A Brain Surgeon on Bicycle Helmets
by Lloyd Alter, Toronto 
on 09.24.07
While at the Bikes Belong in Ontario event, we met Dr. Charles Tator, a brain surgeon and founder of Thinkfirst, an organization with the mission to "prevent brain and spinal cord injury through education aimed at healthy behaviours in children and youth." He was there to promote helmet use by bicyclists; knowing this is a controversial subject among TreeHugger readers, we asked him a few questions.
First, to set the scene, please describe the gory details of what you see in patients who have not worn helmets.
When I go into public schools to speak to children on behalf of ThinkFirst, I bring a Jell-O mold in the shape of the brain to impress them about the fragility of the brain. The brain is like Jell-O. You only get one. We have not learned how to regenerate the injured brain. Protect the one you’ve got!
What led you to found thinkfirst?
As a brain surgeon at the Toronto Western Hospital and University of Toronto, I have helped many bicyclists during my 40 plus year career in Toronto, Ontario, Canada. The worst have had irreparable brain damage, and they are either dead or severely disabled. The best have had only skull fractures and concussions, and they have recovered fully or almost fully. The worst have been unhelmeted.
I founded ThinkFirst, Canada, a national injury prevention foundation in 1992. We have advocated for a number of injury prevention strategies in various activities including motor vehicle traffic, sports and recreation and falls. Our advocacy is based on our own research and those of others.
Bicycling is a major cause of sports and recreation injuries in Ontario. For example, I have written a book about catastrophic injuries in sports and recreation based on our research in Ontario from 1986-1995. In this study, bicycling caused more head injuries that any other sports and recreational activity (to be published by University of Toronto Press, in 2008).
We know that helmets are 85% effective in preventing head injury and in locations with helmet laws, helmet usage goes up and the incidence of injury goes down (see Cochrane Review, Macpherson and Spinks, 2007).
Has it made a difference yet? what are the trends in helmet use on bikes? Should bike helmets be mandatory for all riders?
Our research shows that currently only 42% of adult bikers in Toronto wear helmets. In my view, 58% of adult bicyclists in my city are taking an unnecessary risk of ending up on my operating room table.n Canada, each of us pays for the others’ risk taking behaviour because we have a national, comprehensive, government paid health plan. This is another reason I advocate for compulsory helmet use. Permanently comatose bikers each cost Canadians 8M$, and this leaves less money for treating brain tumors and other neurological disorders which sadly, we have not yet learned to prevent.
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Anyone who's casual about whether or not you should wear a bike helmet hasn't had the unique sensation of your head hitting the pavement after going over your handlebars, that's for sure. I literally cracked a piece of my helmet out that time. My head was the only part of me that didn't hurt. If I wasn't wearing a helmet, the impact may not have killed me, but it would likely have knocked me out, and left me at risk for getting run over in the middle of the road.
The other anecdote I have about this is a friend who's a physical therapist, who deals primarily with head injury patients, most of whom were bicyclists or motorcyclists (mostly motorcyclists, to be fair) who didn't wear helmets. It's senseless.
Do what you want, I guess, but I'll be wearing my helmet.
"Bicycling is a major cause of sports and recreation injuries in Ontario. "
So all those people who use a bike just to get from A to B, rather than as a means of 'sport and recreation', are just as safe without helmets?? Or perhaps they don't exist? That might explain some of the numbers you hear about injury rates NOT going down when helmets get made compulsory...
Having said all that, my kids wear helmets. But for safety, they ride on the pavement!
looking forward to the report, let see if it passes peer review. the last report on helmets there one that is widely quoted was debunked and did not pass peer review.
hopefully the object that caused the collision will be noted in all the injuries. somehow i think the predominate factor is vehicles, and that little Styrofoams helmet does not do a whole lot when your hit by a car doing 50 kph or above.
the bicycle standards are for a sub 10mph fall.
i really wish helmets would prevent more injuries, but i know the aggressive drivers call many in th urban area and the dui drivers kill everybody at night .
Anecdotes are not data - though they may persuade the individual concerned.
Cycling is as safe as walking and we don't campaign for walking helmets do we. Whether helmets even help is highly contentious.
So many people seem to believe that helmets must be safer and must help that they don't even stop to think or question any of the data.
You're right, anecdotes are not data. I like to see the data suggesting that cycling is as safe as walking. It would seem that traveling at 10-40 mph and (except for the case of a recumbent) leading with your hands and head (your hands and head going forward first once the front wheel is stopped) would in fact be more dangerous than walking on a sidewalk at 4 miles an hour. Why then should motorcyclists wear helmets? Because they go faster than walkers as well, leading to serious injuries when they are stopped suddenly.
I can't so for a fact that helmets save injuries/lives, but suggesting that cycling is no more dangerous than walking is somewhat absurd, unless you have some data that says otherwise.
Mike, I have hit my head with a helmet on, but never in the years without one.
In fact it some knowledgeable people refer to reports suggesting that helmeted heads incur more impacts. Be it because people take less care, other people take less care or because your "head" effectively grows both in size and weight. Also : When helmet usage percentages increased dramatically in Australia, New Zealand and ova Scotia (Canada), because of enforced helmet compulsion, the percentage of serious head injuries to other injuries did not change discernibly. What changed much more clearly, was that fewer people cycled. Check out an array of scientific studies both pro and contra at cyclehelmets.org and read the Wikipedia article on "Bicycle helmets".
