Position Statement

on

Legislated Helmet Use

By

Users of Non-Motorized Wheeled Vehicles

Dr. Robert Cushman

Medical Officer of Health

Ottawa Public Health

City of Ottawa

The Medical Officer of Health, Ottawa Public Health,supports the proposed provincial legislation of Bill 129 to amend the Highway Traffic Act, Subsection 104 (2.1) and (2.2) and Section 160 as enacted by the Statutes of Ontario, 1993, chapter 18, section 1, to protect non-motorized wheeled vehicle users on public roads.

The benefit: Properly fitted and worn helmets by users of non-motorized wheeled vehicles (bicycles, scooters, skateboards, inline skates) reduce the risk of sustaining a brain injury and mitigate the extent of such an injury.

The risks: Users of non-motorized wheeled vehicles are at significant risk of brain injury related to:

  • FALLS: These vehicles are relatively unstable as they have a narrow base, coupled with the mobility of the wheels. This makes users susceptible to loss of control and loss of balance. Further, non-motorized wheeled vehicles do require some degree of technical skill. The roads themselves, as a hard surface can increase the severity of an injury.
  • COLLISIONS: Non-motorized wheeled vehicles are vulnerable road users. Injury and fatality rates increase with the proximity to motor vehicles especially at intersections in urban areas during rush hour. They also increase on rural roads and on highways with higher speeds.

The burden: The burden of brain injuries is tremendous in both direct and indirect costs, at both a personal and societal level. We now know that even seemingly minor brain injuries, such as concussions, can produce persistent and disabling problems. Many survivors of brain injury have a diminished capacity of living evidenced by physical disabilities, memory difficulties, headaches, fatigue and mood swings. Some are unable to return to work or even live independently.

Our responsibility: It is ethically and fiscally responsible to ensure our public roadways are as safe as possible for all users.

How: Fifteen years of helmet education and limited enforcement have made great strides but now usage rates have plateaued. Best practice evidence endorses a multi-strategy approach to injury prevention that includes all three elements of education, engineering and enforcement. Research has demonstrated a positive correlation between enforced legislation and increased helmet use and it is clear this is the next step we must take to protect our population.

Rationale

What we know now:

Non-motorized wheeled vehicles account for 29% of hospitalizations due to sports and recreational activities.[1] Head injuries are the second most common sports and recreational injury accounting for 13% of hospitalizations.[2] National data from Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) reports that head injuries account for approximately 20% of scooter injuries[3], 16% of inline skating injuries[4], 7% of cycling injuries[5] (post 1995 helmet-for-children legislation), and 6.5% of skateboarding injuries[6] (local data). Two thirds of cyclists that require hospitalization are due to a head injury.[7] Even mild brain injuries, generally under estimated in current surveillance systems, can have long term disabling effects.[8]

1

Ottawa Public Health

Protecting you. Promoting a healthy city.

SN/ November 29, 2004

Using non-motorized wheeled vehicles on roadways is associated with increased severity of the head injury. 90% of bike related fatalities involve a motor vehicle collision.[9] Transport Canada reports that cyclists comprise 11% of all fatally injured and 15% of seriously injured crash victims[10] on Canadian roads. Identified risk factors include time of day, location, traffic controls, urban areas, rural roads and highways and conspicuity.[11]

Adults make up 51% of the population that are hospitalized due to sports and recreational activities.[12] Males are overrepresented (72% overall).[13] There are pronounced peaks in hospitalization numbers for the 10-14 age group and the 40- 44 age group.[14] Unfortunately, older populations, particularly over 65, may experience longer recovery periods and compromised functioning as a result of injuries sustained during physical activity.[15][16]

Helmets save lives by reducing the risk of brain injury by 88%.[17][18][19] Helmet legislation increases helmet use[20][21][22] and has demonstrated a reduction in the incidence of brain injury by 45%.[23][24] Helmet education linked with legislation results in better adoption rates than those with legislation only.[25] Further, initial studies suggest helmet legislation is a cost effective intervention.[26] This compares favourably to the individual cost of a severe head injury, approximately $3 million (US figures).[27] Some estimates report that every dollar spent on a bike helmet saves society $30 in direct and indirect costs to society.[28]

