Abstract
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Helmets protect against minor skull injuries like bruises and lacerations. |
Helmets:
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Some politicians claim “Helmets save lives“.
Is this true? CRAG has asked for evidence, but the government has been unable to provide any.
Even helmet salespeople do not make such claims. After being asked
“Can your helmet save your life?“,
a helmet salesperson shrugged and laughed uncomfortably, before responding
“Can it?” “Well, not save your life, no.“
What is it that politicians know that helmet salespeople don’t?
What protection do helmets provide?
A bicycle helmet is a piece of polystyrene covered by a layer of plastic less than 1mm thick.
It can protect in a minor accident. However, it is not designed to protect in a serious accident.
Bicycle helmets are a piece of styrofoam designed to protect in minor impacts:
“In cases of high impact, such as most crashes that involve a motor vehicle, the initial forces absorbed by a cycle helmet before breaking are only a small part of the total force and the protection provided by a helmet is likely to be minimal in this context. In cases where serious injury is likely, the impact energy potentials are commonly of a level that would overwhelm even Grand Prix motor racing helmets. Cycle helmets provide best protection in situations involving simple, low-speed falls with no other party involved. They are unlikely to offer adequate protection in life-threatening situations.“
In serious accidents, they tend to disintegrate on impact, absorbing little energy. This crumbling is what many people mistake the helmet for as having saved their life:
“The next time you see a broken helmet, suspend belief and do the most basic check – disregard the breakages and look to see if what’s left of the styrofoam has compressed. If it hasn’t, you can be reasonably sure that it hasn’t saved anyone’s life.“
Dr Carwyn Hooper from St George’s University in London reports:
“Looking at evidence, it does not matter if people are wearing a helmet or not, any serious accident on a bike is likely to kill them,”
Bicycle helmets protect against bruises and minor lacerations.
Yet, cycling injuries tripled after Australia introduced a helmet law.
The rate of cycling injuries tripled after Australia introduced a helmet law.
How can the widespread wearing of helmets increase the risk of injuries?
Although helmets protect, they can also increase the risk of accidents.
Increase risk of accidents
A false sense of safety can induce people to take more risks, leading to more accidents and more injuries. This is risk compensation, a well-known safety factor:
“the law of unintended consequences is extraordinarily applicable when talking about safety innovations. Sometimes things intended to make us safer may not make any improvement at all to our overall safety”
Risk compensation is the tendency to take more risks when wearing safety equipment.
Wearing a helmet can induce cyclists to take more risks. This can lead to permanent disability, as reported in the New York Times:
“the rate of head injuries per active cyclist has increased 51 percent just as bicycle helmets have become widespread. …
the increased use of bike helmets may have had an unintended consequence: riders may feel an inflated sense of security and take more risks. …
The helmet he was wearing did not protect his neck; he was paralyzed from the neck down. …
”It didn’t cross my mind that this could happen,” said Philip, now 17.
”I definitely felt safe. I wouldn’t do something like that without a helmet.” ”
Safety experts recognise the role of risk compensation. From the New York Times article:
”People tend to engage in risky behavior when they are protected,” he said. ”It’s a ubiquitous human trait.”
Even cyclists who discount the daredevil effect admit that they may ride faster on more dangerous streets when they are wearing their helmets.
A 1989 study found that helmet wearers were 7 times more likely to have accidents.
Risk compensation also affects motorists who tend to be less careful around helmeted cyclists. As reported in a study published by the University of Bath in the UK:
“Bicyclists who wear protective helmets are more likely to be struck by passing vehicles”
Children are affected by risk compensation, as reported in Accident Analysis and Prevention :
“Results indicated that children went more quickly and behaved more recklessly when wearing safety gear than when not wearing gear, providing evidence of risk compensation.”
Helmets encourage people to ride faster, as reported by the Risk Analysis international journal:
“those who use helmets routinely perceive reduced risk when wearing a helmet, and compensate by cycling faster”
The severity of injuries is much higher at higher speeds.
Many people believe that helmets protect against brain injury. Do they?
What causes brain injury?
In 1960, people believed that brain injury was due to linear acceleration, from the head hitting a wall for example. This belief has shaped the design of bicycle helmets.
