Why ski helmets alone won’t reduce serious injuries
By Jon Heshka, Citizen Special – The highly publicized death of actress Natasha Richardson in 2009 after she fell while taking a lesson on a beginner’s slope at Mont Tremblant Ski Resort in Quebec put the ski helmet issue back into the spotlight. That she was not wearing a helmet triggered a national debate about legislating standards and making helmet use mandatory at ski hills.
Tragically, an 11-year-old girl died last week in a skiing accident at Calabogie Peaks Resort near Ottawa. She was wearing a helmet when she struck a tree. No doubt this sad incident will prompt another round of debate about safety and skiing.
While little evidence can be drawn from these two incidents about the amount of protection offered by helmets, the research available suggests they aren’t the be all and end all of ski safety.
The Canadian Medical Association Journal (CMAJ) published a paper earlier this month suggesting that helmets are effective in reducing the risk of head injury among skiers and snowboarders. The meta-analysis of 12 previous studies performed in Canada, the U.S., Japan, and Europe systematically reviewed the impact of helmet usage on skiers’ and snowboarders’ head injuries. The researchers found that the use of helmets significantly reduced the risk of head injury; the pooled analysis of the studies indicated that the risk was reduced by 35 per cent. The study was reported in the Citizen beneath the heading “Helmets keep you safer on slopes, says U of C study” (Feb. 2).
Advocates of helmets such as the authors of the CMAJ paper encourage their use as a means to reduce the risk of head injury, and go so far as to say that “helmets do work.” This is difficult to argue against but reliance upon such figures paints a deceiving picture.
For example, a 2009 study by Karl-Heinz Kristen, vice-president of the German-Austrian-Swiss Association for Orthopedic-Traumatic Sport Medicine, showed that ski helmets provided adequate protection only when the speed of a skier’s collision with an immovable object was no higher than 20 kilometres an hour — slower than speeds reached by most skiers. Kristen properly notes that helmets are not a panacea for skiing accidents.
Jasper E. Shealy, professor emeritus at the Rochester Institute of Technology, has studied skier safety at Sugarbush Resort in Vermont and has found that for non-helmeted skiers, only 23 per cent of all potentially serious head injuries are more serious than a mild concussion whereas for helmeted skiers, 67 per cent of their potentially serious head injuries are more severe than a mild concussion. These figures indicate that helmeted skiers go faster than non-helmeted skiers as they are hitting things harder thereby causing more severe injuries. Other studies have suggested that skier and boarder fatality rates are unaffected by helmet usage.
Such paradoxical injury rates may be the result of risk homeostasis. This theory was conceived by Dr. Gerald Wilde of Queen’s University, and it basically notes that people and systems unconsciously calibrate and accept a certain level of risk in order to maximize the overall expected benefit from an activity. For example, football helmets were invented to protect against skull and facial fractures which, at the time, were pervasive in the game. Those injuries have now been replaced by concussions.
While football helmets reduced the likelihood of lethal skull fractures, they also created a sense of invulnerability that encouraged players to collide more forcefully, more often and with hits directly to the head. It is also interesting to note that Australian football players, who do not wear the body armour and helmets worn by their American brethren, are 25 per cent less likely to sustain a head injury — although their incident rates for shoulder and knee injuries are higher. This suggests that players compensate for the lack of personal protective equipment by not being as aggressive and taking fewer risks.
Thus, a control measure designed to mitigate the risk in one area (such as helmets) is compensated by behaviour such as skiing faster, hucking bigger air, skiing in the trees or taking otherwise ill-advised chances which elevate the risk to its pre-existing level. It is admittedly difficult to say whether the skiers increased their risk-taking behaviour because they were wearing a helmet or they wore a helmet because they planned on taking greater risks.
What are we to make of these contradictory findings? In short, helmets are not the silver bullet to skier and boarder accidents. Helmets alone are not the answer and should be part of a comprehensive risk management program at ski hills which includes skiers and boarders not altering their behaviour or taking more risks just because they are wearing a helmet.
Jon Heshka is an assistant professor specializing in adventure and sport at Thompson Rivers University in Kamloops, B.C.
SOURCE: http://www.ottawacitizen.com/opinion/helmets+alone+reduce+serious+injuries/2539248/story.html
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