Cycling and brain injuries.

Frank Krygowski frkry...@cc.ysu.edu

Yesterday I was at a party with a lot of people I didn't know. My wife and I got into a conversation with a woman who has about 40 years experience as a nurse, of which eleven years were spent full-time as a specialist dealing with people with serious brain injuries.
It was an interesting conversation. She described the satisfaction she got from helping these brain-injured people return to normal life - or, as close as they could get to normal life. She also described how she eventually had to get out of that job, mostly because the work often involved "transfers", which is helping a partly or totally incapacitated patient move from, say, a hospital bed to a wheelchair. The heavy lifting eventually became too much for her.
After a while, I asked: "So, I suppose most of your patients got their brain injuries inside their cars?" "Yes, that's definitely most of them. And it's sad, but there are quite a few whose brains are damaged by drugs. There are a lot of people who had aneurisms, and there are some motorcycle riders. But most of them are from cars." "Do you get many bicyclists?" "Let's see - well, we had one guy that had an accident on his bike." "Just one?" "That's right. He somehow fell down into a big ravine." So, in eleven years of that work, she came across _one_ cyclist, and it sounds like it was a rather unusual case. This corroborates what I've heard from another face-to-face conversation with another person in a similar job, who saw only one cyclist in seven years of full-time work.
And they both corroborate the national data. Bicycling is simply NOT a significant source of serious brain injury, despite the hype to the contrary.
Bicycling is NOT very dangerous. It does us no good to pretend that it is.
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Frank Krygowski frkry...@cc.ysu.edu

Per D. S??rensen s...@ii.uib.no

That is probably because most serious riders wear helmets :-) Per D. S??rensen
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"That is not dead which can eternal lie, And with strange aeons even death may die" Abdul Alhazred

Gene webmas...@zylay.com

No it isn't. But as long as having my kids wear a helmet helps convince them that operating a bicycle deserves respect (the same respect as operating any other vehicle on the streets) and convinces motorists that we deserve respect, then they will continue to wear one. On the off-chance that they actually need it, at least it will be there.

Frank Krygowski frkry...@cc.ysu.edu

:-) Well, if that's true, then _exactly_ the right people are wearing helmets. However, I think it's much more likely that the _need_ for helmets is greatly exaggerated. Unless we're talking about motorists, that is! :-) In any case, it seems that those that have chosen not to wear a helmet while cycling are perfectly justified!
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Frank Krygowski frkry...@cc.ysu.edu

"Tom Kunich" tkun...@tality.com

Now there you go again Frank. Any evidence contrary to the helmet zealots ideas is definitely insufficient no matter how much it matches the statistics. Bicycling absolutely MUST be shown to be dangerous in order to sell helmets and if you don't sell helmets you have to justify wearing one to yourself and anyone else that will listen.

nob ...@nospam.pacbell.net (Bill Zaumen)

No one is pretending it is. Are you tired of the 85 percentile thread and trying to restart a helmet war as a diversion?
Bill
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nob ...@nospam.pacbell.net (Bill Zaumen)

I suspect Per's native language is one in which the present tense is taken seriously enough for readers to know that he was refering to what you will see today, not what you might have seen years before helmets were invented.
Bill
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"Cory Fry" cfr...@email.msnXXX.com

Ah jeeeez....
Beat a dead horse.... then when its still dead in a few days, start all over again.... etc etc etc.
Cory

Frank Krygowski frkry...@cc.ysu.edu

Not that the distinction matters. Cycling wasn't a significant source of serious brain injury before helmets were invented. Cycling is not a significant source of serious brain injury now. It's no more risky, in that regard, than many other things we do with no worries at all.
When did cycling get ***ociated with supposed brain injuries? Only when the aggressive marketing of bicycle helmets began.
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Frank Krygowski frkry...@cc.ysu.edu

Frank Krygowski frkry...@cc.ysu.edu

Good grief, can't a guy do a little multi-tasking? ;-) No, I was not trying to start a helmet war. I was merely giving some good news about bicycling - more evidence that it is NOT a significant source of serious brain injury, despite hype to the contrary.
That should be permissible, I think.
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Frank Krygowski frkry...@cc.ysu.edu

nob ...@nospam.pacbell.net (Bill Zaumen)

Given that there are about 800 fatalities in the U.S. per year (the number varying a bit from year to year), with no major changes that I know of, precisely what news are you providing?
BIll
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Frank Krygowski frkry...@cc.ysu.edu

It was yet another confirmation of the fact that riding bikes IS a safe activity.
There are plenty of people who fundamentally disagree with that. (Read the disclaimer on most organized rides, for example.) Since I came across another bit of data that shows cyclists don't populate head injury wards, I mentioned it. I'm astonished this is seen as a problem. Are we not allowed to mention good news??
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Frank Krygowski frkry...@cc.ysu.edu

Chris Stratton cs_post...@hotmail.com

-snipped-
Of course talking to a health care professional involved in long-term care and physical therapy won't tell you anything about the number of bicyclists who _die_ as a result of their accidents - since they don't need PT or continued care. I'm not saying this number is high, just that the above anecdote doesn't provide much data on it.

