Updated December 2020
There is considerable debate surrounding the use of cycle helmets. Do they really provide vital protection? Do they just give cyclists a false sense of security, that leads to more accidents? The eternal question is – do they really save lives?
Why the controversy – do helmets save lives?
Should the wearing of helmets be mandatory?
In 2018, cyclists in Australia risked police fines by cycling without helmets in a protest ride against the country’s mandatory helmet laws. These laws, however, were introduced after a campaign led by the Royal Australasian College of Surgeons. The institution indicates many health professionals believe the use of helmets has positive outcomes for cyclists involved in accidents. The mandatory wearing of helmets in Canada, does not appear to have had a dramatic effect in reducing hospital admissions following cycle accidents.
Here in the UK, there is continuing heated debate on this issue and despite repeated reviews, the jury remains out. There are strong lobbies both for and against the wearing of helmets. The issue continues to be reviewed by Transport Ministers, but it does not look like helmet wearing will become mandatory anytime soon.
My personal viewpoint:
The 2013 Goldacre article in the BMJ looked at the conundrum between clinical advice and epidemiological and societal studies on the wearing of helmets. There is no definitive answer. However, the paper does highlight that there are many individual situations where helmet wearing is likely to have reduced the impact to the head and resulting brain damage. As a nurse, I have certainly seen many such patients and consequently am a strong advocate as to the importance of donning head protection. However, when something is mandatory, people often react differently.
There have been more important advances in cycle safety with investment in infrastructure and road safety, to make cycling safer.
Cyclists, pedestrians, motorists and other road users, all need to be more considerate of each other. Roads are dangerous places.
The arguments against helmets:
Those against making helmets a legal requirement believe it is an ineffective safely measure. They also state it discourages people from cycling and creates an image of a high-risk activity. They argue cycling is a healthy, cheap and environmentally friendly form of transport. For them, many of the risks that cyclists face should be reduced through improvements to infrastructure, signage, education and training.
Another argument against helmets arises from research at the University of Bath. This demonstrated cyclists wearing protective helmets did have an effect – but a negative one. The research showed that car drivers passed, on average, 8.5cm closer when overtaking cyclists wearing helmets, than when overtaking those without. This effect is known as ‘risk compensation’ and can increase the likelihood of a collision.
Many cyclists are perceived to be young and male. Interestingly, the same research discovered that motorists gave more space to a cyclist who wore a long flowing wig to look female.
Research demonstrates ‘risk compensation’ also affects people participating in a range of sports. They tend to take more risks once they are wearing protective clothing, including helmets. That is because they are lulled into a false sense of security. However, it maybe that it is the nature of the sport being undertaken that increases the risk rather than the act of putting on a helmet.
Studies also suggest those wearing helmets are more susceptible to injury. This is due to an increase in head size due to the size of the helmet. Moreover, they are less aware of their surroundings due to muffled hearing.
The arguments for helmets:
There is evidence to support the wearing of helmets and the crucial safety role they play for the wearer.
The National Highway Traffic Safety Administration (NHTSA) view helmets as: “the single most effective way to reduce head injuries and fatalities from bicycle crashes.”
Both Transport for London and the Highway Code both currently recommend wearing a helmet when cycling too.
The Royal Society for the Prevention of Accidents (RoSPA) doesn’t call for compulsory cycle helmet laws. However it strongly recommends cyclists wear a cycle helmet. Helmets might not prevent crashes or guarantee survival. However, they are an important secondary safety feature. They can reduce the risk of a serious brain or head injury in an accident. Read more here
Figures compiled by RoSPA show head injuries are very common injuries to cyclists. Data from hospitals show 40% of cyclists and 45% of child cyclists attend hospital due to head injuries. Three quarters of cyclist fatalities have major head injuries.
Meanwhile, a Cochrane review in 1999 suggested helmets reduced the risk of injury to the head and the brain by a substantial 65%-88%; and the upper and mid-face by 65%.
