How Effective Are Bicycle Helmets?
Nearly every article in print regarding bicycle safety recommends the use of a helmet. So, why is it then that no state has a universal bicycle helmet law and that only 21 states have passed legislation covering young riders? The great debate across America continues: do helmets prevent serious brain injuries or will mandatory helmet laws deter the use of bicycles and result in fewer bikers sharing our roadways?
Research suggests that helmet laws significantly increased youth helmet use by 29-35 percent, but conversely, there has also been a reduction in youth bicycling by nearly 5 percent.
If cyclists know that they should wear protective headgear while riding, why don’t they? Some possible explanations include:
- Riders may not know exactly how effective helmets really are.
- Some riders may feel that in a catastrophic accident, a helmet isn’t going to help them very much.
- Riders feel helmets are too uncomfortable.
- Helmets are expensive.
- Helmets are not considered attractive.
- Helmets are, in general, too much trouble.
There are some who feel that helmet laws make cycling seem more dangerous than it really is and that they may actually encourage parents to discourage bike riding altogether in favor of activities that do not have any mandated legislation attached to them, like skateboarding or rollerblading.
Whatever the case, the question at hand is whether the evidence shows that wearing a helmet is an effective way to reduce the risk of traumatic brain injury. Below we discuss this question.
The Numbers Speak for Themselves
In 2017, there were 6,675 bicycle accidents in Florida; 93.8 percent of these accidents resulted in injuries and 128 people died as a result. According to the Wall Street Journal, Pinellas County, Florida, has the highest cyclist death rate in the Tampa Bay metro area, which has the highest rate of any metro region in the United States.
With or without the use of a helmet, our streets in the Tampa Bay area are among the most dangerous in the country for bicyclists; this is nothing short of atrocious. Some of the possible reasons for our notoriety are that:
- Florida has a disproportionate percentage of elder adults. According to Pew Research, 19.1 percent of the state’s population is 65 and older; this is the highest percentage in the nation.
- Florida cities are more densely populated than many cities in other states.
- Florida attracts a large number of tourists who are unfamiliar with local roads.
- Florida has numerous poor road designs.
It is a common misconception that bicycle accidents are always caused by a collision with a motor vehicle. A poorly maintained city road or sidewalk and insufficient maintenance on private property or at a commercial establishment can cause serious injuries for a bicyclist, as well. Hazards on roads may include:
- Fallen tree limbs
- Irregular surfaces
- Tree roots
- Broken curbs
Helmet Use May Actually Reduce the Odds of Head Injury by 50 Percent
Injuries to the neck, face, head, and brain are common in bicycle accidents. The most serious injuries are to the head, highlighting the importance of wearing a helmet. Surprisingly, many accident-related brain injuries don’t in high-speed impacts; in fact, it is actually low-speed accidents that result in the most concussions. Although a mild concussion may not cause significant damage, a severe one can lead to symptoms, such as:
- Blurred vision
- Memory loss
Despite some theories of bike helmets’ ability to adequately protect a cyclist, they do cut the risk of severe traumatic brain injury (TBI) in half. Researchers have reported that:
- Riders wearing helmets have a 52 percent lower risk of severe TBI when compared to unhelmeted cyclists.
- Riders wearing helmets have a 44 percent lower risk of death when compared to unhelmeted cyclists.
- Riders with helmets have a 31 percent lower risk of facial fractures when compared to unhelmeted cyclists.
- People who wear helmets significantly reduce their likelihood of having brain surgery in the event of an accident.
Wearing a Helmet Does Not Completely Eliminate the Risk of Injury
While logic tells us that bicycle helmets lessen the risk of brain injury, there are no guarantees. With or without a helmet, a brain can sustain serious damage if a biker is involved in an accident. It does not matter if the damage is the result of the forceful impact from a high-speed collision or simple gravity from a fall off the bicycle. The brain is responsible for all of the body’s functions, and it is the most complex of all organs. If it strikes the inside of the skull, is punctured, swells, or starts to bleed, serious—and often fatal—injuries are possible.
Symptoms of Concern
Even if they wore helmets, victims of a bicycle accident should watch for the following alarming symptoms:
- Mild confusion
- Ringing in the ears
- Difficulty focusing
- Memory loss
- Loss of coordination
- Balance issues
- Loss of muscle control
- Clear fluid leaking from the ears or nose
- Sensitivity to light or sound
Closed Head Injury Following a Bicycle Accident
A closed head injury is commonly caused by blows to the head, motor vehicle accidents, physical assaults, falls, and bicycle accidents. This type of injury can range in severity from mild skull injury to death. Scientific data confirms that bicycle helmets reduce the risk of these injuries.
Helmets reduce the risk of head injury by at least 45 percent, brain injury by 33 percent, facial injury by 27 percent, and fatal injury by 29 percent, according to the American College of Surgeons.
Types of Closed Head Injuries
There are several different types of closed head injuries, which we discuss below.
A concussion, the most common type of closed head injury, can result from a direct blow to the head. This type of injury commonly results in lost consciousness, and diagnostic imaging is often not able to point to a definitive diagnosis. Recovery can take anywhere from a few weeks to a few months, and there is a very real danger of developing a blood clot following a concussion.
Brain contusions are bruises on the brain tissue that may lead to hemorrhaging. Large contusions may need surgical intervention to completely resolve.