Overall, statistics for bike helmet use in Canada are about 40% (1998) although notably, frequency of helmet use goes down as severity of injuries goes up.[29] Transport Canada reported that in 2001, 88% of bike related fatalities were not wearing a helmet.[30] In Ottawa, current bicycle helmet use rates have hit a ceiling around 65% for children.[31] It is discouraging that the 2003 Rapid Risk Factor Surveillance System (RRFSS) data has noted a 4% increase in children aged 5-17 who never use helmets,[32] even with legislation targeted to the under 18 age group and current safe cycling initiatives.

This may even be under reported as some research indicates parents tend to overestimate their child’s compliance.[33] Helmet use for inline skates, scooters and skateboards is much lower ranging from 13%[34] to 50%.[35]

What we can predict:

Unless we enact changes now we can predict increased injury rates secondary to increased use of non-motorized wheeled vehicles that will result from:

  • Physical activity promotions
  • Clean air campaigns
  • Marketing of novelty vehicles- Both skateboards[36] and scooters[37] have seen a sudden and profound increase in injury rates increasing by 124% and 700% respectively over a one to two year period.
  • An aging population- Bicycling, in particular, is identified as a recreational activity of choice in older age groups.[38]

Recommendations:

1. Amend the Highway Traffic Act as proposed.

2. Develop an integrated strategy that will:

  • Stage implementation with a one year education campaign about the legislation, its applications, and penalties before concerted enforcement begins
  • Engage all potential stakeholders
  • Identify potential opportunities to link with existing initiatives (ie. Programs already in the schools, workplaces.)
  • Address financial, social and cultural barriers
  • Ensure adequate financial, physical and human resources for each of the components of planning, education (including proper fitting of helmets), enforcement and evaluation.

1

Ottawa Public Health

Protecting you. Promoting a healthy city.

SN/ November 29, 2004

[1] Canadian Institute for Health Information. (August 2004). Sports and Recreational Injury Hospitalizations in Ontario, 2002-2003. Ontario Trauma registry Analytic Bulletin. Toronto, ON.

[2] ibid

[3]CHIRRP. (1998 to date). Injuries Associated with Non-Motorized Scooters. Downloaded on Nov. 11, 2004 from

[4] CHIRRP. (1998 to date). Injuries Associated with Inline skating. Downloaded on Nov. 11, 2004 from

[5] MacKay, M., Scanlan, A., Olsen, I., Reid, D., Clark, M., McKim, K., Raina, P. (2004). Looking for evidence: a systematic review of prevention strategies addressing sport and recreational injury among children and youth. J. Sci Med Sport: 7(1): 58-73.

[6] CHEO CHIRPP Database. (nd). Skateboarding Injuries seen at CHEO Emergency Department from 1997-2001. Children’s Hospital of Eastern Ontario. Ottawa, ON.

[7] Rivara, F.P., Thompson, D. C., Patterson, M. Q., Thompson, R. S. (1998). Prevention of bicycle-related injuries: Helmets, education and legislation. Annual Review of Public Health. 19:293-318.

[8] Gerberding, J. L., Binder, S. (2003). Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem. National Center for Injury Prevention and Control. Atlanta, GA: Centers for Disease Control and Prevention.

[9] Morbidity and Mortality Weekly Report. 1995. Injury Control Recommendations: bicycle helmets. 44(RR-1):1-17.

[10] Transport Canada. 2004. Vulnerable Road User Safety: A Global Concern. Downloaded Nov. 29, 2004 from

[11] ibid

[12] Canadian Institute for Health Information. (August 2004). Sports and Recreational Injury Hospitalizations in Ontario, 2002-2003. Ontario Trauma registry Analytic Bulletin. Toronto, ON.

