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Pedder
children
under
5
years,
in
an
attempt
to
better
protect
the
more
compliant
nature
of
the
heads
of
very
young
children.
There
is
also
some
concern
regarding
the
fit
and
stability
of
child-
ren's
helmets
which
have
been
tested
on
head-
forms
based
on
adult
anthropometry.
Growth
of
the
skull
(and
changes
to
head
shape)
takes
place
for
about
seven
years
after
birth.
Head-
forms
based
on
child
head
shapes
are
important
to
promote
helmet
design
of
good
fit
and
stability
for
infants
and
toddlers.
For
all
these
concerns,
it
should
be
noted
that
field
studies
show
that
bicycle
helmets
are
most
effective
in
reducing
the
likelihood
of
head
injuries
and
helmets
remain
the
single
most
effective
protective
system
available
to
cyclists.
But
bicycle
helmets
can
and
should
be
imp-
roved
to
provide
better
protection
to
all
cyc-
lists.
And
one
effective
way
of
doing
this
is
to
upgrade
the
performance
requirements
of
helmet
standards
and
for
mandatory
helmet
wearing
legislation
to
reference
only
those
standards
which
promote
better
helmet
designs
for
the
entire
cycling
population.
DISSENT
Bicycle
helmets
reduce
head
injuries
and
should
be
worn
by
all
Peter
Vulcan,
John
Lane
Cycling
is
a
pleasant,
healthy
pastime
and
a
low
cost
means
of
transport.
Apart
from
the
draw-
back
of
being
exposed
to
all
kinds
of
weather,
the
main
disadvantage
of
bicycling
is
that
in
a
crash,
cyclists
often
suffer
injuries,
the
most
severe
of
which
is
usually
a
head
injury.
Bicycle
helmets
have
provided
the
means
to
prevent
many
of
these
head
injuries
and
the
challenge
facing
public
health
and
transport
officials
around
the
world
is
to
promote
and
ultimately,
mandate
their
use.
Much
progress
has
been
made
in
the
six
years
since
bicycle
helmet
wearing
became
mandatory
in
the
State
of
Victoria,
and
helmet
wearing
is
now
required
in
all
Australian
states
and
in
many
jurisdictions
throughout
the
world.
British
Columbia
is
to
be
commended
for
having
the
courage
to
take
this
important
step
in
protecting
its
cyclists.
However,
although
global
data
are
not
readily
available,
there
are
probably
several
million
cyclists
throughout
the
world
in
countries
with
varying
levels
of
motorization,
who
are
not
wearing
a
helmet.
This
means
that
several
tens
of
thousands
of
cyclists
sustain
head
injuries
in
crashes
each
year.
The
quoted
85
%
reduction
in
risk
of
head
injuries
and
88%
for
brain
injuries,
should
be
regarded
as
upper
limits
for
helmets.
Some-
what
lower,
but
still
substantial
reductions
have
been
found
in
other
studies.
In
Melbourne,
McDermott
et
al
found
390%
reduction
in
head
injuries
in
riders
wearing
helmets
meeting
the
Australian
standard.'
When
certain
casualties
in
the
data
of
Thompson
et
al
were
reassigned
to
match
the
classification
used
in
Melbourne,
the
Seattle
reduction
was
61
%.2
In
Cambridge,
England,
from
a
series
in
which
about
one
quarter
of
cases
involved
a
car,
Maimaris
et
al
obtained
data
from
which
an
injury
reduction
of
670%
can
be
derived.3
There
are
several
other
studies
which
show
reductions
in
the
same
range.
While
there
is
a
need
to
improve
further
the
protective
performance
of
helmets,
it
is
clear
that
thousands
of
head
injuries
could
be
prevented
world
wide
by
increasing
wearing
rates
of
existing
helmets
now.
For
example,
in
Victoria
in
1983
about
500
of
children
under
12
years
riding
to
school
were
wearing
a
helmet,
and
for
12-17
year
olds
the
figure
was
less
than
2%.
The
wearing
rate
for
adults
commuting
was
26%,
although
much
less
in
recreational
cycling.
After
seven
years
of
promotion,
together
with
a
$10
rebate
scheme
for
purchase
of
approved
helmets,
these
wearing
rates
had
risen
to
7700,
18%,
and
46
%,
respectively.
The
introduction
of
the
mandatory
wearing
law
increased
the
under
12
wearing
rate
to
920%
and
more
than
doubled
the
other
two
rates.
Using
statewide
insurance
claims
for
cyclists
killed
or
admitted
to
hospital
involved
in
motor
vehicle
related
crashes,
we
found
that
the
percentage
with
a
head
injury
dropped
from
52%
in
1981/82
to
350%
in
1989/90
as
helmet
wearing
increased.
There
was
a
further
drop
to
25%
in
the
first
year
after
the
mandatory
wearing
law
was
introduced.4
The
table
shows
the
expected
annual
savings
by
helmet
wearing
in
a
community
which
has
1000
cyclist
head
injuries
per
annum
(assuming
other
factors
remain
unchanged).
It
can
be
seen
Expected
annual
savings
by
helmet
wearing
Helmet
wearing
rate
Helmet
effectiveness
500
100o
20%w
400O
800,,
400,
20
40
80
160
320
80o)
40
80
160
320
640
Monash
University
Accident
Research
Centre,
Wellington
Road,
Clayton,
Victoria
3168,
Australia
P
Vulcan
J
Lane
Correspondence
to:
Professor
Vulcan.
251
Dissent
that,
starting
with
a
wearing
rate
of
say
500,
there
is
scope
to
increase
the
annual
head
injuries
saved
by
eight
times
(from
20
to
160)
through
increasing
the
wearing
rate
to
40'11
through
promotion
and
possibly
16
times
by
mandatory
wearing.
