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Call for mandatory cycling helmets from children's hospital consultant

"We would love to see it become a requirement in Ireland"...

An Irish children's hospital consultant has spoken out making the case for cyclists to be legally required to wear a helmet, arguing accident and emergency units see a spike in crash-related injuries during the summer months.

Speaking on RTÉ's Radio 1 programme Dr Carol Blackburn, a paediatric emergency medicine consultant at CHI Crumlin, argued that the data from Australia is "well demonstrated" and said a mandatory helmet law would likely see "hospitalisations for significant head injuries reduced".

"The data that we have would demonstrate that the safety of bicycle helmets for cycling collisions can reduce the instance of serious brain injury by up to 80 per cent and can reduce facial injuries by around two thirds, and that's in children and young people colliding with other vehicles or just falling off their bicycle," she said.

Asked if she wished to see Ireland follow Australia's lead and introduce a requirement for cyclists to wear helmets, she said: "I think so. We know there is data in Australia that after the wearing of bicycle helmets was made a legal requirement, hospitalisations for significant head injuries reduced so there is an impact of it.

"Also compliance increases and it is a good thing for children to see and a good habit to get into. In many ways it is a simple intervention, helmets are not expensive any more, I think for most people if they can afford a bicycle a small additional cost for a bicycle would not impede them. The benefits are really quite well demonstrated internationally, so yes we would love to see it become a requirement in Ireland."

As the weather improves through spring and into May, Dr Blackburn reports "we start to see children who come in having sustained injuries from road traffic accidents where they've come off their bicycles or scooters, but mostly bicycles".

"Some of these injuries would include fairly significant head injuries; like moderate severity concussions, perhaps skull fractures or indeed facial lacerations and other injuries, a certain number of which would certainly be prevented if these children and young people have been wearing properly fitted bicycle helmets.

"On a bicycle a child is very exposed, there really is nothing protecting them from the elements if they are to collide with something or to come off their bicycle."

The helmet debate is a well-trodden path, the science around wearing helmets complicated. A 2017 review by statisticians at the University of New South Wales found that, based on 40 separate studies, helmet use significantly reduced the odds of head injury, and that the probability of suffering a fatal head injury was lower when cyclists wore a helmet although, the authors noted, helmets cannot eliminate the risk of injury entirely.

Another study from the same year, from Norway's Institute of Transport Economics, concluded – based on an overview of almost 30 years' worth of analysis – that bike helmets reduced head injury by 48 per cent, serious head injury by 60 per cent, traumatic brain injury by 53 per cent, facial injury by 23 per cent, and the total number of killed or seriously injured cyclists by 34 per cent.

However, while they are certainly useful when it comes to lessening the potential severity of a serious head injury, helmets have proved markedly less effective when it comes to preventing concussion, a reality of their protective limitations recognised by only one in five competitive cyclists, according to a recent study.

"Our conclusions are not that cycling headgear doesn't afford protection, but that more independent research underpinning new technologies marketed for reducing concussion is needed," said the study's lead, and former racing cyclist, Dr Jack Hardwicke last year.

In 2020, Eric Richter, the senior brand development manager at Giro also spoke out clarifying some of the "many misconceptions" about helmets, explaining how they "do not design helmets specifically to reduce chances or severity of injury when impacts involve a car".

Away from the science of injury and helmets' effectiveness, campaigners have argued that in the hierarchy of methods to protect cyclists, legal requirements for personal protective equipment should not be prioritised over reducing dangerous driving and building safe cycle routes, Chris Boardman in 2014 calling helmets a "red herring".

Speaking to road.cc he suggested widespread use of helmets spreads the wrong message and "scares people off".

"We've got to tackle the helmet debate head on because it's so annoying," Boardman said. "I think the helmet issue is a massive red herring. It's not even in the top 10 of things you need to do to keep cycling safe or more widely, save the most lives."

Research from Dr Ian Walker also found that drivers gave cyclists wearing helmets less room when overtaking, while last week we reported a new study from Australia that found that cyclists wearing helmets were seen as "less human" than those without.

