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Head
injuries rising despite bike helmets
Some
say gear crates daredevil effect; others blame drivers,
riders' road skills
By Julian E. Barnes, New
York Times News Service | July 29, 2001
- Millions of parents take it as an article of faith
that putting a bicycle helmet on their children, or
themselves, will help keep them out of harm's way.
-
- But new data raise questions about that assumption.
The number of head injuries sustained in bicycle
accidents has increased 10 percent since 1991, even as
helmet use has risen sharply, according to figures
compiled by the Consumer Product Safety Commission.
With ridership declining over the same period, the
rate of head injuries among bicyclists has increased 51
percent even as the use of bicycle helmets has become
widespread.
-
- What is going on here? No one is very sure, but
safety experts stress that while helmets do not prevent
accidents, they are extremely effective at reducing the
severity of head injuries when they do occur. Almost no
one suggests that riders should stop wearing helmets,
which researchers have found can reduce the severity of
brain injuries by as much as 88 percent.
-
- Still, with fewer people riding bicycles, experts are
mystified as to why injuries are on the rise. "It's
puzzling to me that we can't find the benefit of bike
helmets here," said Ronald L. Medford, the assistant
executive director of the safety commission's hazard
identification office.
-
- Some cycling advocates say that rising numbers of
aggressive drivers are at fault, while others suggest
that many riders wear helmets improperly and do not know
the rules of the road. Some transportation engineers say
there are not enough safe places to ride.
-
- Specialists in risk analysis argue that something
else is in play. They believe that the increased use of
bike helmets may have had an unintended consequence:
Riders may feel an inflated sense of security and take
more risks.
-
- In August 1999, Philip Dunham, then 15, was riding
his mountain bike in the Great Smoky Mountains National
Park in North Carolina and went over a jump on a trail.
As he did, his back tire kicked up, the bike flipped over
and he landed on his head. The helmet he was wearing did
not protect his neck; he was paralyzed from the neck
down.
-
- Two years later, Philip has regained enough movement
and strength in his arms to use a manual wheelchair. He
has also gained some perspective. With the helmet he felt
protected enough to ride off-road on a challenging trail,
in hindsight perhaps too safe.
-
- "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."
-
- In the last nine years, 19 state legislatures have
passed mandatory helmet laws. Today, such statutes cover
49 percent of American children under 15. And even some
professionals have embraced helmets. While a majority of
the riders in the Tour de France have worn helmets
infrequently, Lance Armstrong, the American cyclist
favored to win the race on Sunday, wore a helmet through
most of the race.
-
- Texas has no bicycle helmet law, but many cities have
ordinances regulating the use of helmets, especially
among children.
-
- About half of all riders use bike helmets, compared
with fewer than 18 percent a decade ago, the first year
the safety commission examined helmet use.
-
- During the same period, overall bicycle use has
declined about 21 percent as participation in in-line
skating, skateboarding and other sports has increased,
according to the National Sporting Goods Association,
which conducts an annual survey of participation in
different sports. Off-road mountain biking is often
considered more risky than ordinary bicycling, but it is
unlikely to account for the recent increase in
bicyclists' head injuries. Participation in off-road
mountain biking has declined 18 percent since 1998, the
association said.
-
- Even so, bicyclists suffered 73,750 head injuries
last year, compared with 66,820 in 1991, according to the
safety commission's national injury surveillance system,
with the sharpest increase coming in the last three
years. Children's head injuries declined until the
mid-1990s, but they have risen sharply since then and now
stand near their 1991 levels even with fewer children
riding bikes.
-
- The safety commission is now investigating why head
injuries have been increasing. Officials hope that by
examining emergency room reports more closely and
interviewing crash victims, they can find out if more of
the injuries are relatively minor and how many people
suffered head injuries while wearing helmets. Some
bicycling advocates have questioned the statistics on
participation in bicycling, and the commission plans to
re-examine those as well.
-
- Dr. Richard A. Schieber, a childhood-injury
prevention specialist at the Centers for Disease Control
and Prevention and the leader of a national bicycle
safety initiative, said public health officials were
realizing that in addition to promoting helmet use,
safety officials must teach good riding skills, promote
good driving practices and create safer places for people
to ride.
-
- "We have moved the conversation from bicycle helmet
use to bicycle safety," Dr. Schieber said. "Thank God
that the public health world is understanding there is
more to bicycle safety than helmets."
-
- Promoting bicycle helmets without teaching riders
about traffic laws or safe riding practices can encourage
a false sense of security, according to several risk
experts. Helmets may create a sort of daredevil effect,
making cyclists feel so safe that they ride faster and
take more chances, said Dr. Mayer Hillman, a senior
fellow emeritus at the Policy Studies Institute in
London.
-
- One parallel, risk experts said, is anti-lock brakes.
When they were introduced in the 1980s, they were
supposed to reduce accidents, but government and industry
studies in the mid-1990s showed that as drivers realized
their brakes were more effective, they started driving
faster, and some accident rates rose.
-
- Even cyclists who discount the daredevil effect admit
that they may ride faster on more dangerous streets when
they are wearing their helmets.
-
- On May 5, Noah Budnick, a 24-year-old New York
resident, was wearing a helmet and cycling on Avenue B in
Manhattan when he had to pull out from the side of the
street to avoid a double-parked car and a taxicab idling
behind it. As he moved to the left, the cab pulled out,
striking Mr. Budnick. He broke his fall with his hands
and did not hit his head on the ground, but the accident
left him with a deep cut on his leg and a badly strained
knee.
-
- Although the cab was at fault for the accident, Mr.
Budnick said, if he had been riding more slowly he might
not have had the accident.
-
- "I probably would have ridden more cautiously and
less aggressively without the helmet," he said. "I don't
know if I would ride in Manhattan at the speed I was
going."
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- Still, many cycling advocates contend that it is not
bicyclists but drivers who are more reckless.
Distractions like cell phones have made drivers less
attentive, they say, and congestion is making roads more
dangerous for cyclists. They also believe that some
drivers of sport utility vehicles and other trucks simply
drive too close to cyclists.
-
- It is difficult to show statistically that drivers
have become more reckless in the last decade. The
percentage of fatal bicycle accidents that involved cars
has declined, falling from 87 percent in 1991 to 83
percent in 1998, according to the CDC.
-
- Thom Parks, a vice president in charge of safety for
the helmet maker Bell Sports, said safety standards could
be upgraded and helmets could be designed to meet them.
But that would make helmets heavier, bulkier and less
comfortable. "There are limits to what a consumer would
accept," Mr. Parks said, adding that if helmets became
bigger, fewer people might wear them.
-
- But the most effective way to reduce severe head
injuries may be to decrease the number of accidents in
the first place.
-
- "Over the past several decades, society has come to
equate safety with helmets," said Charles Komanoff, the
co-founder of Right of Way, an organization that promotes
the rights of cyclists and pedestrians. "But wearing a
helmet does not prevent crashes."
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