Road Safety News
 

Review confirms cycle helmet effectiveness

Wednesday 19th February 2014

A review of the evidence relating to cycle helmets has concluded that they are effective in minimising the impact of a “low kinetic energy event such as a fall or a trip”, and as such it is therefore “prudent to insist on helmet wearing”.

The study, ‘Cycle helmets and young people: a brief review of the evidence base*’, was commissioned by Devon County Council and carried out by Dr Paul Hewson from Plymouth University. Dr Hewson’s brief was to undertake a literature review into the effectiveness of cycle helmets, particularly during cycle training.

As a result of the review, Devon County Council will continue to require all participants on its National Standard cycle training programme to wear a helmet.

The review was conducted in the context of Bikeability which Dr Hewson describes as “precisely the circumstances capable of generating the kind of incidents for which the British Standard specification implies that helmet will be effective”.

The review concluded that: “Helmets may be a compromise which allows aerobic activity, but clearly they are designed to protect from a relatively low kinetic energy event such as a fall or a trip.

“There is little in the literature that contests the effectiveness of helmets in these circumstances. It seems prudent to insist on helmet wearing for these activities and there is little published research to contradict this view.”

Devon County Council has also undertaken a survey of the local authorities and other providers who deliver National Standard cycle training in England, which reveals that the majority have a policy that requires children to wear helmets.

About half of the providers also either recommend or require adults to wear helmets during training; this is particularly true in the case of the larger providers.

British Cycling has a company-wide policy that all participants on their various cycling courses are required to wear a helmet.

The survey also shows that nearly all National Standard instructors in England wear a helmet when delivering training, regardless of whether there is a policy in place.

The full report is in the library section of the Cycle Devon website.

*Footnote: The review makes extensive use of reviews published by the Cochrane Collaboration on cycle helmet effectiveness and cycle helmet legislation effectiveness. The range of databases searched for relevant literature includes Medline, Web of Knowledge, Scopus, Google Scholar, Transportation Research Information Services and the Education Resource Information Centre.

 

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There are several problems with any type of PPE, maintenance and correct fitting. Most children's helmets are ill fitting and I certainly have seen a few drops in their time. False sense of security? A ill fitting helmet is (in my opinion) worse than none at all. It must be puzzling to children to be told to wear protective equipment (helmet hi-viz) in controlled conditions on a Bikeability lesson but then tear around the local fields/skateboard tracks without one at weekends. The key must be to get more people cycling and the threat to cyclists is from motor vehicles, this does not go away just becasue you are wearing protective equipment. Many public health studies have shown that there are more risks to health if you don't ride a bike, and they take into account casualty rates.

Perhaps if every child was issued with a cycling helmet when starting school things might be different, as it is household expenditure often doesn't go that far - perhaps something to do with the low numbers of children cycling. I wear a helmet when racing my bike but don't when popping down the shops. The 2 different modes of cycling carry different risks.
Roger, London

Agree (1) | Disagree (1)
0

"The comment relating to children in playgrounds not wearing helmets - most playground equipment has been designed with soft(er) surfaces so should a child fall from an object they are afforded 'some' protection. When playing out at playtime, children are supervised and again playground furniture is generally located so as not to pose additional slip / trip hazards."

So why is it the case that on any day I call in to school the auxiliary is often waiting to brief parents on the day's run of accidents? The simple truth of the matter is that a game of playground football is far more likely to produce a head injury than a Bikeability session. We know that the headache and bump produced by football games aren't really an issue in the bigger picture, yet somehow we've conned ourselves in to thinking that the same injury, produced less often, is so terrible on a bike that we've scared ourselves in to requiring crash helmets. A trip to NL is an excellent demonstration that we're over-reacting, and it's worth noting that measured by fatalities/billion km the sort of road Bikeability 2 is taught on has a better safety record in the UK than the Dutch national average (8 against 12).
Peter Clinch, Dundee

Agree (6) | Disagree (4)
+2

I have to say that I agree with pretty much everything Rebecca from Leeds is saying and think she has introduced a welcome grain of commonsense and perspective into this discussion thread.
Nick Rawlings, editor, Road Safety News

Agree (6) | Disagree (4)
+2

Am I the only one who is getting weary of the endless debates on cycle helmets?

