London study shows different nature of injuries suffered by cyclists in collision with cars and HGVs

Head injuries more prevalent in incidents involving by cars, while lorries cause torso, pelvis and lower limb injuries

by Simon_MacMichael   March 6, 2012  

London Concrete lorry and bikes (copyright Simon MacMichael)

A study of admissions of seriously injured cyclists at a major London hospital has revealed that those involved in a collision with an HGV were more than three times as likely to die as those in an incident involving a car, and provides new insight into the different nature of injuries that collisions with each type of vehicle are likely to lead to.

The study, believed to be the first to analyse admissions of cyclists to hospital by the type of vehicle involved and the nature and severity of injuries, has been published online by the Emergency Medical Journal.

It was conducted by researchers from the Trauma Clinical Academic Unit at the Royal London Hospital, Queen Mary University and the London Helicopter Emergency Unit, analysed the records of 265 cyclists admitted during the six-year review period, an average of 44 a year.

Those admissions made up 4 per cent of cases necessitating the involvement of the hospital’s full trauma team, 3 per cent of the deployments of the London Air Ambulance and 5 per cent of fatalities, noted the study.

While cyclists involved in a collision with a car were more likely to survive, with a fatality rate of 6 per cent compared to 21 per cent of those where the incident involved an HGV, they were more likely to sustain head injuries, while collisions wih lorries were more likely to lead to serious injuries to the pelvis, torso and limbs.

According to the study, patients seriously injured collisions with HGVs also spent longer in the hospital, with an average stay of 12 days; however, many of those were subsequently transferred to another hospital, suggesting the injuries were of a long-term nature, and this area will be the subject of further research.

The study also highlighted that blood loss is a major cause of death among cyclists involved in road traffic incidents, highlighting the need to rapidly transfer them to a major trauma unit where surgeons could work to get bleeding under control, although it added that taking steps to prevent collisions in the first place remained a priority.

Generally, uncontrolled blood loss was said to be a factor in around half of deaths taking place shortly after serious injury, while one in four patients suffer a malfunction in their body’s ability to clot blood, an issue that is a key focus in trauma research at Queen Mary.

Dr Joanna Manson, Trauma Research Fellow at Queen Mary and Surgery Registrar at the Barts and The London NHS Trust, said: "Patients are more likely to survive severe injury if they are treated in a major trauma centre, such as The Royal London Hospital, but the injuries caused by colliding with a car or an HGV can be very serious and some patients cannot be saved.

"Overall, increasing cycling in our cities is beneficial both to the individual and to the city but the risk of injury remains a major deterrent. Exactly how to improve the safety for people cycling in urban environments is unclear and we need more evidence to guide policy making in this area," she added.

According to the study, admissions of seriously injured cyclists rose from 24 in 2004, a year in which no fatalities were recorded at the hospital, to 69 plus eight fatalities in 2009.

While The Times, which last month launched its Cities Fit For Cycling campaign, focused on those figures, which show that admissions of seriously injured cyclists increased nearly three-fold during the period in question, that upwards trend is not reflected in official London-wide statistics, and moreover comes in the latter half of a decade in which cycling on London’s roads more than doubled.

According to Transport for London (TfL) figures, eight cyclists died and 332 were seriously injured on the capital’s roads in 2004, rising to 13 killed and 420 seriously injured – the latter reflecting a 26.5 per cent increase on the earlier figure – in 2009.

Comparing those figures with the ones in the Royal London study suggests that as a proportion of the cyclists seriously injured in London, admissions to the hospital more than doubled from 7.2 per cent to 16.4 per cent between 2004 and 2009.

However, it should be noted that 2004 saw the lowest recorded levels of both death and serious injuries among cyclists in London over the past two and a half decades. In the five previous years, 1999-2003, TfL data show an average of 17 fatalities and 430 serious injuries, while for 2005-09, the respective figures are 17 and 404.

While the vast majority of patients admitted to the hospital are brought there by the London Ambulance Service or London’s Helicopter Emergency Medical Service, often deployed in major trauma cases, it also admits a small proportion who number of patients who arrive via the Essex & Herts or Kent & Surrey air ambulances.

