate – call 911. Do the best you can with direct pressure – do not irrigate at this time– direct pressure may stop the bleeding for a while but this is a serious wound – do not hesitate – call 911.

If it is an uncontrollable bleed and advanced medical treatment is unavailable for a considerable amount of time and you strongly suspect that the PT may become in a life threatening condition due to blood loss – you may want to think about a tourniquet. You need to learn how to apply a tourniquet in a class – so take one. Also, tourniquets are not an item that you just apply on a whim – they are a serious procedure and should only be used in a serious situation. I once had a PT that cut open his/her ankle when they hit the road railing on a curve – sliced his/her ankle like a knife. The PT was by themself and he/she had to ride miles back to civilization (a good case why you should not ride alone – or at least have a cell phone). He/she used shoestrings and tied them around his/her ankle and road a few miles back to town where we had an AID station. Upon examination it APPEARED that he/she did not cut an artery – there was no evidence of arterial bleeding. It is possible that between the homemade tourniquet and the fact that arteries tend to “shutdown” when they are ruptured – the artery was no longer bleeding. I called 911 immediately – treated for shock – and the medics were there in a few minutes and the PT was out of my care. I never got the details.

Again, the concept of tourniquets has changed since the wars in Iraq and Afghanistan. During these conflicts soldiers received life threatening wounds and tourniquets were applied. Sometimes the tourniquet was in place for hours and the PT did NOT have any permanent damage to the limb. This contradicts earlier assumptions about tourniquets. Even just a few years ago when I went to EMT School – tourniquets were considered the absolute last resort and even then – they were strongly discouraged. Like many medical procedures – the medical pros have completed changed their minds on this. Keep up.

Shock – this is a serious – life threatening condition. A quick description of shock from my EMT book, “It (shock) is the inability of the circulatory system to supply cells with oxygen and nutrients.” Shock is complex and can be caused by several different factors. This is First Aid –I am not going into all that here. If a PT is in shock it is safe to assume that the PT is losing fluids – usually blood but not always – it can be blood lose and/or severe dehydration.

On the First Aid level, the body is losing fluids and the body starts protecting itself by sending all the blood to the core in order to compensate. Thus the blood starts draining from the arms & legs and sending all the blood to the organs in the chest and head – the core. The PT will probably present with pale, cool, clammy skin; PT may have altered mental status (AMS); nausea and vomiting; PT will probably state they feel cold; any combination of these.

The treatment: O2 if you have it; keep the PT warm and comfortable; watch for breathing issues; keep records of vitals – particularly pulse and respirations; if AMS – keep the PT from wandering off or hurting themself. When keeping the PT warm – remember that much heat from the body can be lost while in the supine position on the ground – especially if the ground is damp/wet. Put layers of clothing/jackets/arm & leg warmers/plastic bags/rain gear/etc. between the PT and the ground and whatever is NOT used to protect the PT from the ground – put on top of PT in order to keep PT’s heat in.

First Aid used to recommend raising the PT’s legs about 8 – 10 inches off the ground. This helps the blood to get to the core. However, due to the possibility of PT having a spinal injury, this practice has been discontinued, at least on the First Aid level of treatment. Medical professionals (EMT/EMT-P/nurses/etc.) that know how to “clear” a spine from injury status can lift the legs if there is no spinal injury. It is still good treatment if the PT has been cleared of spinal injury. However, at this time – raising the legs is NOT First Aid treatment. Again, shock is complex with different stages – etc. First Aid treatment is basically stop the bleeding, ABCs, keep the PT warm and from hurting themselves; get the PT to a higher level of medical care.

I have just addressed external bleeding/shock. Internal bleeding is another subject that could fill pages. However, simple First Aid – if you have a PT with serious external bleeding or suspected internal bleeding – call 911. Your PT needs to be in the hands of a higher medical authority. DO NOT HESITATE.