A cycle helmet is not a suit of body armour. No one says it is. It is something which might afford you some head protection if you happen to fall (or be knocked) from your cycle. I for one think that this is a good thing and think that children should be encouraged to wear helmets (particularly when undertaking cycle training, when they are learning and developing their cycling skills). Of course there are other injuries that can be sustained after a fall from a cycle, but in general (and I am making a generalisation here) cuts, strains, sprains and fractures to limbs and other body parts mend. Injuries to the brain don't (yes, I know this is a generalisation, before I get lynched).

The argument gets silly, when we talk about helmets as if they are going to offer total protection and imply that because they don't there's no point to them at all. My clothes don't offer me total protection from the elements, but that doesn't mean that I don't bother wearing any at all.

As for the other debate about helmets and young children wearing helmets. As parent of a young child who is learning to walk, I take plenty of measures to ensure her safety (including close supervision) and 'baby proofing' things like the fire hearth/tv stand etc so she can't fall and hit her head on the hard corners. When walking outside near hard surfaces, I hold her hand and when climbing stairs, I stand behind her with my hand supporting her bottom so she doesn't fall backwards. Whilst I acknowledge that I won't be able to do this forever, I will continue to take these measures until she develops her skills to a point at which I deem the risks to be minimised to an acceptable level. The comment relating to children in playgrounds not wearing helmets - most playground equipment has been designed with soft(er) surfaces so should a child fall from an object they are afforded 'some' protection. When playing out at playtime, children are supervised and again playground furniture is generally located so as not to pose additional slip / trip hazards.

It is impossible to remove all risk from any activity, but that does not mean that one should not bother trying at all.

Sorry, cross message over. I am sad that all I have probably achieved is to just fuel to this endless debate.
Rebecca Leeds

Agree (13) | Disagree (7)
+6

According to the figures from the ONS for children under 14 in 2010 there were 21 pedestrian fatalities, 17 car passenger fatalities and 12 cycling fatalities. From these figures it would seem that helmet wearing when in a car or on foot would be of significant benefit so why is it only prudent to insist on them when cycling?
Duncan MacKillop, Stratford on Avon

Agree (8) | Disagree (1)
+7

While it is true that beginners are more likely to fall off, and also that the sort of falls one would expect in a Bikeability context are the sort where a helmet will be useful, it is also the case that Dutch children are just as subject to falling off when learning (perhaps more so, since the cycle-centric nature of the country encourages earlier learning, for a nice example see http://www.youtube.com/watch?feature=player_embedded&v=zkPYPeR97rU) and yet nobody is insisting there, despite much higher levels of exposure.

What the approach of insisting here fails to take in to account is the relative frequency of the sort of accident we're looking to protect from in both cycling and other everyday contexts. My children's primary school experiences frequent enough minor head injuries that they have form letters to send home and the school auxiliary has a sheet of "I banged my head!" stickers to supplement the "I've been brave!" ones handed out with TLC to the unfortunates. TLC and a sticker is clearly thought entirely reasonable for the much more frequent playground head injuries children of this age suffer, so why the difference for cycling?

We have the absurd situation where a Bikeability 1 class will go in to a playground and carry out carefully monitored slow drills with high supervision ratios and immediate first aid access while being required to wear PPE, and then within minutes they'll return to the same playground at play time with an order of magnitude more people, less supervision, less regulation and less immediate first aid to play intersecting games of running races, football, tig, hopscotch etc. with no regard to any of the ones they're not doing themselves, and then we don't require the PPE...
Peter Clinch, Dundee

Agree (9) | Disagree (1)
+8

In the light of Michael Schumacher's awful accident and his injury, the focus of the helmet failure has been on the attachment of a camera and the possiblity of that focussing energy in one place on the helmet in the collision. Many cyclists now have these for evidential/fun reasons but no research has been carried out on the integrity of safety helmets for any road user with non standard attachments.
olly, Lancs

Agree (4) | Disagree (0)
+4

Nick, thanks for your response, but I can't help feeling that there may be an element of bias, demonstrated both in reporting about cycle helmets and the award to BHIT.
I thank you for admitting that the headline was your responsibility, but it still remains an inaccurate summation of the report, and is typical of most reporting of cycle helmet research e.g. the TRL report, where all the headlines said that helmets prevented 16% of KSIs, but none mentioned that this was an assumption, and had no basis in the data. The idea that helmets are effective is created by headlines like these, whereas the reports make it clear that they are of very little use.

