Dr Keatinge is a consultant in public health and a member of the editorial board of the Bicycle Helmet Research Foundation (BHRF), which undertakes, encourages, and spreads the scientific study of the use of bicycle helmets, in the context of risk compensation and sustainable transport. 

Dr Keatinge pointed out that there is in fact no good evidence that mass helmet use does anything useful to prevent brain injury, with no clear evidence emerging from countries that have enforced the wearing of helmets.

The following are what the BHRF considers to be reasonable conclusions following examination of wider evidence where helmet use has become significant:

• if worn correctly, a cycle helmet may afford some protection against minor, largely superficial injuries to the head
• a helmet is unlikely to offer protection against more serious or life-threatening injuries
• you are more likely to hit your head in a crash if you wear a helmet. You may be more likely to crash in the first place, particularly if a helmet makes you feel better protected
• a helmet may increase the very small risk of the most serious brain injuries that lead to death and chronic intellectual disability.
• the likelihood of serious head injury when cycling is extremely small and hugely outweighed by the health benefits of cycling*

In recognition of the ongoing debate over the effectiveness of cycle helmets to prevent injury, the Department of Transport commissioned the Transport Research Laboratory (TRL) to provide a comprehensive review of the effectiveness of cycle helmets in the event of an on road accident.

The report, completed last year, concluded that cycle helmets would be expected to be effective at reducing the frequency and severity of injury in a range of accident conditions. The main findings of the report were:

• according to a biomechanical assessment of more than 100 police forensic reports filed between 2001 and 2006, a predicted 10% to 16% of cyclist fatalities could have been prevented if they had worn an appropriate cycle helmet
• approximately 40% of pedal cyclists admitted to hospital in England suffered head injuries.  Ten percent of cyclists admitted to hospital between 1999 and 2005 suffered injuries of a type and to the part of the head that a cycle helmet may have mitigated or prevented, and 20% suffered open wounds that a helmet may have mitigated or prevented
• no evidence was found to suggest an increased risk of rotational head injury with a helmet compared to without a helmet
• cycle helmets would be expected to be particularly effective for young children  as helmets are designed to withstand falls from 1.5 metres, and because they aren't as tall, children are not as likely to fall this far
• helmet use has steadily increased since 1994. In 2004 34% of cyclists wore them on major roads and 17% on minor roads, compared to 22% and 8% in 1999

The report has been criticised for failing to examine links between compulsory helmet use and falls in cycling or to give any detailed consideration of whether helmet use influences the likelihood of being involved in an accident.

We asked for the comments of Headway, the brain injury association, on the BHRF conclusions.

Headway is the leading UK charity helping people rebuild their lives following brain injury. This is what they told us: 

It is Headway's belief that everyone should wear a helmet while cycling, particularly children, as they do not possess the same level of competency or experience as adults and are therefore more vulnerable.

In Headway's view the evidence is clear: cycle helmets can save lives and help prevent lifelong disability. This fact has been proven by numerous peer-reviewed, published scientific studies and is shared by well-respected professional bodies including the British Medical Association, the Association of Paediatric Emergency Medicine, the Bicycle Helmet Initiative Trust and numerous doctors and neurosurgeons across the UK.

There are a number of myths circulated regarding cycle helmets. Firstly, that mandatory wearing of helmets leads to a fall in the number of people cycling, deterioration in public health, and an increase in the cost of healthcare.

This was the view of the British Medical Association until 2004. However, following a systematic review of the evidence by a scientific committee, it reached the conclusion that the interests of public health were best served by making it compulsory to wear cycle helmets.

Opponents of cycle helmet legislation often misguidedly point to Australia as an example of how a fall in the number of people cycling can follow helmet legislation. However, a letter drafted by the Ministry of Transport in Western Australia to Headway states that '...while initially there was a decline in cycling, the trend reverted to normal within a few years...It appears the majority of Western Australians are not dissuaded from cycling by the requirement to wear a helmet'.

In addition, no such reduction in the number of people cycling has been recorded in American states that have introduced similar laws.

Another myth is the claim that helmet laws have not been effective when introduced into other countries. Following the introduction of a law in the State of Victoria, Australia, the number of cyclists killed or admitted with head injuries fell by between 37% and 51%.

In the USA, although there is no federal law, a total of 22 states have passed cycle helmet legislation with the majority of the laws only concerning children. Nationwide, the number of annual deaths among cyclists younger than 16 has declined by 84% since 1975; in contrast, the annual number of deaths among cyclists over the age of 16 has more than doubled in the same period.

In its 2009 review of the evidence regarding the potential for cycle helmets to prevent injury, the Transport Research Laboratory, the independent research, consultancy, testing and advice body for transport in the UK, states '...cycle helmets should be effective at reducing the risk of head injury, in particular cranium fracture, scalp injury and intracranial (brain) injury.'

In addition, it concludes that:

• 10- 16% of fatalities could have been prevented by a cycle helmet
• cycle helmets would be particularly effective for children
• no evidence was found for an increased risk of rotational head injury

While statistic evidence clearly exists to demonstrate that helmets help to save lives and reduce the risk of sustaining life-changing brain injuries, Headway believes the most effective way to encourage more cyclists to wear helmets is by promoting a common sense message that surely, wearing a cycle helmet must offer ones fragile skull more protection than not wearing one.

At Headway, we know the devastating effects a brain injury can have and how easy it can be to damage the brain. A number of Headway service users sustained their injuries through cycling accidents and now face spending the rest of their lives wishing they'd chosen to wear a helmet. To those people, statistics are meaningless.

Use your head – wear a helmet.

Cycle helmet research is controversial, but it seems clear that only a tiny proportion of riders (around 6% according the TRL report) are injured in crashes caused by poor cycling, and that a significant cause of serious injury including brain injury to cyclists is the lack of attention paid to them by motorists, prompting London Mayor Boris Johnson to call on the Government to change driving tests to ensure greater protection to vulnerable road users

Whilst the helmet debate continues to rage, it remains the case that defendants in cycle accident claims have yet to prove in court that failure by the claimant to wear a helmet would in fact have made any difference to the severity of the injuries suffered. 

 * Reproduced by kind permission of the Bicycle Helmet Research Foundation

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