Road rash realities

Road rash: mild to severe skin abrasion resulting from a fall (as from a bicycle or motorcycle) which usually involves sliding on a hard rough surface. – Merriam-Webster

It’s a hot, hot summer in Canada, with little relief. The temptation is to take a motorcycle ride to cool down, just leave the jacket and riding pants at home and let the breeze give you some relief.

There’s one problem with that idea: road rash. Crash without your gear on, and you’re going to get hurt, even if you avoid serious damage like broken bones or internal injuries. Even if you do have jacket, gloves and protective pants on, there are no guarantees; you can be burned through your gear as well.

Still, motorcycling is a risky activity, so why talk about road rash? Every once in a while, it’s good to remember what can happen when things go wrong.

A best-case scenario

If you’re lucky, you’ll end up with only minor scraping, enough to maybe land you in an emergency room with some scraped-up skin, but nothing worse. You might be able to take care of this yourself – I have before, as have most riders – but given the nastiness that can happen if your wounds get infected, it’s good to have a medical opinion.

What sort of treatment can you expect in a basic road rash scenario? I put this question to Jan Doull, a nurse with 30 years experience in emergency rooms in Canada and the US. She says the treatment starts with cleaning the wounds. She says it’s not easy, especially if the abrasions are full of little pieces of rock and gravel; nurses aren’t always able to remove all that.

Doull says her hospital would mostly use saline solution in squirt bottles to do this job. In the past, she might have used a brush to clean out the wound, but at her hospital they use the less painful procedure now (they’re still in use in other hospitals, as you’ll see in the anecdotes below). As well, they’ll also tell riders to clean their wounds out with soapy water from a shower (this is a good way to clean your wounds at home, if you don’t go to the ER).

After cleaning, Doull says nurses will apply antibiotic cream to the wound, then Vaseline, then wrap it in a dressing. The rider can change those dressings at home over the next few days, or, if things are really bad and there are a lot of wounds to treat, the hospital can ask for extramural care to come in and treat them at home.

That’s a best-case scenario. From there, things can get a lot more unpleasant.

Serious road rash treatment

More serious road rash can get you the brush treatment. Medical staff aren’t being nasty — at least, not most of them. They’re trying to clean gravel and dirt out of the wound: crud that carries bacteria that causes infection. Otherwise, you could be looking at a scenario like reader Brad Babcock, who sent us the following tale:

“I had the misfortune of taking a minor fall on a stretch of bad pavement while wearing a short-sleeved shirt thirty years ago … A week later, I was in the hospital with fingers so swollen they looked like sausages and a temperature of 105 F.  The doctors told my wife they expected me to die overnight, but if I survived until morning, they’d have to amputate my right arm.  I didn’t die and they didn’t amputate, but I spent a miserable week in the hospital on intravenous antibiotics. “ — Brad

So, nurses may have to get tough, if the wound is dirty. Another former ER nurse told me she used a pre-packaged sterile brush for the job, and said it looked painful, even when they used anesthetics like Lidocaine (she didn’t think it worked that well) or heavier stuff like Fentanyl.

That heavier anesthetic is where someone like Dr. Johnathan Edwards comes in.

If you want to know about road rash treatment, Dr. Edwards is your man. He’s a former MX racer, and served as a team doctor for Dakar racing teams as well as bicycle racing teams. His specialty is trauma anesthesiology. He’s the guy who knocks you out when they have to start brushing your wounds. And because of his various jobs over the years, he’s seen it all.

But these days, he says even the worst cases of road rash have much more potentially positive outcomes, thanks to advances in medicine in the past few years, especially in skin grafts. Skin grafting is the procedure of moving skin from one part of your body to another, transplanting tissue to repair damage.

Placental skin grafts are revolutionizing burn treatment right now. “Before, we just had these synthetic tissue grafts that were nothing more than just chemicals,” Edwards says. Compared to the old skin graft procedures, the new method has no immune reactions and easily integrates into your skin.

