Putting a lid on it

16 November 2010 | 0:00 - By Anthony Tan

The latest findings on cyclists’ head injuries provide conclusive evidence mandatory helmet laws should stay, argues Anthony Tan.

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A mass pileup involving Lance Armstrong at the 2010 Tour de France (Getty)

The common sense of someone who has not fallen off their bike, helmetless, and hit their head has prevailed.

Co-author of a study by the Royal Prince Alfred Hospital in Sydney that examined long-term trends in cyclist head injuries, Dr Michael Dinh, emergency physician and co-director of the department of trauma services at the RPAH, urged the government not to repeal Australia’s mandatory helmet laws.

“It is the opinion of the trauma service at the RPAH... that mandatory bicycle helmet laws be maintained and enforced as part of overall road safety strategies,” Dr Dinh said.

Published Monday in The Medical Journal of Australia, the study analysed data from 979 patients admitted by the RPAH from 1991-2009 over the age of 16, and found cyclists accounted for a tripling in the percentage of total emergency cases, from 1.3 percent in 2005 to 3.9 percent last year.

Furthermore, evidence that helmets soften the blow to one’s head in the event of an accident was discovered, as the percentage of injured cyclists who required treatment for severe head injuries dropped from 10.3 percent to 2.5 percent over the same period.

“That could be put down to helmet use,” affirmed Dr Dinh.

Among 287 patients for whom information about helmet use was available between 2008 and 2010 – including 26 cyclists who were not wearing helmets – Dr Dinh found non-helmet wearers were five times more likely to develop intracranial bleeding or sustaining a skull fracture.

Dr Dinh added the estimated cost of severe traumatic injury was “about $4.8 million per case”.

Last month, public health and cycling advocate, clinical associate professor Chris Rissel from the University of Sydney, argued helmet laws be repealed on the basis that, “there is little evidence to support the view that there was a drop in head injuries as a result of the helmet legislation.”

“The problem with a focus on helmets is that it seeks to attribute injury responsibility with the vulnerable road user rather than the cause of the injury, which is essentially road and traffic conditions such as, for example, poor road surface, allocation of road space for cyclists, speed of vehicles, and attitudes of drivers,” professor Rissel told Crikey.com.au in May.

“The discussion should not be about whether helmets protect the head or not, but whether the helmet legislation caused less head injuries. There is no evidence that it did,” he said, citing statistics from the 1980s to the end of the last century.

Now there is. Dr Dinh et al., frontline trauma experts, should know, should they not?

I’m reminded on a turning moment in the life of the great post-war cycling hero, Fausto Coppi.

It was 29 June 1951, at the one-day Giro di Piemonte. On the outskirts of Turin, where next year’s Giro d’Italia will start from, an amateur cyclist, Nino Defilippis, saw a couple of cyclists misjudge a bend and tumble down.

One of those who fell was Serse Coppi, Fausto’s younger brother by four years, who had been at the campionissimo’s side ever since they joined the formidable squadra Bianchi at the close of the Second World War. Serse was to Fausto what Frank Schleck is to Andy and vice versa today.

As William Fotheringham wrote in Fallen Angel, his biography of Fausto Coppi:

“Any help [Serse Coppi] gave on the road was merely the visible element of a far deeper relationship of co-dependence. He described himself as Fausto’s ‘gregario’ of the mind’: it was his presence that mattered.”

“Fausto was reliant on Serse for psychological support in his lowest moments. The light-hearted Serse acted as a buffer against his inner doubts: it was Serse who kept Fausto racing as the war ended, who made Fausto continue in the 1947 Giro after he, Serse, had gone home due to a crash.

“‘A father figure’ was [journalist from Italian newspaper Corriere della Sera] Orio Vergani’s view of the younger brother, while Dino Buzzati [another Corriere journalist] described Serse as ‘Fausto’s lucky charm, his guardian spirit, a sort of living talisman – a little like the magic lamp without which Aladdin would have remained a forever a beggar.

“It is Serse who really wins because without him Fausto would have fallen apart a hundred times. Neither is capable of living without the other.’”

In that crash at the Giro di Piemonte, one of those who fell was Serse Coppi, who, like all others back then, was not wearing a helmet.

Recalled Nino Defilippis to Fotheringham: “We picked him up. He said he was fine, so we rode into the finish with him. He signed the finish sheet and then we showed him the way to his hotel, because we were local and knew the roads.