Diffuse Axonal Injury
Diffuse axonal injuries are a devastating and debilitating type of TBI, and can cause:
- Brain swelling
- Intracranial pressure
- Vegetative state
When the brain is forced against the inside of the skull, blood may pool between the skull and the brain. The three types of intracranial hematomas are:
- A subdural hematoma, where a vein ruptures between the brain and the membranes (dura mater) surrounding the brain.
- An epidural hematoma is caused by a rupture between the dura mater and the skull.
- An intraparenchymal hematoma occurs when blood collects inside brain tissue. An intracranial hematoma is a serious condition that often requires surgery and extensive recovery time.
A bicycle helmet will not 100 percent prevent a brain injury from happening, but wearing a helmet will significantly reduce the risk and lessen the danger. In Florida, helmets are required for all bicycle riders and passengers under the age of 16.
Traumatic brain injury is one of the most devastating effects of bicycle crashes. The brain does not heal like a broken bone. Medical treatment and rehabilitation therapies can help reduce symptoms, and over time, improve the quality of life for accident victims. However, many may suffer the following life-altering effects of TBI indefinitely:
- Chronic fatigue
- Muscle and joint weakness
- Loss of coordination
- The inability to concentrate
- Severe mood changes
- Changes in processing speed and function
- Cognitive changes
Closed Head Injury Complications
Every severe head injury case is different. The duration and severity of each are directly impacted by the amount of force the head sustains, the location of the impact and the health of each victim. A traumatic brain injury can put a patient at risk of developing a variety of serious complications, including:
- Intracranial pressure
- Swelling of the brain
- Nerve damage
- Cognitive impairment
- Communication difficulties
- Personality changes
- Changes in sensory perception
- Post-concussion syndrome
It’s All About the Helmet
The purpose of a bicycle helmet is to reduce the force of a sharp impact. Most helmets have a protective layer of stiff foam to cushion the impact of hard falls. To do its job, a helmet must remain on the rider’s head during a fall.
Proper fit is crucial to a helmet’s efficacy, quality, and specific intended purpose. How well a helmet will work is proportional to how well it fits and if it is worn properly. Fitting and adjusting a bicycle helmet is not something that should be left to chance. A helmet should:
- Fit snugly
- Not rock from side to side
- Sit level on top of the head and low on the forehead
- Be placed one or two finger-widths above your eyebrow
With the exception of a multi-use helmet, most helmets will be sized from extra small to extra large. The fit of a bicycle helmet is an important part of its protective ability. To ensure a proper fit, you need to measure your head carefully to determine which size you require.
The general sizing parameters are as follows:
- Extra-small: below 20”
- Small: 20”–21.75”
- Medium: 21.75”–23.25”
- Large: 23.25”–24.75”
- Extra-large: above 24.75
- One size fits all (men): 21.25”–24”
- One size fits all (women): 19.75”–22.5”
- One size fits all (kids): 18”–22.5”
Helmets manufactured in the United States must meet the U.S. Consumer Product Safety Commission Standard (CPSC). When choosing a helmet, it is important to look for a CPSC sticker inside the helmet that lets you know if it meets this standard.
Types of Bike Helmets
Choose a helmet that is right for you. Manufacturers have come a long way in terms of helmet design, and the market is flooded with helmets for every purpose. All types are designed to protect the head from impact while being lightweight and comfortable. Bikers can select from:
- Recreational helmets are economical and can be used for leisure time riding and commuting. This type of helmet sometimes has built-in visors to shield a rider’s eyes from the sun.
- Road bike helmets are lightweight with an aerodynamic design that allows an unobstructed view when crouched in an aggressive riding position.
- Mountain bike helmets are the best choice for those who ride over rough terrain.
Bike Helmet Construction
How well a bike helmet is constructed impacts its safety. The majority of helmets use an in-mold construction process that fuses the shell and the liner without the use of glue. Most cycling helmets are covered with a plastic shell that is puncture-resistance and allows the helmet to slide on impact. The liners are made of expanded polystyrene foam that dissipates the force to the head.
In the United States, we hold bicycle helmets to a high standard. These standards are set by the U.S. Consumer Product Safety Commission (CPSC), and the helmets are evaluated for:
- Peripheral vision
- Positional stability
- Impact attenuation
The use of a helmet significantly lowers the force of impact and improves the victim’s chances for a full recovery.
The emotional trauma that may follow a bicycle accident can be extensive. Victims of a bicycle accident often face a lifetime of suffering, including from the following:
- Post-traumatic stress disorder
- Mental anguish and emotional distress
Keep Safety at the Forefront
Research and statistics tell us that individuals who cycle without a helmet are far more likely to be killed or severely injured in a crash. We may all agree that life should be a daring adventure, but riding a bicycle should not become a life-altering event.
The National Safety Council (NSC) provides guidelines for keeping safe when sharing the roadways, which include the following:
- Become familiar with local traffic laws.
- Get acquainted with traffic laws; cyclists must follow the same rules as motorists.
- Know your bike’s capabilities.
- Ride single-file in the direction of traffic, and watch for opening car doors and other hazards.
- Use hand signals when turning, and use extra care at intersections.
- Never hitch onto cars.
- Before entering traffic, stop and look left, right, left again, and over your shoulder.
- Wear bright clothing and ride during the day.
- If night riding can’t be avoided, wear reflective clothing.
- Make sure the bike is equipped with reflectors on the rear, front, pedals, and spokes.
- A horn or bell and a rear-view mirror, as well as a bright headlight, are all recommended.
Dolman Law Group
800 North Belcher Road
Clearwater, FL 33765