According to a diverse body of research, it is more life-threatening to the average persons life not to cycle than to cycle daily to work or school. One example is the article by Lars Bo Andersen et al, in Archives of Internal Medicine, (2000). When researching 30.000 people over 14 years (cohort study), one of the clearest predictors for having a lower chance of dying during those years, was daily cycling. Cyclists had 30% lower mortality rate (from all types of deaths), after correcting for other physical exercise.
Say what you like, but the thought of sitting in a chair being fed my dinner through a straw by a woman I love who's life has been ruined just because I didnt want to wear a goofy helmet on my head when out cycling kinda makes me reach for the cycle helmet every time.
Why wouldn't you wear a cycle helmet - worried about your image ?
I'm sure the learned Dr is well intentioned, but the road to hell is paved with good intentions.
Anyone who quotes the 85% figure is either utterly ignorant or a liar. This figure comes from a single report which has been completely debunked by peer review. Nowhere that has introduced a helmet law or considerable helmet promotion has been able to demonstrate any reduction in risk to cyclists.
Look at cyclehelmets.org for the facts, not the fairy tales.
Anyone quoting cyclehelmets.org as a reputable site has to get their own brain examined.
Their intentions are clearly motivated towards anti-government and laws in general. Their front page graph some how suggests that the US has a high mortality rate compared to the number of trips made on a bike over the Netherlands. HOWEVER, the do not normalize injuries based on how or where the injuries occurred. They say that the Netherlands (who do not have helmet laws) have the best biking experience with the least fatalities with the most trips on a bike.
But for them to conclude that it is the LACK of a HELMET LAW is preposterous! The Netherlands has the best system of bike lanes in the world. They have solved the CAR/BIKE interaction by removing them from the same roads.
Until the US, and other countries, see the benefit of Bike commuting AND will build an infrastructure to support those users, bikes and cars will continue to share the same roads. Until then, bikers will always have less injuries while wearing a helmet.
Anyone quoting cyclehelmets.org as a reputable site has to get their own brain examined.
Their intentions are clearly motivated towards anti-government and laws in general. Their front page graph some how suggests that the US has a high mortality rate compared to the number of trips made on a bike over the Netherlands. HOWEVER, the do not normalize injuries based on how or where the injuries occurred. They say that the Netherlands (who do not have helmet laws) have the best biking experience with the least fatalities with the most trips on a bike.
But for them to conclude that it is the LACK of a HELMET LAW is preposterous! The Netherlands has the best system of bike lanes in the world. They have solved the CAR/BIKE interaction by removing them from the same roads.
Until the US, and other countries, see the benefit of Bike commuting AND will build an infrastructure to support those users, bikes and cars will continue to share the same roads. Until then, bikers will always have less injuries while wearing a helmet.
Who says walking isnt dangerous? I got a hematoma from walking on an icy stairway! A helmet might have helped just enough to save me from steadily encroaching paralysis and (successful) brain surgery.
The state of bicycle helmet standards is pretty abysmal. The Snell standard (as I recall) involves dropping a heavy ball onto the top of a helmet. How many cyclists get tossed in a loop and come down on the top of their head? Yet the helmet fails to protect the forehead, temples, and back of the head.
Most helmets sit blythely atop the head where the merest glancing blow will send them flying off. What is really needed is a helmet that will sit down low on the head (like BMX helmets) rather than ornamenting the top like Aunt Matilda's Easter hat.
Scorning the speedster streamlined helmets, I chose a "death skull" BMX helmet that already sat low, and used a soldering iron and hot wire to carve out a shape to fit my extra-large head into an extra-large helmet.
Using the standard streamlined helmets is not much better than lacquering your hair and wearing a thick sweatband. I think that my ideal helmet would be gelfoam that is cast to fit my head so it would stay on even without straps! To finish the job, I would want to cover the helmet foam with a good thick aluminum layer. The gelfoam and the aluminum both distort and absorb forces because they are not elastic. Styrofoam is OK for electronics but not good enough for hockey stars, who have recently discovered better helmets.
Whatever the helmet you have, use it. Cars hate cyclists. And I will always grateful to St Michael's Hospital for saving my life with timely surgery.
Some people don't want bicycle and motorcycle helmets and seatbelts to be mandatory? Okay, but those who want that "choice" should have the stones to stand up for what they claim to believe in.
For any injury suffered that would have been prevented by a wearing helmet or seatbelt, the injured, non-wearing party or family loses the legal right to sue anyone and forfeits any right to financial or medical insurance benefits. If you refuse to use the most basic safety measures, you should lose the right to the most basic benefits after an accident.
Anything else is hypocrisy.
You can tell the difference between North American cyclists and European ones.
North American ones are high and mighty on helmet laws, while Europeans (who cycle much more) are dead against them.
Although I was born and raised and still live in Canada, I take the Europeans approach on this issue. As do the vast majority of cyclists where I live. Only those spandex wearing "cyclists" wear helmets here.
Want to introduce helmet laws? Look for the number of cyclists to drop drastically. Look at Melbourne. Use to have a high number of cyclists, then introduced a helmet law and it has dwindle down so bad.
Rather than force people to wear a helmet, let them choose.
I agree with Ryan: Let people have choice or forget about increasing use of bicycles.
I just felt down in a turn some days ago because of oily asphalt (thanks scooters!), I was wearing helmet, and of course my head didn't hit the ground!
I'm not saying it's impossible to get head injuries, but I was using bike almost everyday all my life, and I didn't even scratch my face ( but a lot of other places...)
For me, I would encourage to use an helmet, but cycling is still very safe if you compare with motorcycling. So, there is no need for a few head accident to have a strict law dropping number of cyclists.