The award to BHIT is rather odd: why were they given an award when they had not demonstrated any reduction in risk? Giving an award for distributing cycle helmets, an intervention which has no history of reducing risk to cyclists, is farcical. Surely awards should only be given for demonstrating a reduction in risk, not for distributing ineffective pieces of plastic?

Given that Road Safety GB gave an award to an organisation which has never demonstrated that it is effective in improving road safety, I think my comment that it doesn’t understand road safety is entirely justified.
Richard Burton, Bristol

Agree (9) | Disagree (8)
+1

Richard Burton
A few points in response to your post below:

• As I explained earlier in this discussion thread, the headline and story have been created/edited entirely by me in my capacity as editor of Road Safety News - Road Safety GB was not involved in this process.

• The Lynda Chalker Award you refer to was made Bicycle Helmet Initiative Trust (BHIT) back in 2011 - here is the link to the full story:
http://www.roadsafetygb.org.uk/news/1917.html

If you click on the link you will see that when it was published there were just three reader comments about the story, one of which was negative. In contrast there have already been 18 comments in this discussion thread - a clear indication that cycle helmets are a much more contentious issue now than they were back in 2011.

• The award was presented to Angela Lee, a paediatric trauma nurse who set up the Bicycle Helmet Initiative Trust in 1998. One of the reasons for the award was that in 2010 the BHIT - a charity - distributed more than 10,000 free and low cost cycle helmets to children throughout the UK.

• Finally, while you are of course entitled to your point of view, I wonder whether on reflection you might agree that your comment that Road Safety GB "doesn't understand road safety" is perhaps something of an over reaction, to an award of which you do not approve?
Nick Rawlings, editor, Road Safety News

Agree (9) | Disagree (3)
+6

I wonder whether the headline had anything to do with this organisation's views on cycle helmets.
http://www.roadsafetygb.org.uk/news/2359.html

Anyone who gives an award to BHIT clearly doesn't understand road safety.
Richard Burton, Bristol

Agree (5) | Disagree (6)
-1

Quote:-
A review of the evidence relating to cycle helmets has concluded that they are effective in minimising the impact of a “low kinetic energy event such as a fall or a trip”, and as such it is therefore “prudent to insist on helmet wearing”.

Were cyclists assessed for how much injury could be avoided if wearing elbow protectors; knee protectors; shin guards; or chin guards? And if such a study were carried out, would it lead to compulsory wearing of same? If such were the case, we would have all pedestrians wearing same, and perhaps car drivers wearing full harness seat belts and full face crash hats.

Children will fall from bicycles when learning, it is therefore reasonable to have them wear some head protection. But how far should this intrude into everyone's lives? Leave the choices to the individual when they are of an age to make those choices.
Derek Reynolds, Salop.

Agree (9) | Disagree (0)
+9

Hmm. "A review of the evidence relating to cycle helmets has concluded that they are effective in minimising the impact of a “low kinetic energy event such as a fall or a trip”, and as such it is therefore “prudent to insist on helmet wearing”." Since almost all "low-kinetic-energy falls or trips" occur when walking, I'm surprised the article suddenly shifted the topic to cycling!
Rob X Susx

Agree (12) | Disagree (1)
+11

Apart from the obvious points already made, the sort of impacts cycle helmets can protect against can often be avoided completely: human reactions are fast enough to ensure that some other part of the body hits the ground first.