In terms of admissions, the Royal London has by far the busiest accident & emergency department in London. A study, London’s Trauma Workload, conducted over three weeks in March 2009, showed that during the period it had around double the admissions of the next closest major trauma unit, at King’s College Hospital in South London, with nearly half the Royal London’s patients brought there by air ambulance.
 

28 user comments

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This data further reinforces my opinion that cycle helmets are of little value in boosting safety amongst cyclsits.

OldRidgeback

posted by OldRidgeback [2299 posts]
6th March 2012 - 15:50

5 Likes

When you have whacked your head on metal or tarmac at 20mph or so without your helmet on, do come back and tell us how you got on.

posted by jamtartman [41 posts]
6th March 2012 - 17:01

7 Likes

don't make me get the kittens out, people

Dave Atkinson's picture

posted by Dave Atkinson [7492 posts]
6th March 2012 - 17:08

4 Likes

It does show the need to reduce HGVs in London generally, as well as reducing them at peak rush hour (when there are more cyclists out).

posted by thereverent [317 posts]
6th March 2012 - 17:51

6 Likes

jamtartman wrote:
When you have whacked your head on metal or tarmac at 20mph or so without your helmet on, do come back and tell us how you got on.

Absolutely. I'm sooooo very tired of all the 'data' studies of polystyrene thickness and impact physics. Dear old Ridgeback. As a friendly experiment would you like me to whack you over the head with a cricket bat with your helmet on - or without? Helmets maybe next to useless but no helmet at all is err. useless. Big Grin

Silly me. You're probably right....

MercuryOne's picture

posted by MercuryOne [1090 posts]
6th March 2012 - 19:52

6 Likes

I'm more than happy to whack some heads together. Angry People, do you not realise, h**mets are a device to drive a wedge between us and damage the efficacy of good safety campaigning. Thinking

downfader's picture

posted by downfader [204 posts]
6th March 2012 - 20:48

4 Likes

Read the news item again guys. I think you've missed something.

I'll wear my skate lid when I'm at the skatepark with my BMX or the MX lid when I'm riding my BMX at a track.

I'm allergic to cats Dave.

OldRidgeback

posted by OldRidgeback [2299 posts]
6th March 2012 - 21:14

5 Likes

I had a high speed crash last year, about 40mph, after skidding on a diesel spill, luckily there were no other vehicles around me at the time. I forward rolled still clipped in and destroyed my helmet during the crash, I only realised this after dragging my bike and myself off the road. I dread to think what my injuries would have been without my helmet, I know that I wouldn't have been shouldering my broken bike and calling work to let them know I wouldn't be in, that call would have been made by someone else.
Oldridgeback get a helmet and wear it if not for yourself for family and friends.

I love the smell of cleats (mexican accent, you do the jokes)

posted by paulfrank [80 posts]
6th March 2012 - 21:18

5 Likes

how's about you all stop pissing and moaning about helmets and actually read the article and comment on the issues therein?

something needs to be done about HGVs, especially tippers and cement lorries which aren't designed for city use and simply aren't safe there. they should either be banned during rush hour or forced by law to fit side bars, sensors and effective mirrors

purplecup's picture

posted by purplecup [232 posts]
6th March 2012 - 21:39

6 Likes

DAVE... kitten time...

posted by FMOAB [238 posts]
6th March 2012 - 21:56

6 Likes

paulfrank wrote:
Oldridgeback get a helmet and wear it if not for yourself for family and friends.

Read this:
"I'll wear my skate lid when I'm at the skatepark with my BMX or the MX lid when I'm riding my BMX at a track."

Yep, helmets are not the main answer to safety with regard to road riding as the biggest risk of serious injury comes from HGVs and a lightweight bit of plastic on your bonce is not going to protect you from crush injuries if you go under the wheels of one of those. Requiring HGVs to use the roads during off-peak periods at night for example would be one effective way to allow those truck deliveries we're so reliant on while making a significant reduction in the risk to vulnerable road users. The risks could be further reduced by legal requirements for detection/warning technology for the driver. Most of these also have audible warnings that would tell a cyclist when they're in the danger zone. These should be compulsory for all HGVs on UK roads - including foreign registered trucks - it'd be a good idea for EC trucks to have them fitted too but I know how difficult that would be to push thru in Brussels.