Frank Krygowski frkry...@cc.ysu.edu

The number is not high. As Bill Z reported, there are typically 800 bike fatalities per year, from _all_ causes. That data is rather carefully recorded. And although it's said that most of those "involve head injuries" (as in, m***ive internal injuries plus a cut on the forehead?), cyclists are almost certainly less than 1% of the head injury fatalities in the US. Again, the data is out there, if you look for it. Depending on who's reporting, there are between 56,000 and 115,000 brain injury fatalities in the US each year. Definitely less than 800 happen on bikes.
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Frank Krygowski frkry...@cc.ysu.edu

Brent Peterson b...@my-deja.com

Of course it doesn't say anything about the number of people who die in other activities as well.

Gene webmas...@zylay.com

I don't think that ride organizers are so much paranoid or even believe that it's truly dangerous, as just anxious to cover their butts in a litigation-happy society.

Gene webmas...@zylay.com

Which would lead one to believe that all cycling head injuries were either not serious enough to warrant extensive medical attention or else they died from it. No middle ground. Does this even sound logical?

Jon Bloom jbl...@arrl.org

If the issue is how safe cycling is as compared to other activities, those numbers are meaningless until normalized in some fashion.
Consider: If 800 deaths occurred annually in a population of 1000 participants each engaging in a particular activity for 1 hour per year, I think you would agree that the activity could be considered "unsafe." If those 800 deaths occurred in a population of 10 billion participants each active for 1000 hours per year, probably few would consider the activity unsafe. But without relating the 800 number to the amount of activity it represents, the number is pretty much meaningless. Even then, it's a simplistic analysis. After all, by purely counting the number of deaths during the activity, sleeping is one of the most dangerous acts you can perform!
Look, on a bicycle you're traveling along on a dynamically unstable vehicle at a rate such that if you instantaneously decelerate to 0, significant injury is highly probable. To categorically label such an activity "safe" stretches the bounds of reason and experience. But as with other activities, it has risks that can be limited by proper training, practice and procedures. You do the sport of cycling no favor by suggesting those risks do not exist.
One of the risks is head injury. It's just silly to deny the risk exists. A good helmet can substantially reduce that risk. To deny that is equally silly. The thing to do with risk is acknowledge it, evaluate it and deal with it, not to stick your head in the sand, ostrich like, and deny its existence. (Although I admit that posture will prevent head trauma!) Unfortunately, I can cite a very recent example. This morning my brother crashed coming down a mountain at about 30 MPH when his front tire blew.
(He's in the hospital with a broken hip.) His helmet was severely damaged, but his head was not. There is no question that he would have suffered at least some head injury without the helmet.
Jon

