Helmets for Active Sports

Paul Auerbach — Mon, 07 Dec 2009 04:51:00 GMT

by Paul Auerbach, M.D.

reposted with permission from the Medicine for the Outdoors Blog

The National Highway Traffic Safety Administration reported an analysis of motorcycle helmet use in fatal crashes. What was discovered is not surprising - namely, that in states in which there is not a state helmet law, the odds of a rider in a single-vehicle (e.g., the motorcycle) crash wearing a helmet was 72% less than in states with a helmet law. So, absent a law, people are not particularly inclined to wear a helmet.

One needs to couple this information with the facts about the benefits of wearing motorcycle helmets. First, motorcyle fatalities and fatality rates are increasing at a time when motorcycle riding is becoming more popular. Second, the average age of motorcycle fatalities has moved up to 39 years, from 30 years nearly 20 years ago, probably because the age of motorcycle riders has increased. Third, motorcycles expose the drivers more directly to lethal forces than do enclosed vehicles. Helmets are essential to prevent brain injuries and deaths.

What are the arguments against wearing helmets? Some argue that motorcycle helmets are heavy and therefore increase neck and spinal cord injuries. The opposite has been shown to be true. Some opponents claim that motorcycle helmets impair the driver's ability to hear and see. These senses have been studied in the context of motorcycle activity and do not appear to be impaired, and in certain circumstances, may be improved. The argument that motorcycle helmets are only effective up to a speed of 15 miles per hour is not entirely true. Many head injuries follow glancing blows, not high speed direct impacts. It is true that a helmet can not be effective against a tremendous blow, but it is better than nothing.

Many argue that there is a freedom of choice issue at play. If you knew that you were going to be struck on the head during a particular ride, would you choose to wear a helmet? Probably, you would. The problem is that no one is able to predict the day or moment of their accident and head injury. Few people believe that anything bad will ever happen to them.

Motorcycle helmets are a surrogate for helmets in all situations of risk in which there is a reasonable likelihood of being struck on the head and injuring the scalp, skull, and/or brain. What are those situations? In the water, it is the kayaker who is at risk for being flipped onto a rock or getting caught in a strainer. Knocked unconscious in the water, he is drowned. For the rock climber, it is being struck by falling rocks, swinging into a rock face, or suffering a fall. For the horseback rider, it is coming off the horse. For the motorcycle or ATV rider, or bicyclist, it is crashing and striking one's head. For the skier, it is falling, crashing, or being struck by a ski or snowboard.

One gives up very little (nothing, really) and gains everything by wearing a helmet in the appropriate circumstances. Freedom of choice is a selfish concept when one considers that the head-injured victim forces loved ones or society to provide care and the financial resources to manage the injury and rehabilitation, and sadly, support for the disabled person, who might have avoided most of the injury by wearing a helmet.

There is no excuse for not wearing a helmet approved for high risk (for head injury) situations. It is no different than wearing a seat belt in a car or washing your hands before you eat. Prevention is the name of the game. Having cared for many people with devastating head injuries, most of which would have been trivial or absent if a helmet had been worn, I can only hope that we do what it takes to mandate helmet use in every reasonable situation for which they would be of benefit. That is a necessary and appropriate use of the law.

Helmets & Snowsports

In the most recent issue of the journal Wilderness & Environmental Medicine, published by the Wilderness Medical Society, there is an article entitled "Skiing and Snowboarding Head Injuries in 2 Areas of the United States," authored by Mark Greve, MD and colleagues (Wilderness and Environmental Medicine 10:234-238, 2009). The objective of their research was to explore the use of helmets in skiers and snowboarders injured at ski runs and terrain parks in Colorado and the northeast U.S. and to examine differences in head injury severity in terrain parks as compared to ski runs. The study was done by reviewing emergency department records of injured skiers at nine medical facilities in Colorado, New York and Vermont. Eligible patients were skiers and snowboarders who sustained a head injury.

Most of the injuries occurred when the victim hit her or her head on the snow; fewer occurred when the skiers or boarders were involved in collisions with other skiers or fixed objects. Only 37.1% of the victims were wearing helmets. There were significantly fewer instances of loss of consciousness in fall events in the Colorado group; significantly lower incidence of loss of consciousness in fall events in helmet users who struck fixed objects; and a higher incidence of skiers colliding with fixed objects in the Northeast. Even when controlling for helmet use, there were significantly more head injuries in terrain parks.

What does this all mean? Obviously, the study sample is small, but the big takeaway for me is that helmet use makes sense. Why are there more injuries in terrain parks? Perhaps this represents the mechanics of falls when snowboarding, as opposed to skiing, or perhaps it indicates a higher degree of risk (for a head injury) with this sport, either because of the mechanics, degree of risk (e.g., aerial maneuvers, jumps, etc.), speed for the terrain, or propensity to hit a fixed object. It seems like helmet use is a very logical, and perhaps even necessary, way to prevent head injuries, certainly while snowboarding, and probably while skiing.

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Helmets for Active Sports

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