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How to treat road rash & what to do in a crash

Tumbles are a fact of life for cyclists, and the result is usually a dose of road rash. Here's the safest way to handle the situation.

Jean Christophe Peraud crashes on Stage 13 of the 2015 Tour de France
Sam Jackson
16 Feb 2016

Everyone has an accident-prone friend and ours is called Dave. Following him at a distance into a blind bend, we heard the crash before we saw it. Clearing the turn, we found Dave lying in the road looking very sorry for himself. As we jumped off our bikes to help him, it occurred to us that we’d all feel a lot better if one of us knew how to properly deal with the situation – as nobody wanted to make it any worse.

Ashley Sweetland is the man responsible for St John Ambulance’s team of over 150 cycle responders. Based across the country and covering both the Tour of Britain and the Ride London-Surrey 100, one of his teams could be responsible for putting you back together if you take a spill on your bike. He seemed the ideal man to come to for expert advice… 

‘Using bikes makes it easy to navigate congested urban environments or events where vehicular access is restricted – like races or sportives held on closed roads – meaning, if there is a crash, we’re often the first people on the scene,’ he explains. Seeing someone in trouble, your instinct is to spring to their aid, but take it slowly.

‘After coming across someone in the road, it’s important to first take a moment to ensure the scene is safe,’ explains Sweetland. 

How to help safely

Especially at big events, it’s important to be aware that your presence could also cause further accidents. On open roads, the prime danger is likely to come from traffic or other riders. ‘Enlist someone to alert traffic or place an upturned bicycle ahead of and behind the scene. At night, you can also use your lights as a warning,’ he explains. If they’re not being employed to cordon off the area, quickly get your bikes out of the road.

If you suspect more serious injuries, or if they’re unconscious, call an ambulance

The next thing to decide is if the rider can be moved. ‘The mechanism of injury is crucial here,’ says Sweetland. If you’ve witnessed the rider taking a slow-speed fall and they’re conscious, not in excessive pain and can explain their injury, it’s probably safe for them to get up and out of the road. ‘Crashes at higher speed or those involving collisions are more complex,’ he explains. You should talk to the rider. If you suspect more serious injuries, head or spinal injuries that would prevent moving them, or if they’re unconscious, enlist other people to secure the area and call an ambulance for professional assistance.

If the rider is out for the count, check their response. Call their name, try talking to them and tap them on the shoulder. If they’re unconscious, check their breathing by placing your cheek against their nose and mouth. If they’re not breathing, instantly get started with CPR. Otherwise, move them into the recovery position. Information on how to do this and also deal with a range of common cycling injuries is available from the St John First Aid for Cyclists app (free to download from It’s great for brushing up on your skills and having it on your phone means all the info will be to hand in an emergency.

Luckily, most incidents aren’t so grave. ‘The majority of accidents we see at cycling events aren’t serious, usually consisting of cuts and scrapes,’ explains Sweetland. However, one thing worth checking for, even after a minor prang, is the possibility of concussion. Crashes are confusing events, sending you higgledy-piggledy down the road. Even small bangs to the head, especially glancing blows, can cause concussion.

If it’s just road rash, follow our guide below on how to patch it up.

Road rash

The body’s biggest organ was never meant to be used as a brake pad, and road rash is a rude reminder of just how exposed cyclists are while travelling at speed clad only in a thin layer of Lycra. For most of us, the sight of torn clothing and red raw skin is a signal that our ride is over, but for the pros it is merely something they deal with before carrying on, so it’s no wonder that pro team doctors are pretty experienced when it comes to patching up their riders and getting them back in the game.

‘Usually when a rider goes down you put on a little bit of water, try to scrub them clean a bit, then it’s back on the bike and to the finish,’ says Anko Boelens, team doctor at Giant-Shimano. ‘If it’s really bloody you patch it up because it’s not very nice to look at.

‘After the finish, the work to clean up a wound starts,’ he adds. ‘I ask the riders to scrub the wounds clean in the shower to get off all the dirt and bacteria.’ For the most superficial of wounds this can be as far as treatment needs to go, but generally Boelens will clean and bandage the affected area, depending on the location of the scrape, and whether there are more stages to come.

‘If it’s an area that will be covered by clothes I clean the wound with iodine and antiseptic cream, then apply a paraffin gauze that doesn’t stick to the wounds, and then a bandage. We use 2nd Skin Hydrogel bandages that you leave on for a couple of days. The bandage itself will react with the wound.’

Boelens is an advocate of leaving wounds open to the air unbandaged. ‘Then it heals nicely. As long as it’s open, the body will get rid of the wound itself,’ he says. On a stage race, where riders face consecutive days in the saddle, it’s not desirable to leave road rash open, despite it being better for healing: ‘I always bandage it up because it’s a little bit nicer to look at, and also the riders might fall again. I’m taking into consideration how it looks from the outside and how it feels for the rider.’

But it’s not just down to the doctors. Pro riders are required to regularly check their tetanus vaccinations – once every couple of years – because, as Boelens puts it, ‘Riders fall all the time!’

Rash decisions

How to patch up those unfortunate scrapes

Keep these in your cupboard…


‘Betadine or iodine is good,’ says Boelens. ‘I don’t like to use alcohol-based products, or 70% alcohol-based products. It’s painful but it also interferes with the healing process.’

Paraffin gauze

This sits between the bandage and the skin, which is useful ‘so the bandage doesn’t attach itself to the wound, which can be really painful’, says Boelens.


To cover the gauze. ‘With those three things you can go a really long way,’ says Boelens.

If it looks really bad…

‘It never hurts to show it to a doctor. They can more easily differentiate between a flesh wound and something more serious. A doctor can also bandage it up nicely,’ says Boelens.

Check for infection…

‘Sometimes a wound can have a little bit of a green tinge to it. As long as it’s open and there is no deep penetration to the skin, it’s OK – it’s a part of the healing process,’ says Boelens. ‘If the edges of the wound start to go red, and the redness spreads and starts to feel warm, it’s infected. Go to the doctor.’

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