Taking care of your road rash at home
Although it’s good to have a professional medical opinion, you can certainly take care of smaller cases of road rash at home; these cases usually have a good outcome, as long as the patient is healthy, says Dr. Johnathan Edwards.
A long rinse with soapy water in the shower can clean minor wounds, or even a bath. Just make sure you get the dirt out. Dr. Edwards recommends you apply a topical antiseptic with a numbing agent to make the cleaning process easier, something like Band-Aid Hurt-Free Antiseptic Wash.
After the wound is clean, you can apply a topical antiseptic like Polysporin to the wound before wrapping it in a bandage, ideally gauze that’s kept on with tape. Change this dressing as the wound oozes into it; after a few days, the oozing will stop, and this is where Edwards recommends using a covering like Tegaderm, which reduces pain and keeps the wound moist, making it heal more quickly. In a week to 10 days, Edwards says you should hopefully be mostly healed — but if you’re experiencing pain or something doesn’t seem right with the wound, you should check in with a medical professional to make sure infection hasn’t set in.

From there, Edwards says recovery depends on a few factors. There’s no miracle drug to help your rash heal, he says. Most of it comes down to diet and the patient’s general health. Diabetes, for instance, will complicate recovery, as it inhibits the body’s ability to heal optimally. Proper health means nutrients will be absorbed properly; if you avoid eating a balanced diet, you could prolong or complicate recovery. Edwards says he’s seem extreme vegetarian athletes who were slow to recover from road rash damage as their diet wasn’t keeping up with their body’s needs.

After the initial treatments, there are other complications that can arise. Scarring can be an issue, as no matter how well you treat the wound, it will never heal the same as before, and the deeper the wound, the worse the scarring can be.

Another issue is pain syndrome.

“Sometimes people get what’s called complex regional pain syndromes from nerve injury,” says Edwards. “Sometimes it’s the hit, or the abrasion or the crush injury of the nerves if it’s bad enough. It may take a year or more for those nerves to regenerate or normalize. You always have that increased sense of sensory pain when someone brushes up against it, or your riding pants hit it a certain way, or you stretch it a certain way.”

However, even with complications like this, Edwards says that overall, a rider’s ability to recover from road rash is getting better all the time.

A worst case scenario

It’s encouraging to hear of improvements in medical technology and the improved outlook for injured riders. But the risks of riding unprepared for road rash are still tremendous, even if the doctors can patch you up as good as new, or almost. One of the best people to learn this lesson from is Brittany Morrow. You might know her as the Road Rash Queen.

In 2005, Morrow was riding on the back of her friend’s GSX-R750 in New Mexico when she fell off the bike at high speed, wearing no safety gear besides her helmet.

From her website Rockthegear.org:

“When I hit the ground, it was as if every breath I had ever taken rushed out of me in an instant. I could feel every inch of my body hitting the road; tumbling, sliding and grinding into the unforgiving surface. In my helmet, which seemed so small and yet completely empty, I could hear my whimpers as I fought to breath and my prayer to God as I gave into the asphalt. In a matter of seconds, I had come to the conclusion that I was going to die, and I was ok with it. I knew this was far worse than anything I had ever gone through and I was convinced I would not live to see the next day. My eyes were closed as I finished my 522 foot tumble down highway 550. I never lost consciousness, but I remember wishing that I had.”

The story gets worse from there. Morrow writes about feeling the bones in her kneecaps scraping the road as she was moved. After she was helicoptered to the hospital, the morphine was starting to kick in:

“The rest is somewhat of a blur. I remember hearing a doctor saying I had lost my entire left breast. I remember another asking me if my family had been called. A third doctor asked if she could take pictures of my wounds for documentation. When it came time to clean off my skin, the doctors decided that a surgical debreedment of the dead tissue was necessary, along with invasive repair to my pinky, right big toe, and left side from hip to armpit. I don’t even remember being put under, and the rest is lost in the six hour surgery that followed.”

With third-degree burns to 55 per cent of her body, and undamaged tissue only remaining in the front of her thighs, Morrow spent two months in hospital getting skin grafts, as doctors moved her skin around her body, rebuilding it piece by piece. Her entire recovery story from the next year is all on her Rock The Gear website, and it’s a tough read. Physical pain, mental pain — the suffering from her crash was tremendous. But at least it has a happy ending.

Since her crash, Morrow has been a motorcycle safety advocate through both her own Rock The Gear foundation and other outreach programs. Even though she had the terrible experience of her crash and its results, she’s moved past it to help others, and she closes out her story of her crash with this message.

“I would never wish the pain I felt and still feel today upon anyone in this world. It is completely avoidable with a few extra layers, and I can’t say it enough: it is undeniably worth it to gear up. Everything I have gone through this past year will not be in vain if my testimony is enough to save someone’s skin.”

Think about that the next time you’re tempted to go riding in your T-shirt.