Student Nurse Perspective: Put your bloody helmet on.

For a moment I'm going to put myself on a higher horse than usual. I've been on placement in the community lately which gives me an excuse to use my bike more often than I otherwise would. Today (27.11) I decided to do a little observational survey, now this is anecdotal but it highlighted something that I am slightly passionate about. Helmets, cyclists without helmets. In the morning I observed 30 cyclists, 14 of them had a helmet. There was one pre-teen girl who did have a helmet, just not attached to her head. In the late afternoon on the way home I observed 40 cyclists and only 10 of them had a helmet! There was even a fellow parent without a helmet, but his child had one.

Quite a few of them had some other safety equipments like hi-vis and/or reflective jackets, flashing lights and reflective badges. Now of course those are very important as well. But none of those will prevent you from suffering from head trauma. And those precautions are more relevant for when you are on the road cycling, not a special pedestrian/cycling path. But at some point you have to go on a road to cycle.

"We found that crashes disproportionately occurred during low-light conditions such as at dawn, dusk or at night. Only 34 per cent of cyclists in these low-light crashes were wearing reflective clothing and 19 per cent of them said they weren't using bicycle lights at the time of the crash."

Well as you might have noticed, with my little observational study the higher portion of cyclists without a helmet was in the late afternoon. So that is just a little bit more frightening. And frustrating. Hence this blog. So I decided to cherry pick some safety studies that have been done regarding the use of helmets. Most of the ones I found were done in Australia and the US, not sure why I mentioned that but it would be nice to see something similar being done in the UK considering that the UK has not got as extensive bicycle network as Australia. Though there are some great places for cyclists of course like Lancaster where I live. Of course it is difficult to make a proper ethical double blind study of the effectiveness of helmets. And I would hope that no one would actually suggest that, it would be like suggesting to have a randomized controlled trial on effectiveness of parachutes in prevent death and major trauma.

The main worry when you fall of a bicycle is head trauma, for obvious reasons. Yes, a broken arm and a broken leg will set you back for a few months and you might not make 100% full recovery of said limb but at least you'll be able to maintain a normal standard of living... mostly. Whereas a head trauma can be devastating. If you want to read up on Head Injuries there is a fantastic website called Headway which provides great sources and resources on head injuries, consequences and management of said injuries.

But just taking some chosen effects that head injury can affect:

• Communication problems after brain injury are very common.

• Everyone who has had a head injury can be left with some changes in emotional reaction and behaviour.

• Brain injury may occasionally cause damage to the hypothalamus and/or pituitary gland, which can lead to insufficient or increased release of one or more hormones.

Of course you don't have to believe me, but what about an emergency doctor who sees these kinds of accidents on a regular basis.

Severe head injuries were defined as any with significant brain haemorrhage, complex skull fracture or brain swelling. Some 70% of such patients end up on a ventilator in intensive care units; many patients with severe head injuries are left with permanent brain damage.

In this study done in 1989 in the US they comment on:

Seven percent of the case patients were wearing helmets at the time of their head injuries, as compared with 24 percent of the emergency room controls and 23 percent of the second control group. Of the 99 cyclists with serious brain injury only 4 percent wore helmets. In regression analyses to control for age, sex, income, education, cycling experience, and the severity of the accident, we found that riders with helmets had an 85 percent reduction in their risk of head injury (odds ratio, 0.15; 95 percent confidence interval, 0.07 to 0.29) and an 88 percent reduction in their risk of brain injury (odds ratio, 0.12; 95 percent confidence interval, 0.04 to 0.40).

85% reduction in their risk of head injury. That is pretty pretty significant.

Another study done in the US, this time 1996 concluded with that helmets had protective effect of 69% to 74%, in incidents that involved motor vehicles:

Bicycle helmets, regardless of type, provide substantial protection against head injuries for cyclists of all ages involved in crashes, including crashes involving motor vehicles.

This one done in Australia in 1994 had this to say:

Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%).

A meta analysis done in Australia also added in 2001:

Overall, these results provide clear evidence for the benefit of wearing helmets while cycling in terms of risk reduction for not only head and brain injury, but also facial injury and fatal injury. These results are applicable to riders of all ages, both in less severe crashes and in collisions with motor vehicles. These results confirm those published in initial studies in Australia and the US over a decade ago, although the more recent studies are confined to these two countries, Canada and the United Kingdom. Despite the mounting scientific evidence, the debate over the efficacy of cycle helmets still rages in some circles. How much more evidence is required before helmet use reaches the acceptance level of seat belts for motor vehicle occupants?

And of course the Cochrane Review got in on the game:

The review found that wearing a helmet reduced the risk of head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle. Injuries to the mid and upper face were also markedly reduced, although helmets did not prevent lower facial injuries. - See more at: http://summaries.cochrane.org/CD001855/wearing-a-helmet-dramatically-reduces-the-risk-of-head-and-facial-injuries-for-bicyclists-involved-in-a-crash-even-if-it-involves-a-motor-vehicle#sthash.mXIjmgEt.dpuf

 The review found that wearing a helmet reduced the risk of head or brain injury by approximately two-thirds or more, regardless of whether the crash involved a motor vehicle. Injuries to the mid and upper face were also markedly reduced, although helmets did not prevent lower facial injuries.

So yeah. I am willing to take 65% - 85% and look like an overgrown flying mushroom, as opposed ending up as a mushroom.

Mr Robinson in Australia compiled another major study showing how the legislation in New Zealand came into effect.

Head injuries vs Helmet Use

The Canadians decided to check up on the impact of mandatory helmet use:

Of the 9650 children who were hospitalized because of a bicycle-related injury, 3426 sustained injuries to the head and face and the remaining 6224 had other injuries. The bicycle-related head injury rate declined significantly (45% reduction) in provinces where legislation had been adopted compared with provinces and territories that did not adopt legislation (27% reduction).

So mandatory legislation would be the way to go. But then again there is no point in having a legislation if the education aspect is lacking. A study done in Ohio in 1994 showed that kids under 16 were more likely to were a helmet if there was legislation in place as well as a strong safety education. But the education shouldn't be just confined to schools, parents need to buckle up as well. It really shouldn't even be an issue. What often blows my mind is when I observe other parents stressing out the point to their kids why helmets and other safety gear are important then do not use the safety equipment themselves. Why the hell should the kid listen to a blatant hypocrite like that? Parents, don't just talk the talk, walk the walk as well. You are just as likely to collide, crash and suffer from head injury as your kids if you fall of that bike during those wondrous family cycling tours.

Helmets save lives. Just like seatbelts.