Safety benefits:
The safety benefits seem to be more pronounced for children. Tests on children’s bicycle helmets show helmets offer up to 87% reduction in the acceleration experienced by the skull during an impact. They can also help the skull resist forces up to 470 pounds in a crush accident.
According to a US study in 2016, helmets cut the risks of severe traumatic brain injury by half, when riders suffer a brain injury. The report, in the American Journal of Surgery, also concluded that riders with helmets were 44% less likely to die from their injury. Also, they were 31% less likely to break facial bones.
There is no doubt helmets cannot resist substantial impact and cannot save everyone. Nevertheless common sense suggests surrounding your head with some degree of protection must offer some cushioning from head impact. Neurological studies definitely support this view. However, it is also clear that we will need to undertake more studies in order to adequately prove this, otherwise the debate will continue vociferously into the future.
About us at First Aid For Life
At First Aid for Life we understand the importance of knowing exactly what to do, should you be involved in a bicycle accident – or be the first to arrive at the scene of one. As such, we offer hands on, practical first aid courses, as well as a tailored, online course specifically for cyclists. The course is designed as an introduction to basic first aid in a cycling environment. For a more comprehensive course please see First Aid for Cyclists. This includes CPR, spinal injuries, when to move them, asthma and breathing problems, heat exhaustion and much more.
First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information. we strongly recommend that you attend a First Aid course to understand what to do in a medical emergency.
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The debate over wearing a helmet for cycling is much the same as for horse riding, skiing and I’m sure many other sports too. What is seen all too often on the ski slopes, are people skiing well beyond their abilities, way too fast and possibly because they are wearing a helmet, think they will be safe if they fall / have an accident / etc. Rock climbing most certainly will protect a climber from a rock falling from above, onto their head, but this is different to other activities.
They are likely to be wrapped up in a bubble of a false security. Whether horse riding, cycling, skiing etc, if the person falls, it is very unusual they land head first. If they do land head first, it is more likely they land face first and a helmet will offer little protection in those incidents.
What is necessary is a responsibility of the person partaking in the activity to be competent to the level at which they wish to go / ride / ski / etc and in control and safely AND wear a helmet if they wish. Wearing a helmet does not automatically put a participant at a higher skill level, these must be learnt first. It should be understood that the helmet is a device for slowing down the moving of the brain by a rapid deceleration and therefore shock damage. Being aware of your surroundings is the best protection a participant will have to protect themselves in all situations.
Ian
Dear Ian, Thank you for your excellent comments. I agree completely. Best wishes Emma
As your head is the heaviest part of your body, and because of gravity and the speed at which you fall it is of course going to be the first part to strike the ground.I have seen for myself the damage done to a helmet when a child came off his bike, in this case if there had been no helmet there would be no more child!
i am i cyclist and i have an accident. luckily i was wearing
my helmet and i had no injuries. Wearing a helmet is extremely important
We agree! Glad you were ok
I have just had an accident on my mountain bike were my head took a severe sharp impact to the left side. The shock for me was when I looked at the damage to the helmet. There is a large fracture radiating through from the outside to the to the inner part of the lining. Had I not been wearing my Helmet I’m convinced I would have suffered major head trauma.
That just goes to show how important wearing cycle helmets are! Very glad that you were wearing a helmet and didn’t get seriously injured.
“Figures compiled by RoSPA show head injuries are very common injuries to cyclists. Data from hospitals show 40% of cyclists and 45% of child cyclists suffer head injuries”.
Are you sure about that? Cycling UK estimates 2.3-2.8 million people over the age of 16 cycle at least once per week. By your statistics that would equate to around 1 million head injuries…
It is referring to those attending hospital. It is data from hospitals
My son went head first over the handlebars onto asphalt. He suffered a serious traumatic brain injury and required six months to recover.
His helmet saved his life.
Thank You for your information.