On
the
other
hand,
the
most
that
can
be
achieved
by
improving
helmet
effectiveness
from
400o
to
800o
is
a
doubling
(from
20
to
40
injuries).
Furthermore,
up-
grading
helmet
standards
and
having
new
helmets
replace
the
old
ones
can
take
many
years,
while
doubling
the
helmet
wearing
rates
can
be
much
quicker.
Nevertheless,
improving
helmet
protective
performance
is
also
impor-
tant
and
should
be
done,
but
it
should not
detract
from
the
urgent
task
of
'getting
more
helmets
on
heads'.
The
criticisms
in
the
Opinion
of
most
exis-
ting
standard
and
helmets
are
valid.
Studies
over
the
years
have
repeatedly
noted
inade-
quate
protection
to
the
forehead
and
sides
of
the
head,
particularly
in
the
temporal
region.
However,
the
benefits
of
increased
coverage
need
to
be
balanced
against
generating
further
resistance
to
helmet
wearing.
Such
helmets
should
be
available
but
perhaps
not
mandatory.
It
is
difficult
to
optimize
the
protective
effect
of
the
liner
over
the
whole
range
of
impact
velocities
and
it
has
been
suggested
that
liners
commonly
used
at
present
are
not
effective
at
the
low
severity
end
of
the
range.
To
the
extent
that
this
is
a
problem,
it
could
be
ameliorated
by
the
choice
of
liner
material
able
to
perform
fairly
well
at
velocities
other
than
the
test
velocity.
The
recent
amendment
to
the
Cana-
dian
standard
should
encourage
a
suitable
choice.
A
more
radical
change
would
specify
an
accelaration
limit
and
a
head
injury
criterion
(HIC)
limit
(for
example
200
g
with
HIC
800
proposed
by
McIntosh
et
al).5
In
addition
to
designing
the
helmet
to
ensure
optimum
energy
absorption
and
force
distribu-
tion,
it
is
important
to
provide
appropriate
sizes
and
adjustments
to
ensure
a
good
fit
and
proper
retention
in
use.
Cyclists
should
be
given
appropriate
advice
on
choosing
and
wearing
a
helmet,
preferably
at
the
time
of
purchase.
We
agree
that
specially
sized
helmets
should
be
available
for
young
children
because
despite
advice
from
various
authorities,
they
ride
in
traffic
as
well
as
off-road,
and
even
younger
children
are
carried
as
passengers.
According
to
helmet
manufacturers,
there
would
be
considerable
cost
savings
if
there
was
a
single
bicycle
helmet
standard.
As
the
injurious
effect
of
forces
applied
to
the
head
should
be
similar
for
all
humans
and
the
forces
in
a
crash
are
likely
to
be
similar
in
most
countries,
there
is
no
good
scientific
reason
why
there
should
not
be
a
universal
helmet
stan-
dard.
Such
a
standard
would
need
to
cater
to
the
full
range
of
head
sizes
and
shapes.
There
may
also
be
a
need
to
have
more
than
one
level
of
protection
specified
to
provide
additional
coverage
of
the
temples
and
face
for
those
who
want
it,
and
there
may
be
a
case
for
two
levels
of
impact
energy
to
cover
usage
where
there
is
little
chance
of
higher
velocity
impacts
with
motor
vehicles
and
vice
versa.
There
is,
therefore,
an
urgent
need
to
agree
on
the
performance
criteria,
if
necessary
after
any
further
research
required
to
facilitate
such
agreement.
Eventually,
the
goal
would
be
to
have
a
single
standard.
The
commercial,
national,
and
other
sectional
interests
of
partic-
ular
groups
should
not
be
allowed
to
stand
in
the
way
of
preventing
thousands
of
head
injuries.
In
the
USA,
Australia,
and
some
countries
in
Europe,
consumers
are
given
advice
on
the
safety
performance
of
cars
by
make
and
model.
Similar
information
about
the
protective
period
of
various
brands
of
bicycle
helmets
would
be
valuable.
Bicycle
helmets,
when
properly
worn,
are
a
proven
intervention
and
the
injury
prevention
community
should
play
its
part
in
ensuring
that
they
become
widely
used.
1
McDermott
FT,
Lane
JC,
Brazenor
GA,
Debney
EA.
The
effectiveness
of
bicyclist
helmets:
a
study
of
1710
cases.
J
Trauma
1993;
34:
834-45.
2
Thompson
RS,
Rivara
FP,
Thompson
DC.
A
case
control
study
of
the
effectiveness
of
bicycle
safety
helmets.
N
Engl
7
Med
1989;
320:
1361-7.
3
Maimaris
C,
Summers
CL,
Browning
C,
Palmer
CR.
Injury
patterns
in
cyclists
attending
an
accident
and
emergency
department:
a
comparison
of
helmet
wearers
and
non-
wearers.
BMJ
1994;
308:
1537-40.
4
Vulcan
AP,
Cameron
MH,
Heiman
L.
Evaluation
of
man-
datory
bicycle
helmet
use
in
Victoria,
Australia.
36th
Annual
Proceedings
of
the
Association
for
the
Advancement
of
Automotive
Medicine.
Portland,
Oregon,
5-7
October
1992.
5
McIntosh
AS,
Kalleris
D,
Mattem
R,
Svensson
NL,
Dowdell
B.
An
evaluation
of
pedal
cycle
helmet
performance
requirements.
Proceedings
of
39th
STAPP
Car
Crash
Conference,
Coronado,
California.
8
--
10
November,
Warrendale,
PA:
Society
of
Automotive
Engineers,
1995:
111
-9.
252