“We said goodbye. Not long afterwards he died.”

Fausto Coppi was never the same after his brother’s death. In controversial circumstances, aged 40, ‘il campionissimo’ died less than nine years later.

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29 Nov 2010 10:27 AEST

Anthony

From: Carlton

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I appreciate the concern that Dr Dinh, Anthony Tan and all the willing adherents to paternalism (ie. most of the commenters here) have for the wellbeing of the rest of us outside of SBS Lycra Central, but this is how helmet laws are ruining cycling in Australia: http://www.theage.com.au/victoria/helmet-law-hurting-shared-bike-scheme-20101128-18cf2.html As someone who has used the same scheme in Paris, Lyon & Barcelona (and yes, all of these cities have a lot of traffic as well) it galls me to see how Australia has got it wrong yet again.

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26 Nov 2010 15:37 AEST

Craig

From: Melbourne

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Pfft. Anthony Tan should know better. Every child you care to mention has had (or will have) a buster off a bike when learning to ride. A helmet won't prevent a broken collarbone, or dislocated shoulder, or scabbed knee etc. Nobody has ever convinced me just why Australian cyclists must be lumbered with these knee-jerk laws when the rest of the world seems to get by quite alright without them. There's an awful lot of helmet-less cyclists elsewhere in the world. I ride 200+ klm a week. I wear a helmet. I believe in the freedom of choice in regard to helmets. We have gone past the issue of the efficacy of helmets though. As a population, we have become dulled to the idea that cycling is much more dangerous than it actually is. It must be, I mean you need a helmet to do so right? A pity Anthony Tan couldn't encourage the same emergency room physicians to speak about the rate of head injuries to motor vehicle drivers and passengers. How come they don't get to enjoy compulsory helmet laws too, seeing as their injury rate far outweighs those of cyclists?

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23 Nov 2010 19:17 AEST

waz wallaby

From: newtown sydney

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My wife and I both commute on our pushies, and go for longer rides once or twice on a weekend, then do multi-day rides out in the bush once or twice a year. We figure that with so much saddle time we each have 2 or 3 falls/prangs/stacks/call em what you will a year. And they are caused by whatever; dogs, hitting a bad patch of road, unanticipatable action by drivers, anything...thing is, no head injuries but a range of other injuries...a helmet "makes good, good sense" (AC/DC quote!)

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23 Nov 2010 18:57 AEST

James Davies

From: Newcastle

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I think it is sensible to wear a helmet, however, when helmet laws were introduced there was a significant drop in the number of cyclists. Also despite the number of people cycling we do not have the cycling rate that exists in europe, particularly in Denmark or The Netherlands. These countries also have the safest cycling in the world. It would make sense to copy countries. They dont have compulsory helmet laws.

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23 Nov 2010 18:56 AEST

stan

From: nt

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Listen to the "Sounds of Silence" from our Government, Police, and learned Law Makers.

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21 Nov 2010 20:32 AEST

Fire Dog

From: Port Macca NSW

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I wore a helmet in 1981 when it was terribly "un-fashionable" and have all the years since. In those days I lived in Sydney and a ride down the Princess Highway was a truly scary nightmare(Still is). I still have that old antique "Skid Lid" though it has been long retired. My son at the age of 10 years found the value of a helmet when he had a high speed wobble that stacked him into a curb at the bottom of the hill where we lived here in Port.... The helmet sustained a complete linear fracture and he walked away with only a few scrapes and a headache....

