Putting a lid on it

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

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and cycling advocate, clinical associate professor Chris Rissel from the University of Sydney, argued helmet laws be repealed on the basis that, "there is little evidence to support the view that there was a drop in head injuries as a result of the helmet legislation."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