The CycleChat Helmet Debate Thread

[Racing roadkill]

After my accident I was subject to a bit of state telling off.

Firstly the police accident form actually had a question on whether you were wearing a helmet, which seemed a bit beyond the remit of the police.

Then I went to Minor Injuries and got a telling off from the nurse about not wearing a helmet.

Frustrating when even the NHS website quotes the BMJ saying helmets make sod all difference. But hey, why have anything evidence based.

Bit of a selective reading problem regarding what the BMJ actually say about helmets there. To paraphrase, they pretty much say, in a serious accident, the helmet's efficacy is hard to judge, if there are other serious injuries to the rider, which result in life changing injuries or death. Or to put it another way, the corpses of the helmeted riders may be pretty beaten up, but they didn't, suffer the degree of head injury of the helmetless corpses.

 

[KnackeredBike]

Bit of a selective reading problem regarding what the BMJ actually say about helmets there. To paraphrase, they pretty much say, in a serious accident, the helmet's efficacy is hard to judge, if there are other serious injuries to the rider, which result in life changing injuries or death. Or to put it another way, the corpses of the helmeted riders may be pretty beaten up, but they didn't, suffer the degree of head injury of the helmetless corpses.

Actually it's a much simpler point. When helmet use increases or decreases the number of KSIs stay the same. There are likely to be a multitude of causes but in reality you probably decrease your risk of a KSI much more in other ways, such as good road positioning, compared to helmets.

My observation from shifts in A&E is that serious injuries are usually caused by collision with a vehicle, and by the head being rotated on impact rather than the impact itself. It's much better to avoid those impacts than try to mitigate them with PPE.

 

[benb]

I've said it many times, but IMO the best explanation for the fact that any protective effect of helmets is undetectable in the data, is that:
1. Cycling is fairly safe. The risk of any kind of crash whilst "normal" cycling is low
2. Therefore the risk of a crash involving a head injury is even lower
3. Therefore the probability of having an incident where a helmet would make the difference between a serious injury and a slight one, or between death and "only" a serious injury, being a subset of already very unlikely #2, is so vanishingly unlikely that any protective effect is not statistically significant.

That is, there are probably some situations where a helmet will help prevent injury (I'm not talking about minor cuts, scrapes and bruises here, which obviously helmets will help to prevent, but so what?) but such an event is extremely rare. So rare in fact that it's not worth taking any measure to mitigate. There are lots of activities with a similar (low) risk of head injury that it would appear absurd to wear a helmet to mitigate (DIY!) and cycling is the same. Widespread helmet use will not help reduce cyclist KSIs, and will not even significantly reduce an individual's risk of serious head injury.

 

[ufkacbln]

The BMA is not the best example of good practice when it comes to cycle helmets

A few years ago there was a debate at the annual conference that one of my colleagues attended and was concerned about how the "support" was established

Firstly the "debate" was shortened allowing all the pro support evidenced to be heard, but insufficient time for the anti-support to give evidence

It was then the only debate that was voted by a "show of hands" as opposed to electronic voting, and according to witnesses appeared very close, but the brief manual count came out in favour of support


Yet again raising the question common to most pro-helmet lobbies.

If it is really clear that helmets were something the BMA supported, why stage manage the vote and debate to engineer the outcome

 

[ufkacbln]

Bit of a selective reading problem regarding what the BMJ actually say about helmets there. To paraphrase, they pretty much say, in a serious accident, the helmet's efficacy is hard to judge, if there are other serious injuries to the rider, which result in life changing injuries or death. Or to put it another way, the corpses of the helmeted riders may be pretty beaten up, but they didn't, suffer the degree of head injury of the helmetless corpses.

The same BMJ that published that in terms of head injury pedestrians and people on stairs are at greater risk of head injury than cyclists?

Shouldn't we be acting on this ?

 

[velovoice]

I've said it many times, but IMO the best explanation for the fact that any protective effect of helmets is undetectable in the data, is that:
1. Cycling is fairly safe. The risk of any kind of crash whilst "normal" cycling is low
2. Therefore the risk of a crash involving a head injury is even lower
3. Therefore the probability of having an incident where a helmet would make the difference between a serious injury and a slight one, or between death and "only" a serious injury, being a subset of already very unlikely #2, is so vanishingly unlikely that any protective effect is not statistically significant.

That is, there are probably some situations where a helmet will help prevent injury (I'm not talking about minor cuts, scrapes and bruises here, which obviously helmets will help to prevent, but so what?) but such an event is extremely rare. So rare in fact that it's not worth taking any measure to mitigate. There are lots of activities with a similar (low) risk of head injury that it would appear absurd to wear a helmet to mitigate (DIY!) and cycling is the same. Widespread helmet use will not help reduce cyclist KSIs, and will not even significantly reduce an individual's risk of serious head injury.

That's pretty much my take, as well. The question is, why does society deem it "necessary" (or even advisory) for people riding bikes to wear helmets but not anyone engaging in other activities such as, as you say, DIY? Or negotiating stairs? Or riding as a passenger in a car? It's society's judgement that is so baffling and, for us people on bikes, dangerous in terms of the vitriol and hostility so often directed towards us.

 

[jefmcg]

Sorry you were injured, and i hope you have recovered well.

Frustrating when even the NHS website quotes the BMJ saying helmets make sod all difference. But hey, why have anything evidence based.

I don't care if my nurse isn't familiar with evidence based studies on cycle accidents, as long as he follows closely NHS care guidelines, and that they are evidence based. If he says something that is incorrect, but doesn't effect my care, I am ok with that. Most nurses don't have a lot of spare time for researching risk factors.