> "Not at all surprised": Cyclists react to research showing riders wearing helmets and high-visibility clothing seen as "less human"

That research came just days before Conservative MP Mark Pawsey raised the question of mandatory helmets in Parliament, suggesting: "If mandatory safety measures are acceptable for car drivers, they should surely be acceptable for cyclists."

As recently as December his own government had shut down similar talk, the Department for Transport saying it has "no intention" to make wearing a helmet while cycling a legal requirement.

Dan is the road.cc news editor and joined in 2020 having previously written about nearly every other sport under the sun for the Express, and the weird and wonderful world of non-league football for The Non-League Paper. Dan has been at road.cc for four years and mainly writes news and tech articles as well as the occasional feature. He has hopefully kept you entertained on the live blog too.

Never fast enough to take things on the bike too seriously, when he's not working you'll find him exploring the south of England by two wheels at a leisurely weekend pace, or enjoying his favourite Scottish roads when visiting family. Sometimes he'll even load up the bags and ride up the whole way, he's a bit strange like that.

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108 comments

Avatar
Hirsute | 1 year ago
5 likes

What are the stats for broken limbs and dog lead related injuries?
Do they go up when more activities are undertaken?

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Sriracha | 1 year ago
11 likes

Why stop at banning cycling by proxy when directly banning it would see even more people saved from the consequences of crashing or falling off?

Has he consulted with colleagues who deal with obesity and its consequences, mental health, etc? All we'll see is his numbers going down a little whilst theirs go up further.

The trick to making helmets actually save lives overall is to encourage their voluntary adoption, so that no one is dissuaded from cycling owing to compulsory compliance.

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chrisonabike replied to Sriracha | 1 year ago
6 likes

Also - since this is a children's hospital - we need much more controls around those kids running about and playing.  Lots of injuries from that...

It's about sensible balancing of overall health risks both from doing certain activities AND not doing others.  Currently the environment we live in promotes sedentarism / restricts the independent movement (and indeed interactions) of children.

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HoldingOn replied to Sriracha | 1 year ago
5 likes

Confession time - when I (re)started cycling, I thought it was compulsory to wear a helmet, so I have always worn one.

I came off once (I had run my chain wayy too long) head first onto the pavement. The helmet had a nice dent that otherwise would have been in my head. Was happy to be wearing a helmet that day.

However, I am fully aware that the helmet will do next to nothing for me when a drivist hits me.

Cycling is a sport. Yes, people cycle their commute (I'm one) but it is primarily a sport. I have also fallen when running - should runners need helmets? How about rugby players? Football players? Should swimmers have to wear life jackets?
(by the way - I'm not actually clumsy, despite the evidence)

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Jetmans Dad replied to HoldingOn | 1 year ago
5 likes

HoldingOn wrote:

Cycling is a sport. Yes, people cycle their commute (I'm one) but it is primarily a sport. 

In the UK, that is probably true, but it shouldn't be. 

If we want to encourage more people to cycle in order to improve general health, deal with the obesity crisis and cut the use of motor vehicles for stupidly short trips across town to reduce air pollution and our contribution to the climate crisis then we need to not be placing further barriers on uptake and making decisions that reinforce the ideas that (a) cycling is inherently dangerous and (b) you can only do it if you use specialist equipment. 

Also, Mark Pawsey falls into the classic trap of making an argument based on the erroneous assumption that cars and bicycles are basically the same. 

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HoldingOn replied to Jetmans Dad | 1 year ago
1 like

Firstly - if it wasn't clear - I am most definitely in favour of leaving helmets as a choice.

Jetmans Dad wrote:

.... reinforce the ideas that (a) cycling is inherently dangerous and (b) you can only do it if you use specialist equipment. 

The "dangerous" aspect - do lights* have the same impact? About half of my commutes legally have to be done with lights so I can be seen - I would argue that lights represent a bigger danger, as they are there to prevent metal death boxes from ploughing into me. (yeah - that'll stop them...) Whereas a helmet is there in case I topple over.
*lights and reflectors

I find it weird that helmets are generally seen as representative of "danger" - but humans are a weird creature.