Since, scientific research has shown that the main cause of brain injury is diffuse injury, caused by the head turning quickly. The skull may be intact, but there can severe internal brain injury. This article reports from a surgeon who operates on cyclists:
” “The ones with brain swelling, that’s diffuse axonal injury, and that’s bad news” …
the whole brain is shaken up, creating many little tears in its inner structure …
Such patients undergo personality change, can contract epilepsy and have difficulty controlling their anger. They might become unemployable. Depression is a common accompaniment to brain injury. Rosenfeld sees patients’ families shattered, too. “They’re never the same. It often leads to marriage disharmony and family breakdown.” …
Rosenfeld’s opinion is candid. “I don’t know if [helmets] do much to protect the inner part of the brain,” “
Helmets can increase brain injury, according to this research:
“The non-shell helmet did in all trials grab the asphalt surface, which rotated the head together with
the helmet. The consequences were in addition to the rotating of the head, a heavily bent and compressed neck, transmitted on through the whole test dummy body after the impact. …This gives an average angular acceleration of 20800 rad/s² for rotating the head from 0 to 0.26 rad during the 5 ms. Löwenhielm proposes 4500 rad/s² to be the maximum angular acceleration that can be tolerated for a limited time period”
Helmets amplified rotational acceleration to four times higher than the tolerable maximum.
On impact, the larger head volume amplifies rotational acceleration. A 3cm increase in helmet circumference increases rotational acceleration by 150%:
“the 3000rad/s² to 8500rad/s² measured during abrasive and projection oblique tests with size 54cm (E) helmeted headforms. However, for the most severe cases using a size 57cm (J) headform, rotational acceleration was typically greater than 10,000rad/s² and increased to levels of 20,000rad/s², a level at which a 35% – 50% risk of serious AIS3+ injuries is anticipated.”
The difference between a helmeted and non-helmeted head is about 20cm.
Increase risk of the head hitting the road
In the event of an accident, helmets increase the risk of the head hitting the road. Helmets increase the volume/size of contact area of the head. Helmeted riders are more than twice as likely to hit their head in an accident, with more impacts to the sides. Post-crash studies found that most helmets show impacts to the side,where a bare head is protected by the shoulders.
A 1988 study reports that helmeted riders hit their heads seven times more often than un-helmeted riders.
Helmets are not suitable for children’s more deformable head
In 1987, the Federal Office of Road Safety published research on helmets. This research highlighted serious deficiencies with bicycle helmets:
“The substantial elastic deformation of the child head that can occur during impact can result in quite extensive diffuse brain damage. It is quite apparent that the liner material in children’s bicycle helmets is far too stiff …
rotational accelerations were found to be 30% higher than those found in similar tests using a full face polymer motorcycle helmet. More work needs to be done in this area as there would seem to be a deficiency in rotational acceleration attenuation that may be the result of insufficient shell stiffness. “
Bicycle helmets helmets are designed for adult heads. They are too stiff for children more deformable heads. Despite this, helmets are promoted as “protecting” children, without appropriate warnings.
Helmets are associated with more severe brain injuries
A New Zealand doctor reports:
“cycle helmets were turning what would have been focal head injuries, perhaps with an associated skull fracture, into much more debilitating global head injuries”
In Canada, the length of stay in hospital increased increased following helmet laws, from 4.3 days to 6.9 days. The number of serious head injury admissions increased by 46%.
Do helmets provide a net safety benefit?
Bicycle helmets are a safety trade-off. They protect the skull against bruises and lacerations. But they increase the risk of accidents and can increase brain injury.
Evidence provided in court suggests that helmets provide limited protection.:
“So in at least one case now, a High Court has decided that the balance of probability was, in the matter before the Court, that a cycle helmet would not have prevented the injuries sustained when the accident involved simply falling from a cycle onto a flat surface, with barely any forward momentum. …
the QC … repeatedly tried to persuade the neurosurgeons … to state that one must be more safe wearing a helmet than would be the case if one were not. All three refused to do so, claiming that they had seen severe brain damage and fatal injury both with and without cycle helmets“
A recent meta-analysis of helmets effectiveness reports reports no net beneficial effect. They do not protect against facial injuries, and increase neck injuries.