OldRidgeback

posted by OldRidgeback [2299 posts]
7th March 2012 - 9:02

5 Likes

Come on Dave, quick! This is getting serious, we need the kittens.

Simon E's picture

posted by Simon E [2049 posts]
7th March 2012 - 10:08

4 Likes

I agree that HGVs, particularly foreign ones, are a major hazard but the legislation you guys are looking for just won't happen, or won't happen soon, so it's down to us to look after ourselves as much as we can.
Helmets, dayglow, and reflectives are the simple things we can do, beyond this we need to look at defensive riding techniques (making and taking your space on the road to deter "squeeze passes" and SMIDSY drivers) and training new/young riders in those techniques.
Also don't be afraid to exercise your rights under Section 59 of The Road Traffic Act and report "vehicles used in a manner causing alarm, distress or annoyance"; 2 strikes in 12 months and that vehicle will be seized and crushed,they don't half slow down after that first letter drops on their doormat Big Grin

I love the smell of cleats (mexican accent, you do the jokes)

posted by paulfrank [80 posts]
7th March 2012 - 11:13

3 Likes

OldRidgeback wrote:
This data further reinforces my opinion that cycle helmets are of little value in boosting safety amongst cyclsits.

Sir, if cycling with a helmet on reduces my risk of serious injury by 0.0x percent I will happily wear my helmet for the other 99.9x percent of the time ... think helmet hair is a price worth paying when the other option is my life. Sorry you feel otherwise, I wish you all the best and hope you live nearer safer roads than myself.

RhysW's picture

posted by RhysW [77 posts]
7th March 2012 - 13:30

4 Likes

jamtartman wrote:
When you have whacked your head on metal or tarmac at 20mph or so without your helmet on, do come back and tell us how you got on.

Surely as far as I know helmets are not designed to withstand 20 mph direct impacts.

antonio

antonio's picture

posted by antonio [1011 posts]
7th March 2012 - 14:08

5 Likes

The helmet might not survive the impact but it's going to go along way to making sure you do.

I love the smell of cleats (mexican accent, you do the jokes)

posted by paulfrank [80 posts]
7th March 2012 - 14:29

5 Likes

paulfrank wrote:
I agree that HGVs, particularly foreign ones, are a major hazard but the legislation you guys are looking for just won't happen, or won't happen soon, so it's down to us to look after ourselves as much as we can.

that's one way of looking at it. another is to concentrate on the big wins and not get sidetracked by the small wins. there's no amount of dayglo and polystyrene that you can wear that'll make you safe under the wheels of a lorry. the big win is to remove the conflict between the cyclist and the lorry. that's why places where that's the top priority have the best record in cyclist safety.

paulfrank wrote:

we need to look at defensive riding techniques (making and taking your space on the road to deter "squeeze passes" and SMIDSY drivers) and training new/young riders in those techniques.

so you want me to train my 6-year-old daughter to ride in the middle of the road in front of lorries, rather than spend my time campaigning for safer places for her to ride? it's an interesting suggestion, but i think i'll carry on pushing for better facilities.

paulfrank wrote:

Also don't be afraid to exercise your rights under Section 59 of The Road Traffic Act and report "vehicles used in a manner causing alarm, distress or annoyance"; 2 strikes in 12 months and that vehicle will be seized and crushed,they don't half slow down after that first letter drops on their doormat Big Grin

if you've any evidence of that section of the RTA being invoked due to a report by the member of the public of bad driving, i'd be really interested to see it. the only instances i've ever seen it invoked is directly by the police for green laning and cruising. If you're suggesting that I can go to the police with a number plate and a complaint and they'll hand out a section 59 notice, then everything i've ever read on here suggests otherwise. It's hard enough to get someone into court when you have video evidence of a driver verbally threatening to kill you, or punching you in the face.