m ...@evansville.net

The material following my comments is straight from the Center for Disease Control (CDC) Web Site. The basic problem I have when reading posts that I've read on this subject is when people make the fundemental error of drawing general conclusions from specific instances or the reverse. Although I think you could possibly argue with the conclusions and actions of the CDC, there is a significant difference in the 813 reported deaths and the estimated 567,000 bike riders requiring hospital treatment. Here are some additional stats I dug up at the Brain Injury ***oc.
Crash Statistics More kids, ages 5 to 14, go to hospital emergency rooms with injuries related to biking than with any other sport. [i] Each year, about 567,000 people go to hospital emergency departments with bicycle-related injuries; about 350,000 of those injured are children under 15. Of those children, about 130,000 sustain brain injuries. [i] Each year, bicycle crashes kill about 900 people; about 200 of those killed are children under age 15. [i] Statistics show that between 70 and 80 percent of all fatal bicycle crashes involve brain injuries.
Ninety percent of bicycle-related deaths involve collisions with motor vehicles. [ii] Who, What, When and Why The number of people who ride bicycles rose from 66.9 million in 1991 to 80.6 million in 1998. [i] Distribution of bicycle deaths in 1996: 49 percent of all deaths occurred between 3 p.m. and 9 p.m.
Summer: May, June and July have the highest percentage of bicycle related deaths.
Males are six times more likely to die in bicycle crashes than females.
In 1996, 33 percent of deaths occurred at intersections. [ii] Bicycle incidents are most likely to occur within five blocks of home.
Almost half of all bicycle crashes occur in driveways and on sidewalks.
Bicycle Helmets Ninety-six percent of bicyclists killed in 1996 were reportedly not wearing helmets.
Medical research shows that 88 percent of cyclists??™ brain injuries can be prevented by a bicycle helmet. [iii] About 50% of all bicycle riders in the U.S. regularly wear bike helmets while riding a bike - a rise from 18% in 1991. [i] Of the 50% of bikers who regularly wear a bike helmet, 43% said they always wear a helmet and 7% said they wear a helmet more than half of the time. [i] Bicycle helmets reduce the risk of brain injury in the event of a crash or fall by almost 90 percent.
Universal use of helmets could prevent one death every day and one brain injury every four minutes. [iv] Half of all bike riders, however, do not regularly wear a helmet, which is the single most effective protection against brain injury.
[i] Having friends or parents who wear bike helmets significantly encourages children to use them. [v] Educational campaigns are proven to increase bike helmet use by more than one third and decrease the incidence of bicycle-related brain injuries by more than 60 percent among children. [vi] Bicycle Helmet Checklist: Buy a helmet that meets the safety standards of the American National Standards Institute (ANSI), the Snell Memorial Foundation or the American Society for Testing and Materials (ASTM).
Always do these things to ensure a proper fit: Tighten the chin strap to keep the helmet from slipping forward or backward.
Only two fingers should fit under the chin strap.
Place the helmet directly over the forehead.
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[i] CPSC, McDonald??™s Release National Survey on Bike Helmet Usage: Helmet Use on the Rise But Half of All Riders Still Not Wearing Helmets, April 21, 1999.
[ii] BHSI, A Compendium of Statistics from Various Sources, [iii] BHSI, A Consumer??™s Guide to Bicycle Helmets, February 8, 1998 [iv] Sacks JJ. Holmgreen MS, Smith SM, Sosin DM. Bicycle-***ociated Head Injuries and Deaths in the United States from 1984-19988: How Many Are Preventable? JAMA. 1991; 266:3016-3018.
[v] Dannenberg, AL. Hardheaded Partnerships. Prevention January 1994; 46(6) [vi] Rivera FP, Thomphson DC, Hompson RS, et al. The Seattle Children??™s Bicycle Helmet Campaign; Changes in Helmet Use and Head Injury Admissions. Pediatrics. April 1994; 93 (4): 567-9.
(This from the CDC) Preventing Bicycle-related Head Injuries How large a problem are bicycle-related head injuries in the United States?
In 1997, 813 bicyclists were killed in crashes with motor vehicles, an increase of 7% over the previous year.1 Of these, 31% were riders younger than 16 years old and 97% were not wearing helmets.2 In 1997, an estimated 567,000 Americans sustained a bicycle-related injury that required emergency department care. Approximately two-thirds of these cyclists were children or adolescents.3 An estimated 140,000 children are treated each year in emergency departments for head injuries sustained while bicycling.4 In 1991, societal costs ***ociated with bicycle-related head injury or death were estimated to exceed $3 billion.5 What can be done?
Riders should wear bicycle helmets every time they ride.
In the event of a crash, wearing a bicycle helmet reduces the risk of serious head injury by as much as 85% and the risk for brain injury by as much as 88%.6 Helmets have also been shown to reduce the risk of injury to the upper and mid-face by 65%.7 In fact, if each rider wore a helmet, an estimated 500 bicycle-related fatalities and 151,000 nonfatal head injuries would be prevented each year??”that??™s one death per day and one injury every four minutes.8 Unfortunately, estimates on helmet usage suggest that only 25% of children ages 5-14 years wear a helmet when riding.9 The percentage is close to zero when looking at teen riders. Children and adolescents??™ most common complaints are that helmets are not fashionable, or "cool", their friends don=t wear them, and/or they are uncomfortable (usually too hot). Riders also convey that they do not think about the importance of bike helmets, nor about the need to protect themselves from injury, particularly if they are not riding in traffic.
Accordingly, the national health goal for 2010 is for 50% of teenage bicyclists in 9th-12th grade to wear wear helmets.10 What strategies are available to get bicyclists to wear helmets?
The primary strategies to increase bike helmet use include education, legislation, and helmet-distribution programs. Educational programs have been conducted in different communities and schools around the nation, with generally positive results. The most successful programs are multifaceted and often multi-site campaigns that combine education with helmet giveaways or discount programs and state or local legislation requiring helmet use.
Some evidence suggests that legislative efforts are more cost-effective than school- or community-based programs.11 What is CDC doing to increase national helmet use?
CDC developed and disseminated injury control recommendations on bicycle helmets.12 CDC provides grant funding to state health departments to implement and evaluate programs that promote helmet use.
CDC gives funds to selected injury control centers to promote helmet use.
CDC funds research to improve helmet design.
CDC collaborates with a host of other federal agencies and non-profit organizations to promote helmet use and bicycle safety. For more information about this collaborative effort, visit the National Bicycle Safety Network website: www.cdc.gov/ncipc/bike.
How many states have bicycle helmet laws?
By early 1999, 15 states and more than 65 local governments had enacted some form of bicycle helmet legislation. Most of these laws pertain to children and adolescents.13 What standards exist to ensure that helmets are truly protective?
The U.S. Consumer Product Safety Commission issued a new safety standard for bike helmets in 1999. The new standard ensures that bike helmets will adequately protect the head and that chin straps will be strong enough to prevent the helmet from coming off in a crash, collision, or fall. In addition, helmets intended for children up to age five must cover a larger surface of the head than before. All bike helmets made or imported into the United States must meet the CPSC standard.14 How can you help prevent injuries while bicycling?
Wear a bicycle helmet every time you ride. A bicycle helmet is a necessity, not an accessory.
Wear your bicycle helmet correctly. A bicycle helmet should fit comfortably and snugly, but not too tightly. It should sit on top of your head in a level position, and it should not rock forward and back or from side to side. Always keep the helmet straps buckled.
Only buy a bicycle helmet if it meets or exceeds the safety standards developed by the U.S. Consumer Product Safety Commission.
Learn the rules of the road and obey all traffic laws. Ride with the traffic, on the right side of the road. Use appropriate hand signals.
Respect traffic signals, which are meant for riders as well as drivers. Stop at all intersections, not just those intersections with pedestrian markings. Stop and look both ways before entering a street.
Children should not ride in the street until they are 10 years old, demonstrate good riding skills, and are able to observe the basic rules of the road. And, of course, children should always wear helmets when they ride.
References NHTSA Traffic Safety Facts, 1997: Bicyclists. Washington, D.C.: National Highway Traffic Safety Administration Insurance Institute for Highway Safety (IIHS). 1997 Fatality Facts: Bicycles. Arlington (VA): IIHS, 1997.
U.S. Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS). Washington, DC: Consumer Product Safety Commission; 1997.
Sosin DM, Sacks JJ, Webb KW. Pediatric head injuries and deaths from bicycling in the United States. Pediatrics 1996;98(5):868-70.
U.S. Consumer Products Safety Commission (CPSC). Bicycle-related head injury or death. Washington (DC): CPSC, 1994.
Thompson RS, ...