The promotion of cycle helmets is fundamentally an anti-cycling measure, whose main effect is to put people off. Impacts cycle helmets can protect against are (a) not serious and (b) as or more likely to be generated by other activities.
Colin McKenzie, London

Agree (13) | Disagree (2)
+11

I'm afraid the plot has been lost here, and I write this as a Bikeability Scotland instructor with letters on the subject published in the BMJ and JRSM. Let's look back at the top...

A review of the evidence relating to cycle helmets has concluded that they are effective in minimising the impact of a “low kinetic energy event such as a fall or a trip”, and as such it is therefore “prudent to insist on helmet wearing”.

What's the biggest cause of this sort of accident? Of course, it's trips and falls! Is it prudent to insist on PPE for that? Apparently not, since pretty much nobody does. So why make an exception for the less accident-prone cycling? It doesn't make any sense, and is just rationalising a gut-feeling that cycling is especially dangerous and we ought to insist on helmets to do it. Look at the numbers, and as Mr. Boardman often points out they just don't add up to an answer of cycle helmets being a default position we should promote, less still insist on.
Peter Clinch, Dundee, Scotland

Agree (16) | Disagree (1)
+15

Robinson DL; Head injuries and bicycle helmet laws; Accid Anal Prev, 28, 4: p 463-475, 1996 http://www.cycle-helmets.com/robinson-head-injuries.pdf
see Tables 3 and 5 showing data for children in NSW. The equivalent number of pre-law injuries increased from 1310 (384 head + 926 other injuries) in 1991 to 2083 (488 head + 1595 other injuries) in 1993.

Clarke, CF, Evaluation of New Zealand’s bicycle law, NZMJ 10 February 2012, Vol 125 No 1349
http://journal.nzma.org.nz/journal/125-1349/5046/
In addition, concerns were expressed about the safety outcome: ‘Of particular concern are children and adolescents who have experienced the greatest increase in the risk of cycling injuries despite a substantial decline in the amount of cycling over the past two decades’.

Clearly there is an issue here to consider in more detail.
Colin Clarke

Agree (8) | Disagree (2)
+6

Thanks for that mea-culpa Nick, but isn't that the curse of the headline in that they tell the story without you having to read the story? The Sun and the Mirror newspapers rely on that very fact.
Duncan MacKillop, Stratford on Avon

Agree (7) | Disagree (1)
+6

I'm afraid the conclusions as headlined are not justified by this research, as it relies on discredited research: the two Cochrane reviews. The first Cochrane review has been criticised for failing to follow the basic criteria for such a review, and the second has been criticised for drawing unjustified conclusions.

The paper says "The Cochrane systematic review on the effectiveness of cycle helmet wearing is the most authoritative single reference one could hope to use."

Unfortunately, the first Cochrane review failed to implement any of the quality criteria for such reviews, and it was conducted by researchers already convinced of the effectiveness of cycle helmets, who mostly reviewed their own research and ignored other data. These researchers (Thompson, Rivara and Thompson) had already published research and articles expounding their views that cycle helmets were highly effective, so the most demanding criterion for a Cochrane Review, independence, was not met.

The research does not compare child cycling accident head injury rates with other typical child play head injuries, therefore it cannot justify helmets for one activity if the risk is the same or less, than for other activities.
Richard Burton, Bristol

Agree (14) | Disagree (2)
+12

Wildnorthlands, Duncan MacKillop and others:

I take full responsibility for the headline! It is not an attempt to 'put a spin' on the story, simply to create a concise, accurate (hopefully!) and eye-catching headline that draws readers into the story. The reader only needs to read the first para to gain a much fuller insight as to the thrust of the story:

"A review of the evidence relating to cycle helmets has concluded that they are effective in minimising the impact of a “low kinetic energy event such as a fall or a trip”, and as such it is therefore “prudent to insist on helmet wearing”.
Nick Rawlings, editor, Road Safety News

Agree (11) | Disagree (7)
+4

It's all about the spin you put on it isn't it? roadsafetygb could have said "Review confirms cycle helmets only effective at low speeds" but they chose to say "Review confirms cycle helmet effectiveness" instead.
wildnorthlands, wildnorthlands

Agree (12) | Disagree (5)
+7

Your statement about British Cycling 'requires helmets to be worn on their courses' seems completely at odds with their high profile spokesman Chris Boardman who has been widely quoted as saying that of the safety and promotional actions that are needed for cycling, helmet wearing is nowhere near the top ten.