Dave Atkinson's picture

posted by Dave Atkinson [7492 posts]
7th March 2012 - 14:32

6 Likes

RhysW wrote:
Sir, if cycling with a helmet on reduces my risk of serious injury by 0.0x percent I will happily wear my helmet for the other 99.9x percent of the time ... think helmet hair is a price worth paying when the other option is my life. Sorry you feel otherwise, I wish you all the best and hope you live nearer safer roads than myself.

This is interesting because it's not the same mentality we have with other activities that have a similar or higher risk of head injury. These include DIY, and being a pedestrian.

The main reason that the mentality is different, so far as I can see, is because it's possible to buy a cycle helmet but not a DIY or walking helmet. The fact that cycle helmets exist suggests that it's a risky activity when, in real terms – that is, compared to lots of other stuff we don't think is risky – it isn't.

The problem with that is that when something's deemed risky, suddenly the onus is on the person partaking in the risky activity to protect themselves, not the people that are actually causing the risk: in this case, people in motor vehicles.

head over to the netherlands, and no-one wears a helmet because cycling isn't considered risky. so lots more people do it. people still fall off their bikes and hit their heads and die, of course, but that's life. and the health benefits of cycling far, far outweigh the risks, even in this country.

Dave Atkinson's picture

posted by Dave Atkinson [7492 posts]
7th March 2012 - 14:55

5 Likes

also, please let's not either a) confuse hammering down an alpine pass at 50mph with pootling a mile to work on a hybrid; or b) assume that those two things carry the same inherent risks

Dave Atkinson's picture

posted by Dave Atkinson [7492 posts]
7th March 2012 - 14:57

5 Likes

I have put a helmet to good use on 2 occasions now. 2 helmets destroyed, one head still intact.

In one of the accidents, I put a dent the size of a water melon in the wing of a Ford Fiesta with my noggin.

I must add though, that I have never been under the wheels of an HGV.

posted by jamtartman [41 posts]
7th March 2012 - 15:29

4 Likes

Dave, I agree that we should campaign to make roads and other by-ways safer for all users but until those laws are in place we've got to protect ourselves as best we can.

I am teaching my 6 year old daughter to ride on suitably quiet roads and cycle paths and as she gets older we will move onto busier roads but only when she feels ready and I believe she has the maturity required.

As for Section 59 the Community Support Officer for our area is more than willing to follow up on reports of careless and dangerous driving and has asked me to file reports; maybe that is not the norm everywhere but I hope it is.

I love the smell of cleats (mexican accent, you do the jokes)

posted by paulfrank [80 posts]
7th March 2012 - 15:37

4 Likes

paulfrank wrote:
Dave, I agree that we should campaign to make roads and other by-ways safer for all users but until those laws are in place we've got to protect ourselves as best we can.

I am teaching my 6 year old daughter to ride on suitably quiet roads and cycle paths and as she gets older we will move onto busier roads but only when she feels ready and I believe she has the maturity required.

me too. but my point is that we should be concentrating on the big wins. this kind of story always descends into a helmet rant. helmets aren't the solution, they're a symptom of the problem and a red herring. people focus on helmets and don't tackle the wider issues. that's my main beef with helmets.

paulfrank wrote:
As for Section 59 the Community Support Officer for our area is more than willing to follow up on reports of careless and dangerous driving and has asked me to file reports; maybe that is not the norm everywhere but I hope it is.

it most certainly isn't the norm everywhere.

Dave Atkinson's picture

posted by Dave Atkinson [7492 posts]
7th March 2012 - 15:47

5 Likes

I would love the big win of crash safe HGVs or a useful connected up cycle network, or even the small win of all BMW drivers, who are far more dangerous than any HGV IMHO, being rounded up in a field and nuked Cool but until then I'll be wearing a helmet, huge reflective rucksack, 3 rear lights and 3 front lights to fend of the idiots

I love the smell of cleats (mexican accent, you do the jokes)

posted by paulfrank [80 posts]
7th March 2012 - 16:10

4 Likes

dave_atkinson wrote:
RhysW wrote:
Sir, if cycling with a helmet on reduces my risk of serious injury by 0.0x percent I will happily wear my helmet for the other 99.9x percent of the time ... think helmet hair is a price worth paying when the other option is my life. Sorry you feel otherwise, I wish you all the best and hope you live nearer safer roads than myself.