m ...@evansville.net

"Pete" p...@usaf.org

The relevant phrase is "Per hour" Look, in or on ANY vehicle faster than a walk (and even then sometimes) you're carrying some risk of 'siginificant injury'.
Car Seatbelts? Don't help in a side crash.
Shower? Standing on a surface, lubricated with moving water AND soap. Far more dynamically unstable than bike tires.
Stairs? Far farther to fall. Distance = speed = injury.
Jogging/running? 10mph is plenty fast enough to involve 'significant injury'.
"Safe", as used above, is a comparitive concept. Biking is "safer" than many other daily activities (as displayed by fatality rates PER HOUR), yet none of those are subject to the same hysteria as biking is WRT to foamies.
If "biking" != safe, and a foamie is warranted (sometimes mandated), then apply the same logic to just about everything other than lying flat on the floor.
Quite. The risk ALSO exists at all other times. The particular person/risk factor differs. Sometimes within the same person/type of activity. Some types of biking is not as risky as other types. Don't denigrate a cyclist who may be involved in a less risky version of the sport than you, simply because he has chosen, for himself and that particular ride, that a particular piece of safety equipment is not necessary.
Yes. Evaluate the risk involved, FOR YOU. And then decide if the foamie is required for any individual ride.
And not every ride involves a 30 mph mountain descent. With the attendant increased risk factor.
Pete Do you wear a helmet when driving? Why not? Some drivers are REQUIRED to wear one, so driving MUST be unsafe...

rwilli ...@sigecom.net

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