It’s good that the Goldacre/Spiegelhalter editorial is picked out, and also that it is acknowledged that there is quite some controversy. Having said that…
Quoting hospital admissions is a loaded way to look at it, because you’re looking at people who’ve already had accidents and that’s not representative of the population as a whole. It’s also the case that if you look at hospital admissions then the things you see the most of for head injuries are car crashes followed by trips and falls, and yet nobody is recommending helmets against those. Why not? As the BMJ editorial points out, it’s about culture, not actual risk. My daughter ended up in hospital with concussion and blurred vision after a fall on foot in a playground: nobody criticised her or her parents for not wearing a helmet, had she had exactly the same injury falling off her bike with the same lack of protective headwear we’d have never heard the last of it! The actual bone-breaking, brain-shaking energy in a fall comes from the vertical acceleration from gravity because that’s the direction one stops suddenly in, and it’s just the same for a fall from feet as from a bike. We know from countless school playground falls that an entirely appropriate response is TLC and a sticker, it really needn’t have a different emphasis just because a bike is involved.
I don’t want to dissuade anyone from wearing helmets if that’s what they want to do, but the common claims of life saving just don’t stack up. if they did then places where they don’t bother with helmets would have significantly higher serious brain injury rates (but they don’t) and we’d see a relative decrease in serious head/brain injury relative to pedestrians as increasing numbers of cyclists took up helmet wearing (but we don’t).
The Cochrane Review is generally good thing, but for cycle helmets it is not reliable. It has a small selection of very dated papers dominated by the work of the editor, and it concentrates on just the sort of hospital study that Goldacre and Spiegelhalter point out large methodological problems for. It is not a credible resource for cycle helmet research.
I would strongly suggest a perusal of Tim Gill’s “Cycling and Children and Young Children”, which has a lucidly argued annex from a children’s risk specialist who admits he wears a helmet to cycle… and concludes that the case has not been properly made to require *or even to recommend them*. Free download at https://timrgill.files.wordpress.com/2010/10/cycling-rpt-gill-05.pdf
The main problem with helmets isn’t the helmets themselves, it’s the loaded discussion about them (as suggested by the BMJ editorial). In the UK they’re felt important because everyone goes on about them, and everyone goes on about them because they assume they’re important. But the lack of clear improvement in numbers since their uptake increased, or in comparison to places where they’re little used, show that they’re not. So we end up with huge amounts of energy spent on something of little real safety effect across a population, at the expense of stuff that makes a genuine difference.
What they were designed for is a “better hairnet” for sports riding. Not to save lives, but so if you fall in a race it might mean the difference between abandoning with a sore bump and seeing stars or getting back on and finishing your race. That’s a worthwhile thing for people doing that sort of riding, but it’s been extended in to a culture of belittling and shaming people who, entirely reasonably, choose to ride without one. (I’ve had abuse shouted at me in the street by strangers and any time Cycling UP show a picture of an unhelmeted rider there’s a pile-on saying how irresponsible they are, even though they have an excellently researched briefing on the subject, see https://www.cyclinguk.org/campaigning/views-and-briefings/cycle-helmets). This puts people off of cycling which is an own goal for public health. Maybe a little less work for first aiders, but a lot more work for their colleagues in the cardiac and diabetes wards!
Helmets for cycling for utilitarian transport should be a strictly personal choice with no pressure at any level (including Rule 59 of the Highway Code). The evidence really isn’t up to any more.
Typo above: “Cycling UK”, not “Cycling UP”
The first time I wore a ski helmet a skier “took me out” he/she (they didn’t stop) was going at speed on the flat rock hard snow near the lifts. I apparently went up in the air several feet, travelled forward some distance and landed on my head on the concrete hard snow. Out cold! My helmet did what it was supposed to do and cracked right through the entire shell. I remember the impact of the border hitting me felt like hitting an invisible solid wall at 70 amp. I couldn’t make sense of it at the time as I was hit from behind. Cycling helmets don’t cover your entire skull and leave the fragile part below and behind the ear (where the cricketer was struck and died) dangerously exposed. I skied on that day. My ski helmet was later replaced free of charge as per manufacturers sales agreement! Cycling helmets seem to concentrate on the top of the head (the least likely area to be hit) and do the visor projections crumple sufficiently? I’m working out whether to buy one and of course which one?
This is so true, I hope this reaches as many people as possible!