The belief that helmets can only improve safety may be a myth:
“Bicycle helmets might not protect cyclists much at all. And, in fact, in some cases, they might actually be more dangerous than going lidless. …
head injuries had increased even though the use of helmets had skyrocketed throughout the 1990s. The risk of injury per cyclist had gone up by 51%. …
“We don’t know what’s going on,” said one political appointee who should know. Well, I’ll offer my idea. People accepted the idea that helmets work, and then created studies to “prove” that they do. “
We do not know whether helmets provide a net safety benefit. We do know that injuries have increased after a helmet law was imposed in Australia. The risk of death & serious injury increased by 50% for child cyclists.
The UK’s National Children’s Bureau provided a detailed review of cycling and helmets in 2005:
“The conclusion from the arguments outlined above is that the case for cycle helmets is far from, sound. The strong claims of injury reduction made by helmet proponents have not been borne out for fatalities (which this paper argues is the most methodologically sound test of effectiveness) in real-life settings with large populations. …
the benefits of helmets need further investigation before even a policy supporting promotion can be unequivocally supported. ….
The cycle helmet debate shows the dramatic power of real life events in shaping our understanding of causality. Tragedies happen; child cyclists are killed or left disabled for life; and we cannot let go of the belief that something
could and should have been done to stop that particular event from happening – especially when that something is so simple as wearing a helmet. We find it hard to accept that the helmet may have made no difference. We find it harder to accept that encouraging or forcing children to wear helmets might also encourage them to ride in a more dangerous way and paradoxically to increase the risk that they will suffer an accident. And we find it much harder to accept that compulsory helmet use might put children off cycling altogether, leaving them less physically active, and – many years later – more likely to die of heart disease.Think of all the uncertainty behind that line of argument, compared with the seeming rock-solid conviction that a helmet could have saved that particular child’s life, at that particular time. And of course the fact that we are talking about children, who have a claim on our protection and who are still getting to grips with the world, makes it so much more difficult to accept the limitations on our ability to prevent them coming to harm. We cannot ignore the human suffering, pain and loss that lie behind the research and statistics. But our response to it demands reflection and perspective as well as sympathy and conviction.“
Is it worth to increase the risk of brain injury to mitigate minor skull injuries? An Australian cyclist challenged a helmet fine as helmets can increase brain injury. After reviewing evidence in a court of law, NSW District Court Judge Roy Ellis concluded:
“”Having read all the material, I think I would fall down on your side of the ledger …
I frankly don’t think there is anything advantageous and there may well be a disadvantage in situations to have a helmet and it seems to me that it’s one of those areas where it ought to be a matter of choice.”
What about the studies that claim that helmets protect against 80% of head injuries?
There have been many “studies” claiming that helmets protect against brain injuries. The most famous one was done by helmet lobbyists and funded by the helmet industry. This “study” had methodological errors. It was the basis for a US government claim that helmets reduce 85% of head injuries. The US government has since dropped this claim.
Many studies assume that helmets are effective and attempt to “prove” it. Such studies jump to a predetermined conclusion, with a disturbing lack of scientific discipline. Often the claims are contradicted by the study’s own data.
Governments who enacted helmet law have funded policy-driven studies defending their policy. Such “studies” use biased statistics, resulting in misleading claims. Bill Curnow, a scientist from the CSIRO, wrote as a conclusion of a scientific article:
“Compulsion to wear a bicycle helmet is detrimental to public health in Australia but, to maintain the status quo, authorities have obfuscated evidence that shows this.”
In 2000, a government agency published a meta-analysis, that claimed to provide
“overwhelming evidence in support of helmets for preventing head injury and fatal injury“.
This study was re-assessed by an independent researcher who concluded:
“This paper … was influenced by publication bias and time-trend bias that was not controlled for. As a result, the analysis reported inflated estimates of the effects of bicycle helmets …
According to the new studies, no overall effect of bicycle helmets could be found when injuries to head, face or neck are considered as a whole“
After attempts to justify its policy through misleading “studies”, and following CRAG submission to the Prime Minister in 2009, the federal government abandoned its compulsory helmets policy.