Cycling helmets - do they actually save lives?

Hi – bit of shameless self-promoting but just uploaded a special report on cycling safety

nhs.uk/news/2014/02February...

Some of the points covered are unsurprising – cycling when drunk is never a good idea and people involved in collisions with HGVs don’t usually have a good prognosis.

Some of the points are surprisingly counter-intuitive – evidence shows that more aggressive cyclists are actually less likely to be involved in a HGV collision.

But the one point I could not find any sort of consensus on is cycling helmets and whether they actually reduce accidents in a real world setting. A researcher for the DOT told me that he looked at the issue for years, it was the most complex thing he had ever studied and he had still not come to any conclusion.

And none of the main cycling organisations has a firm policy on whether they should be used

A good overview of the contrasting views can be found in the following BMJ editorial

bmj.com/content/346/bmj.f3817

Was interested in other views and is there any evidence out there that we need to consider?

Thanks,

Gerard

(NHS Choices News Editor)

9 Replies

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  • One of the problems with the issue when it comes to public debate (and even political and learned debate) has been the same problem that has dogged seatbelt law and crash helmet law, and that is the question you post above - do they "save lives."

    The problem here is that actually none of these things are designed to save lives but rather to reduce injury - mostly to reduce minor injury.

    If as a cyclist you are hit by a bus doing 30 mph - there is a very high chance of serious injury or death even if you are wearing a motor cycle helmet and armoured racing leathers. The force of that impact is huge.

    But, thankfully, and especially amongst children, the majority of cycle accidents involve doing things like breaking a bit hard and flipping yourself over the handle bars or skidding out of control on a corner. In these cases, head protection could make the difference between a graze and a cracked skull, or even just prevent concussion.

    And that is why cycle helmets are a good thing.

    The trouble is that governments when promoting policy think that if they don't make it sound like it will make some dramatic difference that it wont be taken seriously - and what is more dramatic than saying something will save a life?

    To make matters worse, it seems that some medical professionals also get caught up in this hype, also believing that they need to substantiate their opinions in the terms of lives saved.

    I remember years and years ago a newspaper (cant think which one now) did this huge spread about how the incidents of seatbelt bruising and burns and broken ribs had dramatically increased since the introduction of the seat belt laws. What they failed to mention was the dramatic decrease in the number of people who became scarred for life or who suffered serious head injury by slamming into their windscreens.

    In my mind, reducing something from moderate harm to insignificant harm is as laudable as saving lives, even though it might not make the politicians look quite as good and might get the Daily Mail huffing on the sidelines.

  • Indeed!

  • Hi

    For an individual cyclist I think whether to wear a helmet or not it is a 'no-brainer' almost literally! I have come off my bike on a number of occasions and hit my head on the ground. Without the helmet I'd have had a nasty bruise and possibly a cut head as well.

    However, to find out whether a policy of legally requiring cyclists to wear a helmet will actually save injuries and lives is far more complicated. People may be put off cycling because of the restrictions and so lose out on the health benefits. Cyclist may take more risks because the feel safer. There is good evidence to show that, whilst driver and passenger injuries dropped after the seat belt legislation, pedestrian injuries increased because drivers felt safer and so increased their risk to 'compensate'.

    I find there are three major risks to cyclists overtaking on the inside: motorists turning left without signalling (they are much more likely to signal when turning right); pedestrians stepping out onto the road without looking (especially when the traffic is stationary) and passengers opening doors to get out in the middle of the road in stationary traffic, rather than pull into the curb. All these have happened to me and a helmet has certainly reduced my injury risk.

    Mike

  • My wife has read that in WW1 when steel helmets began to be used the number of head injuries increased dramatically, but the number of deaths reduced. Between death and no consequence there is a huge range of outcomes and unless someone can point to actual harm through the wearing of a cycle helmet, then plain common sense says it has got to be safer for any individual to do so than not to do so. Just counting "head injuries" doesn't say very much.

  • Interesting work Gerard!

    You asked whether there was other evidence that we need to consider - how about the issue of cycling while using headphones?

    Last year Mayor of London Boris Johnson described cycling with headphones in as an "absolute scourge," and suggested that he was considering a ban.

    I asked him for evidence that cycling while using headphones "increased likelihood of accidents - or of raised accident severity - amongst cyclists who wear headphones versus those who don't."

    In response, the Mayor's cycling commissioner Andrew Gilligan said that because there was "no requirement under the Department for Transport national guidance 'Instructions for the Completion of Road Accident Reports' to record if they [headphones] were in use at the time of a collision," Transport for London doesn't hold such data.

    He then cited, as evidence of the effect that headphones - and mobile phones - can have on cyclists, "a paper by de Waard, Edlinger and Brookhuis published in the journal Transportation Research part F, 14 (2011) entitled 'Effects of listening to music, and of using a handheld and hands free telephone on cycling behaviour'. This concludes that listening to music worsens auditory perception."

    I wonder if you, or anyone you've spoken with in compiling this report, could help us interpret this research and its applicability to the question I asked? Looks like a valid study but I am no expert!

  • This is hardly scientific, but I remember years ago when Phill Colllins track in the Air Tonight came out a colleague put it on his brand new Sony Walkman and listened to it on his way home on his bicycle. He had not heard the track before and turned it up to hear over the traffic.

    When the big drum fill came in he was so surprised that he fell of is bike and cracked his arm.

    A lesson learned!

  • I'm a former aggressive cyclist (as mother to two young boys I've had to tone it down a lot) and it's not very surprising to me that they're not as likely to collide with HGVs - I was always especially alert to what was going on around me. I also think a so-called 'aggressive' road position enables you to see and be seen much more clearly by other vehicles' drivers.

    I've had numerous crashes that culminated in me landing on my head, and far more that didn't (oddly, I never crashed as a student cycling home in the dark after too much too drink). I haven't biked anywhere without a helmet since immediately after my first big crash, in 1989, which landed me in Chester A&E for a couple of stitches to my head and a tetanus jab to my backside. I'm also a health editor and writer, so I know anecdotal evidence doesn't count for much. But to me it's obvious that although a helmet hasn't cut my chances of an accident, it has most definitely saved my life on at least one occasion - I hit black ice going downhill at high speed on a busy road, went straight over the handlebars and landed head first on the kerb. That would have given me a serious brain injury without the helmet, which was trashed. Why on earth wouldn't I wear one?

    Despite all that, I don't want mandatory helmets, at least not for adults, if it means discouraging them from exercise. Perhaps they should be compulsory for children - although given that 90% of those I see are worn too loose and too far on the back of the head, would they do any good?

  • I am really not sure about mandatory wearing of cycle helmets, but when the kids were younger, I was surprised by one thing.

    I suggested to our local school that they should insist that children who cycled to school and parked their bikes in the school cycle sheds should wear head protection.

    However, the school thought it was a silly idea that was not worth worrying about, despite the fact that the school was on a very busy road

  • I have worn a cycle helmet since the day I (a regular and experienced cyclist) had a freak accident and went over the handlebars. I happened to be wearing a helmet that day and it was dented but it saved my face and probably my skull. I still have a scar from my split lip. I've known two other cyclists with similar accidents where a helmet saved their life.

    Sadly, just recently someone I know was killed in a bike accident. It was a day with low sun and the driver simply didn't see her - urban road, slow speed - she wasn't wearing a helmet and was killed as a result of head injuries. She was 68, lively, fit, popular, a mother and grandmother. Sad waste of life.

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