More risk? Safety engineer slams proposed helmet law

With the city on the verge of passing a new law that will require bike riders ages 14 and under to wear helmets, most bike safety enthusiasts are applauding, citing research that shows helmets can reduce the incidence of head injuries by 85 percent. One longtime bike rider, however, says the proposed law is misguided, based on outdated research, and could actually lead to a greater number of the most serious injuries.

"It is ludicrous to mandate helmet usage," says J. Tyler Ballance, a Henrico County resident who frequently visits Charlottesville to bike ride. "If safety were the real concern, then the Council might be mandating pedestrian helmets, or banning cars."

While it might seem blasphemous to oppose one of the most widely accepted safety devices and one that purportedly saves the lives of children, Ballance says the supporting research is outdated, and he cites new research to back his position.

A Safety Officer in the Navy for more than two decades, Ballance is a member of the American Society of Safety Engineers. He's also an avid bicycle racer and a father who says the statistics for helmets and safety are hardly as clear as some would like to believe, especially when it comes to child riders.

"Some research has demonstrated the potential for the helmet to 'dig-in' on impact," Ballance told City Council in an email before its most recent meeting. That "dig-in," Ballance told Councilors, actually increases the risk of paralysis.

Ruth Stornetta isn't buying such claims. An ordinance supporter, as well as a UVA neuroscientist and coach of the UVA club bicycling team, Stornetta refers to the "overwhelming evidence published in peer-reviewed journals that helmets do decrease risk of brain injury when you fall."

"I've ridden in excess of 50,000 miles," says Stornetta, recalling three falls in which she hit her head. "If I hadn't been wearing a helmet, I wouldn't be here."

City resident Mac Lafferty, an engineer and cycling instructor, appeared in Council Chambers to back the ordinance by citing statistics showing that bike injuries are more prevalent than football injuries with 314,000 hospitalized– more than half with traumatic brain injuries.

There have been at least four fatalities stemming from bike-car collisions in the Charlottesville-Albemarle area in the past 20 years. Most recent was the 2010 death of UVA grad student Matt King. Last April, King was allegedly passing cars along West Main Street when he pedaled into a city wastewater truck as it turned right. King was wearing a helmet; the driver in that accident was cleared.

While helmets can't save every life, Lafferty asserts they're a step in a safer direction.

"I know of no organized biking event that does not require a helmet on every rider," Lafferty told Council. "If you don't wear a helmet, you don't ride."

So how did Ballance unbalance the debate? Recent studies in peer-reviewed journals appear to support his claims.

In January, the journal Accident Analysis and Prevention published work by Norwegian researcher Rune Elvik slamming the 1989 study that launched the widely-quoted 85 percent injury-reduction statistic, asserting that helmets increase the risk of neck injury, and offer no net protective benefit.

In March, a study in Risk Analysis suggests that helmets encourage riskier riding (and deter some people from this eco-friendly sport/commute). And in Australia last year, a woman ticketed for helmetlessness won her case when the judge, according to the Sydney Morning Herald, agreed with the defendant, saying, "I frankly don't think there is anything advantageous, and there may well be a disadvantage in situations to have a helmet."

Ballance says his anti-ordinance position should not be misinterpreted as being anti-helmet. He says there are situations when helmets make sense for children and adults such as in high-speed racing and when pedaling along busy roads.

But for the average child rider, cruising around a cul-de-sac or along a paved trail like the Rivanna Greenbelt, the notion of enforced helmet wearing makes no sense, says Ballance.

"Why would a city government," he asks, "want to impose something like a helmet law without having a solid foundation based on fact?"

The research that has motivated Ballance may not sway Charlottesville leaders, who got the ordinance idea from their own Bicycle and Pedestrian Safety Committee. Councilor Kristin Szakos replied to Ballance by mentioning that helmet use has been supported by such renowned organizations as the Centers for Disease Control and Prevention, and she noted that a childhood friend's bike-borne quadriplegia weighs heavily on her mind.

"It's not that children are terribly likely to hit their heads while riding," Szakos asserts, "but that the injuries can be so catastrophic if they do."

