Collision with a Cyclist at a Junction
You are first on the scene of a collision at a town junction. A cyclist, an adult, is lying on the road beside a damaged bicycle. The cyclist is conscious but confused, complaining of neck pain and a painful right forearm that is visibly deformed. There is a small amount of bleeding from a graze on the elbow. The cyclist's helmet is cracked but still on. Traffic is still moving past, a car has stopped with hazard lights on about 10 m away, and a bystander is filming on a phone. It is dusk and the road is damp. You have a first-aid kit and a mobile phone.
1. Set out your priorities and actions in order for the first few minutes.
Read the worked answer
Priorities: protect the scene, then treat life threats, then get help.
- Scene safety. Ask the stopped driver to switch on hazard lights and, if safe, place a warning triangle or use the vehicle as a shield. Switch on your own hazards. Keep the bystander from crowding the casualty and ask them to direct traffic or call for help rather than film.
- Call emergency services. Give location, number of casualties, that the casualty is conscious but confused with neck pain and a deformed forearm, and that a helmet is cracked. Stay on the line for instructions.
- Do not remove the helmet. A cracked helmet with neck pain suggests possible spinal injury. Support the head in the position found with your hands or rolled clothing, and tell the cyclist not to move.
- Control bleeding. Apply gentle pressure to the elbow graze with a sterile dressing; it is minor compared with the other injuries.
- Do not straighten the forearm. Cover the deformity loosely, do not push bone ends, and keep the arm supported as found.
- Monitor. Watch breathing and consciousness, keep the casualty warm with a blanket or coat, and reassure them calmly until help arrives.
2. The cyclist becomes drowsy and stops responding. What changes, and what must you not do?
Read the worked answer
Drowsiness and loss of response mean the casualty's condition is deteriorating; treat it as a life threat and act at once.
- Recheck the airway and breathing. Call the emergency services again or update the dispatcher. If breathing is normal but the casualty is unresponsive, place them in the recovery position only if you can do so without twisting the neck; with suspected spinal injury, the priority is airway and breathing, so use a careful log-roll with help if available, keeping the head aligned.
- If breathing is absent or abnormal, start CPR and ask for an AED; the dispatcher will guide you.
- Keep the head supported and do not let bystanders move the casualty.
- Do not give anything by mouth, do not remove the helmet by force, do not try to set the arm, and do not leave the casualty alone.
Record the time of any change in consciousness and pass it to the paramedics, along with what you observed on arrival.