If you are that concerned about road user protection from head injury the group to target is car occupants.

Everyday use of cars, cycles and just walking around has no need to require any special clothing whatsoever. A healthy human body has a few million years of proven safety systems (eyes and ears being the key ones) and resilience to typical knocks and bumps it receives - which is why a human skull is good for a fall or bash with a surface at running speeds, and taxed to just 30% of its impact capacity, compared to a helmet which is at 400% of its impact capacity at this point.

Perhaps most telling is that in countries with miniscule levels of helmet wearing and high levels of cycle use, there are equally low rates of head injury.
Dave H - Glasgow

Agree (18) | Disagree (1)
+17

I wonder why we should limit pedestrian helmet wearing to the over 50s? I assume everyone should wear such helmets, walkers, joggers etc. I suggest that as we start to teach children to walk they should be strapped into a helmet which apart from sleeping and head size growth should be kept on. I also think we should use modern technology to check individuals are wearing their helmets at all times. So RDF should be included and people failing to do so should be fined. Mothers teaching kids to walk should also wear helmets to ensure the kids think it is normal.
bilboburgler, Otley

Agree (12) | Disagree (2)
+10

Yup, let's all wear helmets all the time, especially around the house where lots of head impacts occur - doh!
Mike, Sussex

Agree (13) | Disagree (3)
+10

As with most of these reviews the headline of the story makes a claim that is not substantiated by the actual findings. All that anybody would read would be that a "Review confirms cycle helmet effectiveness" and not bother to read the various caveats or the terms of reference for the study. Before long somebody will be saying that because helmets have proved to be effective then a law should be brought in to mandate their use.
Duncan MacKillop, Stratford on Avon

Agree (9) | Disagree (7)
+2

This is a review of the evidence of the suitability and effectiveness of cycle helmets for low speed falls and trips - with specific focus on children undertaking Bikeability training. Low speed trips and falls are entirely typical of the typical incidents to children on these courses and as they learn to cycle. The review does what it says on the tin.

Instructors should also wear helmets because children learn from what we do not just what we say - therefore the instructors example of wearing a helmet reinforces our requirement that children should do so. They are novices who face different risks to experienced older cyclists and should be sensibly protected whilst they learn.

The law also recognises this principle by, for example, requiring children who ride horses to wear an appropriate crash helmet up to the age of 14 years.
Honor Byford, North Yorkshire

Agree (24) | Disagree (6)
+18

I suppose the question we need to ask is what injuries do cyclists actually sustain in the course of an accident? From the rather scant literature about the subject it appears that apart from scrapes and sprains there are a significant number of long bone and crush injuries as well as head injuries. With most cycle impacts happening from the rear and the side it surprises me that there isn't a greater focus on encouraging cyclists to fit mirrors to their machines rather than encouraging them to wear helmets.
Duncan MacKillop, Stratford on Avon

Agree (7) | Disagree (7)
0

That really puts the cat amongst the pigeons. All those people who believe that have at least a modicum of protection from brain injury actually do have a modicum of protection. A fall or a Trip? Do they not realise that a cyclist on a modern racing style machine is capable of 30 mph and even more downhill and it only will protect them at say 5 mph. I have suggested previously and been poo poo'd that they wear a motorcycle helmet and other body protection, and at least that will, to some lesser or greater degree, mitigate the injury from a fall or collision. Is it time for a re-think on helmet safety?
bob craven Lancs

Agree (8) | Disagree (5)
+3

So a helmet provides protection in the case of a trip or fall. In that case we should be pushing for all pedestrians, particularly those over 50, to be wearing helmets as they are the most likely to suffer a trip or fall - far more than a cyclist.
Steve, Merseyside

Agree (24) | Disagree (10)
+14