At the May 16 hearing, the Councilors expressed support for the ordinance as long as ticketed children can get their $25 ticket waived– or receive a free helmet. They directed City Manager Maurice Jones to explore the practicality of buying a trove of helmets and plan to take their vote on June 6.

“The goal of this," said Councilor Holly Edwards, "is to improve the safety of our children."

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Why kids and not all riders? Because city council doesn't trust parents to provide proper safety guidance to their children? Because it's easier to impose rules on children rather than adults because children don't vote?

Right or wrong, and I haven't done enough research to confirm or refute the various contradictory studies cited, I oppose laws written to only apply to a disenfranchised group.

We require seat belts in cars, so why not helmets? They can hit their heads just as easily on the curb of a cul de sac or a rock on a trail. To me it is a no-brainer - pardon the pun!

Q: "Why would a city government," he asks, "want to impose something like a helmet law without having a solid foundation based on fact?"

A: Why would they want to base this decision on facts? It might set a precedent that they would feel inclined to follow...

I would like to see stronger enforcement of current biking laws rather than continuing to create new ordinances. I have yet to see an officer of the law stop a bicyclist for running a red light or stop sign. Along the West Main corridor you can see alot of biking violations. No enforcement whatsoever....

"If safety were the real concern, then the Council might be mandating pedestrian helmets, or banning cars."

Or, better yet -- banning bicyclists on roads.

What sort of cretin would deny that wearing protection on your head would prevent damage to your head, especially on impact with a hard surface going 25+ miles per hour in almost any case? It takes a special sort of mouth breather to make the City Councilors look smart by comparison.

Cruncher, you must be some sort of nanny state coward that wants to dictate how other people live their lives if you think there is any merit to having a helmet law.

Is that you JennSilv? That sound I was hearing must be you getting fatter.

Also I don't remember saying anything about laws, just that saying it's common sense that putting something on your head protects your head. Shouldn't be against the law for anyone to do something stupid, like for instance you cramming a box of Ho Hos down your trap.

Yeah, who needs peer reviewed scientific papers when one could just ask the all knowing Cruncher with his world famous "mind worthy of a high schooler" what he thinks? I know the analysis presented in the papers cited above probably baffles and confuses you, being that it requires what amounts to rudimentary critical thinking, but until you can respond to some of the points raised in the articles cited, points that dispute your gut level feeling that "it's common sense that putting something on your head protects your head," then you are merely continuing to make yourself look like a fool by responding.

You're obviously in favor of the law, since you didn't call it stupid, boneheaded, fat, or refer to it as the product of "latte liberals," which so far have proven to be the only responses you are capable of when you encounter something you dislike, fear, or are incapable of understanding.

Nice try with the insults. You don't know how far from the truth it is. But my response to a sad little boy with a limp uhmm... "richard" would be the same whether he tried charm or insults. It's something we used to say when I was in high school, so I'm sure you'll understand. "You ain't never gonna smell it.... little boy."

Fat (you).

I grew up riding. I ride for fun and for work. I rode to and from work in the commute rush for a few years. I have been hit a couple times, once severe when I was 13. I have fallen off of the shoulder into traffic.
I always wear my helmet because it is a habit I learned when I was forced to do so as a child. A lot of statistics, and links to the studies that they come from. Some for helmet use, some against, some indifferent. No matter the outcome of studies and whether the ordinance gets passed, I don't see CPD actually enforcing it.

Yes, we should ban bicycles. Makes complete sense. Let's ban loud music, holding hands in public, and letting women vote while we are it.

The noose is tightening a little more each day. How about governing the city and not the people?

If I had been involved in 3 bicycle crashes in which a helmet saved my life.....

...... I think it's time that I stop riding a bicycle!

Actually it's the pavement that most often causes injuries, so let's ban pavement.

JennSilv, that is the best response to Cruncher I've read yet!