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20 Nov 2010 13:45 AEST

Marc

From: Gympie

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There are a lot of people talking about the helmet laws hurting the bike industry. I really don't think that is the case, at least not anymore. It may have hurt it slightly when the laws were first introduced, but the amount of people riding now is still higher than it was back then, and new bike sales are generally close to, or above, 1 million units per year. That works out to be roughly 1 new bike for every 22 people in australia every year. As I mentioned in my post the other day, I'm in the bike industry, and the helmet laws are well down the list on reasons why people don't ride much in Australia from my experience. At the top of the list are things like laziness, and lack of infrastructure (bikeways, etc). The lack of infrastructure means people have to share the road with cars, and a lot of people simply don't see this as safe (mostly due to the extremely arrogant attitude of motorists that bikes have no right to be on the road), as well as often poorly maintained roads or no shoulders on the road. For this reason you cannot compare the cycling culture in Europe to that of Australia. Helmet laws play very little part in it, it is just the easiest excuse for some people to use to justify their lack of participation (you have to remember that Australians are a lazy bunch). If cycling is to become more of an alternative mode of travel here changing the helmet laws isn't the magic solution. Getting rid of helmet laws won't make the cycling industry suddenly boom. You will hardly see a change. The industry itself won't gain much as what it will gain in bike sales it will lose in helmet sales. To really get cycling taken seriously 2 things have to be addressed. The first is motorists attitude towards cyclists on the road, which will also mean changing the attitude of a lot of arrogant cyclists who have little regard for the road rules. The second thing is the attitude of the general public. They need to stop being so lazy and see the health benefits of cycling, as well as the financial benefits of not having to pay for as much petrol, etc. Ask your friends who don't ride to be honest and tell you which is the biggest reason they don't ride, having to wear a helmet or laziness? You will find that 99% will choose laziness, or some variant of it (don't have time, too busy, etc). If you look at the cycling statistics from before the helmet laws, Australia was still miles behind Europe. The figures were still only down between 1.5% and 2% of people cycling to work, which only dropped by approximately 0.5% to between 1% and 1.5% with the introduction of helmet laws. Hardly high participation rates to start with. Now I'll finish by saying, I'm neither pro helmet, nor anti helmet laws. I'm simply pointing out that anyone thinking that scrapping helmet laws is going to drastically change the way cycling is viewed in this country is dillusional. Scrapping helmet laws would do little to boost cycling participation rates, so please stop using it as a reason to scrap them. Any decision should be based purely from a safety point of view, which in my opinion is an extremely balanced argument with no side having enough data to easily win the debate.

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20 Nov 2010 11:59 AEST

Barry

From: Brisbane

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I cycled in New Zealand last year. Came a cropper at about 25km/h on a greasy 'pick-a-plank' bridge about 1km from a rest stop. Result: much loss of skin and pride, smashed helmet but not even a head-ache. Conclusion: I didn't intend to crash, I wasn't speeding, I had been warned about the bridge, I wasn't expecting it to be so slippery. Lesson learned: wear a helmet, you don't know when you will need it's help.

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20 Nov 2010 0:34 AEST

Karl Melrose

From: Sydney Australia

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A point that hasn't been mentioned yet - If you smash your head into the road at 60km/h it will probably kill you. If you are wearing a helmet when that happens, it probably wont - bottom line, you can argue with the law, the cars, the roads, the motorists and anyone else but the asphalt is impartial, it just stops you - quickly, and it doesn’t care. Motoring safety focuses on speed and concentration because the australian standards for motor vehicle design put motor vehicles on the road that will protect people if they are involved an accident under certain conditions - a significant average deviation from these conditions means that the standard needs to be redesigned. Personally my car has 18 airbags and I haven't once thought about having them deactivated - and I still wear a seatbelt because the notion that a helmet or any device designed to protect you in a crash penalizes you over someone else on the road who hasn’t had an accident is ludicrous. Our bodies aren't designed under an australian standard - we're flesh and blood and the quickest way to kill us (other than slashing an artery) is to hit us in the head really hard - helmets protect us from that. If you have time, look up the army statistic on the difference in mortality rates among soldiers wearing helmets and not wearing them - makes interesting reading, not totally comparable but works for a similar reason - something hitting you in the head really hard is bad for your health - with a helmet, it's more bearable. People die riding bikes, crashes happen, helmets mess up your hair. . Helmets just stop you dying. Personally, I really like being alive, so I wear one - whether I'm on the road or on the trail (where there aren't any cars or roads, just rocks, trees etc - they don’t care either, they just stop me).

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19 Nov 2010 18:22 AEST

David

From: Perth

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When the helmet law was brought in I was strongly against it for a couple of reasons. 1. It was just another law that was going to be widely ignored, just as hundreds of other existing laws are ignored every day. 2. It was about injury prevention rather than crash prevention and nothing was done to modify driver behaviour. Having said that, I always wear a helmet. There are so many ignorant, aggressive, incompetent, unlicensed, uninsured, unregistered, unfit drivers behind the wheel that it's a battlefield out there! If governments were fair dinkum about saving lives then helmets would be compulsory for all car occupants too, because huge numbers of car crash victims die from head injuries. But that wouldn't be a good vote-winner!

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