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Car Delenda Est replied to HoldingOn | 1 year ago
1 like

Your body: your choice

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CyclingInGawler replied to HoldingOn | 1 year ago
1 like

To be honest, I'm not sure I'd agree that in the UK cycling is primarily a "sport", if by that we mean "competitive". It may be true of the demographic on road.cc, but as I sit here just of Russel Square in London, all of the cyclists going past are definitely not racing anyone. What metric are we using to classify UK cycling as "sport" (and hence an out group for the majority of the population) when I'd have thought it would serve us all to avoid exaggerating that classification.
And in the interests of full disclosure yes I fled the country to South Australia in 2005; we're back for a holiday.

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HoldingOn replied to CyclingInGawler | 1 year ago
1 like

I have no metric to support my wild claim that cycling is primarily a "sport" - it's merely how I was brought up with it.
I am classifying it as a sport in much the same way I classify running as a sport (also how I was brought up to see it) Running is in the Olympics, but I certainly don't run at Olympic level. I used to run competitively, but don't anymore. I have even run my commute before.

As for whether or not it would be beneficial to classify it as a sport - my point was to liken it to football/rugby/swimming to point out that these are other "dangerous" activities, that don't require legal intervention for safety.

I was certainly not attempting to force an unwanted classification on cycling. I am keen to encourage everyone to cycle and wouldn't want to exclude anyone by calling it a sport.

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CyclingInGawler replied to HoldingOn | 1 year ago
1 like

Thanks for the clarrification. As you've experienced, many things* can exist as both sport and "passtime", and I think most cyclists sit in the latter category, or as commuters, at least most of the time. I tend not to count the occasional ad hoc race I would fall into with another commuter as "sport", just good fun :).
* I accept that javelin throwing, and it's ilk, may be less often seen as passtimes  1

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Brauchsel replied to Sriracha | 1 year ago
3 likes

Sriracha wrote:

The trick to making helmets actually save lives overall is to encourage their voluntary adoption, so that no one is dissuaded from cycling owing to compulsory compliance.

For adults, yes. For (small) children though, everything is compulsory to an extent. My 6-y-o has to wear her helmet when riding her bike or scooter, because I won't let her ride otherwise. It's never stopped her, and it's one of the few things we've not yet argued about, but there is a force for little kids in "look, it's the law: we'll get in trouble if we don't do this."

Obviously this won't work when she's much older, let alone a teenager who will be delighted to see me clapped in irons. But by then, I'd hope she'd have grown into the sort of moderately-resilient person who isn't going to abandon an enjoyable and useful activity because a helmet might mess her hair up or need locking to her bike or something.

I'm firmly against mandatory helmets for adults, because although I don't like banging my head very hard against the road I feel that the overall balance might not be clear-cut enough to justify compulsion. I probably wouldn't vote for legal compulsion for children, either, largely because I'm not sure it's workable. But having grown up wearing a helmet while cycling and not once finding it the worst inconvenience of a journey, I don't fully understand why people (other than Martin73's imaginary wife) would find it such a problem. 

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hawkinspeter replied to Brauchsel | 1 year ago
4 likes

Brauchsel wrote:

For adults, yes. For (small) children though, everything is compulsory to an extent. My 6-y-o has to wear her helmet when riding her bike or scooter, because I won't let her ride otherwise. It's never stopped her, and it's one of the few things we've not yet argued about, but there is a force for little kids in "look, it's the law: we'll get in trouble if we don't do this."

Obviously this won't work when she's much older, let alone a teenager who will be delighted to see me clapped in irons. But by then, I'd hope she'd have grown into the sort of moderately-resilient person who isn't going to abandon an enjoyable and useful activity because a helmet might mess her hair up or need locking to her bike or something.

I'm firmly against mandatory helmets for adults, because although I don't like banging my head very hard against the road I feel that the overall balance might not be clear-cut enough to justify compulsion. I probably wouldn't vote for legal compulsion for children, either, largely because I'm not sure it's workable. But having grown up wearing a helmet while cycling and not once finding it the worst inconvenience of a journey, I don't fully understand why people (other than Martin73's imaginary wife) would find it such a problem. 

There's a strong argument for not getting kids to wear helmets as it gives them a false sense of security and increases their risk appetite as well as giving them the impression that riding a bicycle is an inherently dangerous activity. However, if you do choose to make them wear a helmet, then ensure that the chin strap can come apart under stress to avoid any strangulation risk.