Bicycle helmet efficacy: a meta-analysis
R. G. Attewell, , a, K. Glasea and M. McFaddenb
a Covance Pty Ltd, PO Box 64, Ainslie, ACT 2602, Australia
b Australian Transport Safety Bureau, PO Box 967, Canberra, ACT 2608, Australia
Received 6 December 1999; accepted 31 March 2000 Available online 5 February 2001.
Bicycle helmet efficacy was quantified using a formal meta-analytic approach based on peer-reviewed studies. Only those studies with individual injury and helmet use data were included. Based on studies from several countries published in the period 1987–1998, the summary odds ratio estimate for efficacy is 0.40 (95% confidence interval 0.29, 0.55) for head injury, 0.42 (0.26, 0.67) for brain injury, 0.53 (0.39, 0.73) for facial injury and 0.27 (0.10, 0.71) for fatal injury. This indicates a statistically significant protective effect of helmets. Three studies provided neck injury results that were unfavourable to helmets with a summary estimate of 1.36 (1.00, 1.86), but this result may not be applicable to the lighter helmets currently in use. In conclusion, the evidence is clear that bicycle helmets prevent serious injury and even death. Despite this, the use of helmets is sub-optimal. Helmet use for all riders should be further encouraged to the extent that it is uniformly accepted and analogous to the use of seat belts by motor vehicle occupants.

Journal of the American Medical Association, 1996;276(24):1968-1973

Effectiveness of Bicycle Safety Helmets in Preventing Head Injuries

A Case-Control Study

Diane C. Thompson, MS; Frederick P. Rivara, MD, MPH; Robert S. Thompson, MD
[+] Author Affiliations
From the Harborview Injury Prevention and Research Center, Departments of Pediatrics and Epidemiology, University of Washington, Seattle (Ms Thompson and Dr Rivara), and the Department of Preventive Care, Group Health Cooperative of Puget Sound, Seattle, Wash (Dr Thompson).

Objectives. —To examine the protective effectiveness of bicycle helmets in 4 different age groups of bicyclists, in crashes involving motor vehicles, and by helmet type and certification standards.

Research Design. —Prospective case-control study

Setting. —Emergency departments (EDs) in 7 Seattle, Wash, area hospitals between March 1, 1992, and August 31, 1994.

Participants. —Case subjects were all bicyclists treated in EDs for head injuries, all who were hospitalized, and all who died at the scene. Control subjects were bicyclists treated for nonhead injuries.

Main Results. —There were 3390 injured bicyclists in the study; 29% of cases and 56% of controls were helmeted. Risk of head injury in helmeted vs unhelmeted cyclists adjusted for age and motor vehicle involvement indicate a protective effect of 69% to 74% for helmets for 3 different categories of head injury: any head injury (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.26-0.37), brain injury (OR, 0.35; 95% CI, 0.25-0.48), or severe brain injury (OR, 0.26; 95% CI, 0.14-0,48). Adjusted ORs for each of 4 age groups (<6 y, 6-12 y, 13-19 y, and ≥20 years) indicate similar levels of helmet protection by age (OR range, 0.27-0.40). Helmets were equally effective in crashes involving motor vehicles (OR, 0. 95% CI, 0.20-0.48) and those not involving motor vehicles (OR, 0.32; 95% CI, 0.20-0.39). There was no effect modification by age or motor vehicle involvement (P=.7 and P=.3). No significant differences were found for the protective effect of hard-shell, thin-shell, or no-shell helmets (P=.5).

Conclusions. —Bicycle helmets, regardless of type, provide substantial protection against head injuries for cyclists of all ages involved in crashes, including crashes involving motor vehicles.

Did the author of this actually read the Rune Elvik study she cites purportedly saying that helmets do not decrease risk of head injury? A quote from the first paragraph of the Discussion section:

"Do bicycle helmets reduce the risk of injury to the head, face
or neck? With respect to head injury, the answer is clearly yes,
and the re-analysis of the meta-analysis reported by Attewell et al.
(2001) in this paper has not changed this answer."

This Rune Elvik study is basically a dissection of the meta-analysis used by some of the other studies and seems like a pissing match between some scientists. If one looks at the balance of all the research, it clearly supports the use of helmets to reduce brain injury.

The issue is not about helmets protecting people. The issue is the 'gubment' trying to be our mommies and daddies.

The trade-off is between head injuries and neck injuries. Helmets reduce the likelihood and severity of the former but increase that of the latter due to the "dig-in" effect and bulk/weight. On balance, it seems helmets are worth it.

