Should Cyclists be Required to Wear Helmets?

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By Bill Bender

Don’t Even Ride a Bike in the Driveway Without a Helmet!

My perspective comes from being a cyclist for many years, but is heavily tempered by my experience as a neurologist. In my work, I have heard countless testimonials from people who have had even minor brain injuries irreparably change their lives. A look at the statistics suggests that riding without a helmet is not a decision to make lightly.

While football tends to dominate the discussion of sports-related head injuries, research shows that bike accidents account for far more traumatic brain injuries each year. Cycling accidents played a role in about 86,000 of the 447,000 sports-related head injuries treated in emergency rooms in 2009. Football accounted for 47,000 of those head injuries, and baseball played a role in 38,394. Cycling was also the leading cause of sports-related head injuries in children under 14, causing 40,272 injuries, roughly double the number related to football (21,878). In short, bike accidents contribute to more sports-related head injuries than any other activity.

More numbers:  In 2010, 618 bicyclists were killed in traffic crashes. Over the past several years, roughly 9 in 10 bicyclists killed were not wearing helmets. Nearly 70% of all fatal bicycle crashes involve head injuries. Head injury is the leading cause of permanent disability in bicycle crashes. Head injuries account for more than 60 percent of bicycle-related deaths. Bicycle helmets have been estimated to reduce the risk for head injuries by 85%. Despite these facts, only 20-25% of all bicyclists wear bicycle helmets.

The CDC estimates that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of a traumatic brain injury.TBI can cause a wide range of functional changes affecting thinking, language, learning, emotions, behavior, and/or sensation. It can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.

Professional and amateur athletes in many sports wear helmets. Football, hockey and even baseball players wear helmets. Cyclists need protection for the special risks they face, too. Brain injuries, even minor ones from falling over at a low speed, are usually the most serious injuries a bicycle rider will sustain. Helmets prevent many of these injuries or reduce their severity. This is most true in the low speed injuries, like the test ride in the driveway. Studies in the U.S. and elsewhere have shown that bike riders wearing helmets are less likely to suffer brain injuries than those who don’t. Compared to the dollar and human cost of brain injuries, helmets are inexpensive insurance.

So, it is clear that head injuries have tremendous impact, and that helmets reduce that. How about safety laws?  Are they beneficial?  So far, laws requiring bicycle helmet use have increased use in children and adults.

Motorcycle helmet laws significantly reduce the strain on public resources. Unhelmeted riders cost more to treat at the hospital, spend a longer time in rehabilitation, and are more likely to require some form of public assistance to pay for medical bills and rehabilitation. In 1991, prior to enacting its helmet law, California’s state medical insurance program paid $40 million for the treatment of motorcycle-related head injuries. That figure dropped to $24 million after enactment of a universal helmet law.

During the first full year after enforcement of automobile seat belt laws, fatality rates dropped 21 percent in five primary states compared to only 7 percent in 11 secondary law states. During the same period there was a 24 percent reduction in fatality rates for persons under 21 years old in the primary states compared to a 3 percent reduction for that age group in the secondary law states.

So, what is the argument against helmet laws? Let’s face it, most of the time we are riding, the helmet is a useless appendage, much like the seatbelts and airbags in your car. Can we protect everyone from every risk they may take?  No. We all have the freedom to take risks that we are comfortable with. This is a privilege our society offers us. At the same time, our society bears the costs of these risks, in terms of loss of productivity, medical costs, and long term support for those injured. We need to legislate this for ourselves and our children. Helmets make potentially major brain injuries less severe, and make minor falls into non-brain injury events. And every brain injury counts.



By Hank Greer

I Shouldn’t be Forced to Wear a Helmet!

In August of 2011, the Spokane county commissioners heard testimony on a proposed county ordinance that would make helmet wearing mandatory for cyclists. Several cycling advocates, including Bill Bender and me, spoke that day. Other than one person who rambled on about government intrusion on liberty and freedom, I was the only one who spoke against the ordinance. I brought up numbers I obtained from the Centers for Disease Control and Prevention showing how cycling injuries and deaths paled in comparison to the big picture. For example, unintentional falling was the number one cause of injury for all age groups except 10-14 and 15-24. Cycling only shows up in the top ten at number six for ages 5-9 and number five for ages 10-14. That seems logical because that’s when most kids learn to ride.

I did not think anything I had to say would sway the commissioners. Usually helmet laws are adopted because helmets work. My intent was to make sure the commissioners had the opportunity to hear an opposing voice in hopes they would be able to make the best decision. Bill, whom I respect and admire very much, later said to me, “We were surprised by your testimony.” (Bill, to his credit, is too much of a gentleman to say, “WTF was that Hank?!”).

It’s not that I’m anti-helmet. I wear a helmet when I feel it’s necessary, which is most of the time. I commute by bike, I race, and I ride on rough trails. But there are times I think a helmet is not necessary, and I shouldn’t be forced to wear one – for example, if I’m taking a lazy ride on residential roads, or if I’m in a protected space such as the Fish Lake Trail, the Children of the Sun Trail, and much of the Centennial Trail.

In the Netherlands about 1% of cyclists wear helmets and the country has 1.6 bicycle fatalities for every 62 million trips. Depending on whose estimate you go by, anywhere from 40-60% of cyclists in the United States wear helmets. Yet our country suffers 21 bicycle fatalities for every 62 million trips.

Safer cycling is relatively new to the Netherlands. Cycling deaths and the 1973 oil embargo, among other things, contributed to the change in culture. In the mid-1970’s, cycling took off in the two cities where they started building dedicated cycling infrastructure separate from vehicles. The rest is history.

The main contributors to cyclist safety in the Netherlands are the large amount of protected space for cyclists and a culture that recognizes their vulnerability. Both are greatly lacking in our country.

And therein lies the problem. We have very little protected space for cyclists and our transportation system is centered on motor vehicles. So our answer to the vulnerability of cyclists in a vehicle-laden environment is, “Wear a helmet.” That, and the good graces of the many drivers who care, is the only protection you have while riding in traffic.

Now if we were serious about protecting people from traumatic brain injury (TBI), and not just when they’re on a bicycle, then we should require helmets in the home. Unintentional falls is the number one cause (40%) of TBI. We should also require helmets while in a motor vehicle where collisions cause 14% of TBI. Obviously, we’re not consistent in our approach to public safety. Protecting heads from injury shouldn’t apply to the most vulnerable who are out on two wheels. But that’s almost all we do.

As you can see, I have not presented a compelling case for not requiring people to wear a helmet. And that’s about how strong my argument was for the county commissioners. In my opinion, they took the easy way out. They passed an ordinance requiring helmets for ages 3-15 years of age, but excluded a penalty for not doing so. All a deputy sheriff can do is give a child a stern talking to about wearing a helmet.

Regardless, while I support wearing a helmet, especially under circumstances like racing, trail riding, and commuting in traffic, I don’t think I should be required to wear a helmet all the time. To me they’re not necessary in a protected space or while on a leisurely ride on quiet roadways. Under those circumstances, I prefer to decide for myself.

If we want to seriously address cycling safety, we should drastically improvement upon our infrastructure. The economic, environmental, and societal benefits are there for us to reap. In the meantime, you should choose to wear a helmet. //

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