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News / Articles

FYI on TBI (traumatic brain injury)

Samantha Wotiz  | Published on 8/19/2021

Do you know what to do if a fellow cyclist goes down and hits her head? If she’s knocked out but comes to—are you supposed to call 911? What is your role after witnessing a potential head injury? While you could spend hours or days taking a certification class to learn more, it is my hope that this article gives you a quick perspective on some best practices around cycling head injuries. (Disclaimer: I’m not a doctor and this article does not provide medical advice.)

First, and I hope it goes without saying, that wearing a helmet is one of the best steps you can take in preventing a concussion. Helmets reduce the likelihood of sustaining severe brain damage or receiving a concussion from a fall or crash on a bike. For a good video on properly fitting your helmet visit: https://www.youtube.com/watch?v=IyhyrITHDgw Please wear a helmet for all rides and encourage others to do so.


Let’s walk through a hypothetical scenario involving helmets and a bike accident. You and your friend, Cait, are riding your bikes when Cait’s front wheel loses traction on a curve and she goes down. You watch her slide across the blacktop and come to a stop, separated from her bike. Now what?

According to local Paramedic and EMS Instructor, John, you want to look for signs of consciousness. The recommended way to check for consciousness is to tap a person on their shoulder and try talking to them. There are 4 types of responses:
  1. Awake and able to focus on you. This person may appear dazed, but you can watch them watch you as you walk toward them. This a GOOD sign. They may or may not be verbal at first. You do not need to call 911. This person would be best served by being evaluated at an urgent care if anything changes.

  2. Responds to your voice. This person can talk to you. This person did not focus on you when you walked up to them but does when they hear your voice. Again, they might be confused but they are able to verbalize their thoughts and questions. You do not need to call 911 at this time but be prepared to if anything changes. The fact that a person is awake and talking is a GOOD sign. This person would be best served by being see evaluated at an urgent care soon after the accident.

  3. Won’t wake up until you touch them. This person was not moving and not speaking, but maybe you were able to bring them back by tapping them on their shoulder or calling their name. You should call 911 for this person immediately.

  4. Unresponsive. This person will not talk or wake up despite your efforts to rouse them. You should call 911 for this person immediately.
Back to our hypothetical situation. Cait is on the ground. You put your bike on the side of the road and run to her. She’s awake and moaning. She sits up by herself and is taking a minute to piece together the events. Best practices say that she should be evaluated at an urgent care or by a family doctor. You might consider calling a ride to get you all back to cars, and then someone should drive Cait to a doctor.

Suppose Cait isn’t moving. You run to her and tap her on the shoulder. It takes a few seconds of you calling her name, but she wakes up. She’s groggy. You must call 911. Cait insists that she has a killer headache, but she will be fine. You should call 911 anyway. If a person has lost consciousness, then you should call 911 because that person needs go to an ER for a CT scan or possible an MRI.

Why does a person lose consciousness after a head injury? A concussion is a traumatic brain injury (TBI). In the case of Cait falling off her bike and hitting her head—you can picture that her brain has sustained something similar to whiplash where the brain bounces off one side of the skull and possibly across to the other side of the skull when she hits the pavement. In some cases, blood can pool in the brain and cause pressure on the brain. This is very serious (potentially lethal) and requires immediate medical attention.

If Cait appear awake after her crash but starts exhibiting any of the following symptoms (as provided by the CDC) then you should call 911 right away.
  • One pupil larger than the other
  • Drowsiness or inability to wake up
  • A headache that gets worse and does not go away
  • Slurred speech, weakness, numbness, or decreased coordination
  • Repeated vomiting or nausea, convulsions or seizures
  • Unusual behavior, increased confusion, restlessness, or agitation
  • Any loss of consciousness, even a brief loss
Do any of these rules change if you’re riding off road instead of on blacktop? No. If Cait crashes and hits her head on a log while navigating a wet patch of single track then you should stop to assess for consciousness and the likelihood that Cait has sustained a concussion. Even if you are several miles into a trail system you should call 911; they have crews and specialized training for these types of rescues. Additionally, cyclists are also at risk for a spinal cord injury when they crash. So, do you really want to move your friend if there is any chance of a spinal cord injury? You should not move your friend, and you should call 911.

There are a lot of factors involved in whether a cyclist will sustain a concussion as a result of a crash/fall. Helmet or not helmet, the type of impact to the head, the location of the impact, how far a person fell, how fall that person traveled in the fall, and the type of surface type of the impact (blacktop, gravel, grass).

Remember how helmets are one of the best ways to prevent a concussion/TBI? Save the helmet from a crash to give to EMTs or bring them with you to the urgent care. A doctor and/or EMT might ask to see the helmet to understand the point of impact. And once a helmet has been cracked then it should be replaced. And no one who has experienced a severe crash should not participate in sports again until they have been medically cleared by their doctor.

This article is not a substitute for CPR/First aid training. This article does not scratch the surface of things you want to look for or take into account when witnessing a cycling accident. However, I hope that it provides some quick facts that you can remember if you ever witness a fellow rider crash. Try to keep that rubber side down!

A special thank you to John who is a local Paramedic and EMS Instructor and provides CPR/First aid certifications through his company North Georgia Safety Training Center, Inc. To learn more about John visit NGSTC.COM. He is a valuable resource and took the time to answer my questions about cycling head injuries.”. John also volunteered his time with the organization BRAG – Bicycle Ride Across Georgia as a paramedic who assists in their rides during the year. He has been providing this service for the last 11 years.

To learn more visit the CDC’s Brain injury basics at https://www.cdc.gov/headsup/basics/index.html and https://www.cdc.gov/headsup/basics/concussion_danger_signs.html