This is interesting because it's not the same mentality we have with other activities that have a similar or higher risk of head injury. These include DIY, and being a pedestrian.

The main reason that the mentality is different, so far as I can see, is because it's possible to buy a cycle helmet but not a DIY or walking helmet. The fact that cycle helmets exist suggests that it's a risky activity when, in real terms – that is, compared to lots of other stuff we don't think is risky – it isn't.

The problem with that is that when something's deemed risky, suddenly the onus is on the person partaking in the risky activity to protect themselves, not the people that are actually causing the risk: in this case, people in motor vehicles.

head over to the netherlands, and no-one wears a helmet because cycling isn't considered risky. so lots more people do it. people still fall off their bikes and hit their heads and die, of course, but that's life. and the health benefits of cycling far, far outweigh the risks, even in this country.

RhysW's picture

posted by RhysW [77 posts]
7th March 2012 - 20:09

4 Likes

RhysW wrote:
OldRidgeback wrote:
This data further reinforces my opinion that cycle helmets are of little value in boosting safety amongst cyclsits.

Sir, if cycling with a helmet on reduces my risk of serious injury by 0.0x percent I will happily wear my helmet for the other 99.9x percent of the time ... think helmet hair is a price worth paying when the other option is my life. Sorry you feel otherwise, I wish you all the best and hope you live nearer safer roads than myself.

Just so you know, I live in a place called London, which you may have heard of. It is quite a big and busy city, with high traffic densities at peak periods and no, I don't live in the quiet leafy suburbs. I've commuted by bicycle there for many years and had many interesting experiences. I can't think how wearing a helmet, which I do sometimes, would've protected me in any of the close calls I've had caused by bad driving.

OldRidgeback

posted by OldRidgeback [2299 posts]
8th March 2012 - 8:48

4 Likes

OldRidgeback wrote:
RhysW wrote:
OldRidgeback wrote:
This data further reinforces my opinion that cycle helmets are of little value in boosting safety amongst cyclsits.

Sir, if cycling with a helmet on reduces my risk of serious injury by 0.0x percent I will happily wear my helmet for the other 99.9x percent of the time ... think helmet hair is a price worth paying when the other option is my life. Sorry you feel otherwise, I wish you all the best and hope you live nearer safer roads than myself.

Just so you know, I live in a place called London, which you may have heard of. It is quite a big and busy city, with high traffic densities at peak periods and no, I don't live in the quiet leafy suburbs. I've commuted by bicycle there for many years and had many interesting experiences. I can't think how wearing a helmet, which I do sometimes, would've protected me in any of the close calls I've had caused by bad driving.

How odd, I too live in London, somebody once said something interesting when I was doing something for an adrenaline fix (not on a bike) 'it's your life'. I don't think a helmet will provide me protection if I come off my bike .. I know it will. I don't think helmets should be made compulsory though, but I am glad to see more people wearing them.

RhysW's picture

posted by RhysW [77 posts]
8th March 2012 - 9:23

4 Likes

I do wear a helmet out of choice, but surely there is evidence that they can make death and paralysing neck injury more likely. Plus since car/van drivers pass helmet wearers 4 inches closer than the bare headed there is more chance of being struck by a wing mirror. So I'm, not sure you can simply say that helmet even provides 0.0% protection. But as I say I DO wear a helmet - I guess I'm just confused.

posted by Actium [42 posts]
8th March 2012 - 16:20

4 Likes

purplecup wrote:
how's about you all stop pissing and moaning about helmets and actually read the article and comment on the issues therein?

something needs to be done about HGVs, especially tippers and cement lorries which aren't designed for city use and simply aren't safe there. they should either be banned during rush hour or forced by law to fit side bars, sensors and effective mirrors


[[[[[[Purplecup---that's more like it, squire.
P.R.

PhilRuss

posted by PhilRuss [305 posts]
30th November 2012 - 16:22

3 Likes