I'm also ok with the police collecting data, because that could provide researchers with evidence on helmet safety. If we don't collect that data, how can we know?

 

[Racing roadkill]

That's pretty much my take, as well. The question is, why does society deem it "necessary" (or even advisory) for people riding bikes to wear helmets but not anyone engaging in other activities such as, as you say, DIY? Or negotiating stairs? Or riding as a passenger in a car? It's society's judgement that is so baffling and, for us people on bikes, dangerous in terms of the vitriol and hostility so often directed towards us.

It's probably more to do with the problem of secondary involvement. A DIY accident, or falling down the stairs is more likely to be a solo effort , "it was his own fault", etc etc etc. The bicycle related incidents, that are perceived to be in the majority, for the purposes of helmet debating, involve other people, and therefore the argument is becoming more about social responsibility, reducing the undoubted mental traumas inflicted on others / risk mitigation from an insurance standpoint.

 

[ufkacbln]

That's pretty much my take, as well. The question is, why does society deem it "necessary" (or even advisory) for people riding bikes to wear helmets but not anyone engaging in other activities such as, as you say, DIY? Or negotiating stairs? Or riding as a passenger in a car? It's society's judgement that is so baffling and, for us people on bikes, dangerous in terms of the vitriol and hostility so often directed towards us.

There is not a multi Billion pound industry with a vested interest in making pedestrians, people on stairs, and passengers in cars responsible for the injuries inflicted by that industry's users

 

[ufkacbln]

Sorry you were injured, and i hope you have recovered well.

I don't care if my nurse isn't familiar with evidence based studies on cycle accidents, as long as he follows closely NHS care guidelines, and that they are evidence based. If he says something that is incorrect, but doesn't effect my care, I am ok with that. Most nurses don't have a lot of spare time for researching risk factors.

I'm also ok with the police collecting data, because that could provide researchers with evidence on helmet safety. If we don't collect that data, how can we know?

My problem is they only collect selected data......

It is like looking at wrist fractures............. but only actually collecting data on those who are left handed, wearing odd shoes and standing one legged at the time of the injury, then putting their fingers in their ears and singing LALALALALA when anyone points out that the data on majority of these with wrist fractures is being ignored

I would have no problem if the data was collected properly and all head injuries looked at, however that is not the case

In fact independent Cohort Studies that DO look at all head injuries unequivocally do not show cycling as one of the major causes

 

[benb]

Also, it's hardly ever conceded, but must obviously be the case that wearing helmets must result in some impacts that would not have occurred if the rider had not been wearing one.

 

[martint235]

It's probably more to do with the problem of secondary involvement. A DIY accident, or falling down the stairs is more likely to be a solo effort , "it was his own fault", etc etc etc. The bicycle related incidents, that are perceived to be in the majority, for the purposes of helmet debating, involve other people, and therefore the argument is becoming more about social responsibility, reducing the undoubted mental traumas inflicted on others / risk mitigation from an insurance standpoint.

So I should wear a helmet so that the person with no control of their vehicle feels less bad about causing the accident? Or have I misunderstood what you are referring to by mental trauma?

 

[Racing roadkill]

So I should wear a helmet so that the person with no control of their vehicle feels less bad about causing the accident? Or have I misunderstood what you are referring to by mental trauma?

I'd be more concerned about the other people's insurance company's attitude.

 

[Racing roadkill]

My problem is they only collect selected data......

It is like looking at wrist fractures............. but only actually collecting data on those who are left handed, wearing odd shoes and standing one legged at the time of the injury, then putting their fingers in their ears and singing LALALALALA when anyone points out that the data on majority of these with wrist fractures is being ignored

I would have no problem if the data was collected properly and all head injuries looked at, however that is not the case

In fact independent Cohort Studies that DO look at all head injuries unequivocally do not show cycling as one of the major causes

Well said, but you have to look at the fact that the proportion of bicycle riding, in situations where the head injuries occur is relatively low anyway, so the fact that the actual number of bicycle accidents / recordable head injury, is not that high, in comparison to the number of other situations that result in the head injury. That coupled with the fact that no one is willing to front the cash to enable the scientific studies required, leaves the whole thing a bit messy from a numbers / stats point of view. For example, if a cyclist is in a big accident and they wear a lid, they injure all sorts of things, but they don't sustain a head injury, it's unlikely that anyone records the injury they didn't suffer, over the injuries they did suffer. Also, there are so many things that have happened to me, whilst riding a bike, with a lid ( which I actually don't always, dependent on my assessment of the likely risks I face on the ride), which ( in my opinion) would have had a very different outcome, if they had happened without the presence of the lid, makes me think.

 

[Racing roadkill]

I've had situations where I've been hit square on the section of my forehead, protected by a lid, flicked up off of the road, by ( for example) a truck coming in the opposite direction. These were substantial impacts, which ( I believe) would have at least stunned me momentarily, without the lid being there. Now suppose, the stunning had resulted in me wobbling under the truck's trailer. Chances are I wouldn't get away with it, but the injuries would have been recorded in such a way, as to not be overly concerned as to whether I was wearing a lid or not, they certainly wouldn't record notes to the effect, that a lid would have prevented the accident, because they wouldn't have realised that going under the truck, was a secondary incident, caused by a primary incident, which ( in my opinion) would have been negated, by the lid, and they would only have seen the result of the secondary incident, which "a helmet couldn't have helped in". Because the lid took the sting out of the initial incident, I didn't have the serious secondary incident. No one records the avoidance of the big incident, because the lid prevented it, why would they?