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Brauchsel replied to hawkinspeter | 1 year ago
3 likes

"There's a strong argument for not getting kids to wear helmets as it gives them a false sense of security and increases their risk appetite"

Have you ever met any small children? Pretty much all they have is a false sense of security, and their appetite for risk is enormous for even a tiny potential reward. If you're advocating a Darwinian thinning of the ranks, so be it, but kids can make pretty much any activity inherently dangerous which is why they often have safety equipment that adults might not choose for themselves. 

I didn't die or have permanent life-changing injuriesfrom any of the stupid things I did as a kid, but a fair few I knew did and it doesn't feel like as many do nowadays. H&S culture isn't wholly bad. 

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hawkinspeter replied to Brauchsel | 1 year ago
1 like

Brauchsel wrote:

"There's a strong argument for not getting kids to wear helmets as it gives them a false sense of security and increases their risk appetite"

Have you ever met any small children? Pretty much all they have is a false sense of security, and their appetite for risk is enormous for even a tiny potential reward. If you're advocating a Darwinian thinning of the ranks, so be it, but kids can make pretty much any activity inherently dangerous which is why they often have safety equipment that adults might not choose for themselves. 

I didn't die or have permanent life-changing injuriesfrom any of the stupid things I did as a kid, but a fair few I knew did and it doesn't feel like as many do nowadays. H&S culture isn't wholly bad. 

I think the idea is to let them explore their limits with the occasional crash being a teaching moment rather than it being all or nothing. There must be some optimal strategy between covering kids in as much PPE as practical and letting them cycle on the edge of a volcano.

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Brauchsel replied to hawkinspeter | 1 year ago
1 like

hawkinspeter]</p>

<p>[quote=Brauchsel wrote:

I think the idea is to let them explore their limits with the occasional crash being a teaching moment rather than it being all or nothing. There must be some optimal strategy between covering kids in as much PPE as practical and letting them cycle on the edge of a volcano.

And that's what I aim for. She doesn't wear elbow/knee/wrist protectors, as road (pavement) rash and a few bruises are learning experiences and even the odd fracture wouldn't be the end of the world. If she falls and catches her head the wrong way on a kerb or bollard it could be the end of my world, and even "just" a brain injury could seriously limit the absorption of future teachable moments. So she wears a helmet as partial mitigation of that risk, and I don't see any downside beyond it being another fucking thing for me to carry when she gets bored or distracted. 

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eburtthebike replied to Brauchsel | 1 year ago
1 like

Brauchsel wrote:

"There's a strong argument for not getting kids to wear helmets as it gives them a false sense of security and increases their risk appetite"

Have you ever met any small children? Pretty much all they have is a false sense of security, and their appetite for risk is enormous for even a tiny potential reward. If you're advocating a Darwinian thinning of the ranks, so be it, but kids can make pretty much any activity inherently dangerous which is why they often have safety equipment that adults might not choose for themselves.

Research was done on kids risk taking during play, and it turned out that they were just like adults, in that the more ppe you gave them, the bigger the risks they took.  So it seems likely that giving them a helmet does give them a false sense of security: just like adults.

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giff77 replied to Brauchsel | 1 year ago
2 likes

As a child of the 60's/70's I don't think I ever came off my bike and hit my head. I did though sprain wrists and loose skin on my hands, elbows and knees on various occasions. I did though learn to take it easy in order to avoid further damage.  Even the handful of times I've come a cropper as an adult it's been my hands and wrists that have taken the brunt. 

I would much rather these experts demand that motorists demonstrate greater care on the roads as it is the doctors who have to put the victims back together. 

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Brauchsel replied to giff77 | 1 year ago
2 likes

"I would much rather these experts demand that motorists demonstrate greater care on the roads as it is the doctors who have to put the victims back together."

It's not either/or. I don't let my child cycle on many of the roads around me, because I don't trust the motorists to drive safely around a six-year-old. I push for expansion of LTNs and School Streets for that reason (and others). But I also make her wear a helmet, because I think about the time my brother fell and his helmet split like an egg on the kerb when he was eight. It's an unlikely risk, but one with catastrophic consequences if it was realised. As there are zero downsides to putting a mitigation in place, I simply don't understand why I wouldn't do so. 

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