[13] ibid

[14] ibid

[15] Gerson, W. & Stevens, J. A. (2004). Recreational injuries among older Americans, 2001. Injury Prevention; 10 (134-138)

[16] Hukkelhoven, C., Steyerberg, E., Rampen, Farace E., Habbema, J., Narsgakkm K., Murray, G, Maas, A. (2003). Patient age and outcome following sever traumatic brain injury: an analysis of 5600 patients. Journal of Neurosurgery 99:666-673.

[17] Howard, A. (2002). New survey reveals kids are not using helmets. Downloaded July 20, 2004 from

[18] Foss, Robert, Beirness, Douglas. (2000). Bicycle Helmet Use in British Columbia: Effects of the Helmet Use Law. University of North Carolina/ Traffic Injury Research. Ottawa, ON

[19] Cook, A., Sheikh, A. (2003). Injury Prevention. 9:266-267

[20] ibid

[21] MacKay, M., Scanlan, A., Olsen, I., Reid, D., Clark, M., McKim, Kk., Raina, P. (2004). Looking for evidence: a systematic review of prevention strategies addressing sport and recreational injury among children and youth. J. Sci Med Sport: 7(1): 58-73.

[22] MacPherson, A., Parkin, P, To, T. (2003). Reply to Robinson. Injury Prevention.9: 382

[23] MacPherson, A. (2002). Sick Kids study shows bicycle helmet legislation leads to fewer bicycle-related head injuries in children. Downloaded July 32, 2004 from Media/Media_PressRelease7.html.

[24] Henderson, M. (1995). The Effectiveness of Bicycle Helmets: A Review. Motor Accidents Authority of New South Wales. Australia

[25] MacKay, M., Scanlan, A., Olsen, I., Reid, D., Clark, M., McKim, Kk., Raina, P. 2001. Sports and Recreation Injury Prevention Strategies: Systematic Review and Best Practices. British Columbia Injury Research and Prevention Unit/ Plan-It- Safe, Children’s Hospital of Eastern Ontario.

[26] Hatziandreu, E., Sacks, J., Brown, J., Taylor, W., Rosenberg, M., Graham, J. (nd). The Cost Effectiveness of Three Programs to Increase Use of Bicycle Helmets Among Children. Source not available.

[27] Traumatic Brain Injury. (nd). Traumatic Brain Injury- Costs. Downloaded Nov. 11, 2004 from

[28] Bicycle Helmet Safety Institute. (2004.) Statistics. Arlington, VA. Downloaded Nov. 19, 2004 from

[29] McFaull, S. (2000). Bicycle injuries- analysis of 1998 hospital admissions with a focus on the injury hazard associated with handlebars. CHIRPP. Downloaded Nov. 29, 2004 from

[30] Transport Canada. 2001. Bicycle Helmet Safety Institute. Statistics. Arlington, VA. Downloaded Nov. 19, 2004 from

[31] RRFSS. (2004). Bike Helmet Use by Type of Use in Households with Children Aged 5-17, City of Ottawa 2001- 2003.

[32] RRFSS. (2004). Bike Helmet Use by Type of Use in Households with Children Aged 5-17, City of Ottawa 2001- 2003.

[33] Foss, Robert, Beirness, Douglas. (2000). Bicycle Helmet Use in British Columbia: Effects of the Helmet Use Law. Univerity of North Carolina/ Traffic Injury Research. Ottawa, ON

[34] McKay, K., Ray, R. (2004). Injury Prevention Strategy Proposal- Recreational Sport Safety.

[35] CHIRRP. (1998 to date). Injuries Associated with Inline skating. Downloaded on Nov. 11, 2004 from

[36] CHEO CHIRPP Database. (nd). Skateboarding Injuries seen at CHEO Emergency Department from 1997-2001.

[37] Brain Association of BC. (2003). The Brain Association of British Columbia (BABC) Position Paper on Helmet Use when Operating Small Wheel Vehicles.

[38] ibid