But why are city leaders wasting their time and police officers' time with this? Passing a law that will make police officers fine kids for riding in their home area cul-de-sacs under parental supervision without a helmet is silly. Do they really have nothing better to do with their time?

And free helmets? If parents can buy their kids bicycles, they can buy a helmet as well. Why not save the money for food banks or existing CDSS programs and just make parents buy helmets if they buy a bike, if a law needs to be passed?

There is also an inherently wrong headed message implicit in any law that gives you a prize from the police for breaking it. "Councilors expressed support for the ordinance as long as ticketed children can get their $25 ticket waived-- or receive a free helmet." That's awkwardly written, so it's hard to say exactly what it was supposed to mean, but it reads as though a ticketed child would get a free helmet. That's a pretty dumb way to try to get people to obey a law.

@cookie jar - the idea here is that if a child isn't wearing a helmet because he or she doesn't have one owing to the fact that his or her parents can't afford one....they'll provide the child a helmet. Works for me.

It's not about getting someone to obey a law for its own sake - it's about making children safer.

As an avid racer and bike commuter I always wear a helmet. It's not because of any law, it just makes sense and of course it is mandated in sanctioned races. Yet, it comes down to choice. Not trying to get all political, but I do not like the encroachment of the nanny state. I wish everyone would always wear a helmet, but to put the long arm of the law into play is wrong.

The kids out in West Leigh won't be affected by this new law. When the City comes out testing their water dredging again they will likely look down on the Country rubes without the City laws.

50,000 miles on the bike (although I suspect that ruth's lifetime bike riding comes closer to something like 100,000 for 20 years of riding) adds up to 6,666 hours (for 100,000 miles) on the bike at a speed of 15 mph on average. This is the equivalent of 330,000 car miles at an average speed of 50 mph. If you make the reasonable assumption that every crash at a speed of 20 mph and above is potentially really damaging to you head if you hit the pavement, the 3 crashes cited here over that length of time indicate a very safe and reliable rider. Unfortunately what would be a bad fender bender or such in your car is a body-injury for a cyclist. Look at the studies cited here, the risk of a serious head, neck, face injury goes down with a helmet. While you might not completely prevent damage, you will minimize damage to your most valuable possession: your brain. And no, a helmet will not protect you from a crush injury to the chest (much like a motorcycle helmet), so the question of helmet or no helmet in the case of last years tragic accident is irrelevant.

With most accidents (many fatal) occuring in the home, perhaps everyone should wear a helmet everywhere!

Perhaps the town council should wear helmets for a day, everywhere they go, and let us know if they are dangerous or not.

I would think it is the person wearing the hemet who would be "dangerous" this case it would be the City Council members.

Why give this guy Ballance any credence? I'll bet he is a tea partier, or a conservative republican at least; since they've taken over in the last election they seem to pontificate all kinds of stupid things and pretend that they have authority and credibility. Don't pay attention to them.

Beyond my amazement that the Hook publishes a story denegrading the efficacy of helmet use based on one person's counter to the issue in which he cites (poorly, as Ruth shows) one meta-study and makes a plainly unsupportable claim that studies supporting helmet use are categorically outdated, the author completely pulls the rug out from his own argument with this statement: "Ballance says his anti-ordinance position should not be misinterpreted as being anti-helmet. He says there are situations when helmets make sense for children and adults such as in high-speed racing and when pedaling along busy roads." This is precisely what the city proposition is arguing for. The debate in the last council meeting came down to this question posed by a city resident--how can the city regulate their child's bicycle riding in our own driveway or in a neighborhood park? Council conferred with the city's legal council to confirm that this ordinance as approved by the state applies only to bicycle use on the open road. It is not a blanket mandate for helmet use in our city parks or in other non-road situations, regardless of how appropriate helmet use may be. The goal is clearly to get helmets into the hands of our young riders as the city has partnered with Bike Charlottesville to purchase helmets for this program. The Hook would do everyone a greater service if their stories took time to make balanced presentation with more complete information rather than simply looking for ways to fan the flames.