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Transport Research Laboratory: Mandatory helmet laws “prevent head and brain injuries”

Jersey's helmet laws for children should be repeated across the UK says report from leading transport research centre...

The new legislation forcing all under 14s to wear helmets in Jersey will “prevent head and brain injuries”, according to a report by the Transport Research Laboratory (TRL).

The respected centre for transport research was commissioned to review literature on helmet laws and cycling injuries, as well as a possible disincentivising of cycling.

In its report, it concluded that the legislation would “prevent head and brain injuries, especially in the most common collisions that do not involve motor vehicles, often simple falls or tumbles over the handlebars”.

It added that cycle helmet legislation “leads to reductions in injuries in all ages of cyclists, although helmets are particularly effective for children”, and “the plausible mechanism by which this benefit occurs is that legislation tends to lead to increased wearing rates”.

Richard Cuerden, technical director for vehicle safety at TRL and an author of the report, told Road Safety GB: “There is no doubt that cycle helmets are effective in a crash, although some anti-helmet advocates still argue the opposite.

“The other arguments frequently made against them include, they put people off cycling and this results in a net health disbenefit; some even argue that helmet wearing increases the risk of an accident.

“These are extremely serious claims and the literature surrounding these issues was considered very carefully.”

TRL found that current evidence “does not support the assertion that cycle helmet legislation leads to large reductions in cycling participation that outweigh any potential injury reduction benefits through a corresponding reduction in health benefits”. It adds that any reductions in cycling activity “are likely to be small and short term”.

Richard Cuerden added: “Firstly, it is not true to state that the accident rate has been proven to be higher for helmet wearers per km of travel - this is simply not an accepted fact.

“The very large reductions in cycling activity cited by opponents of cycle helmet legislation are based on early analyses of observations of cycling rates in Australia in the 1990s, which subsequently have been shown to be statistically flawed.

“It is also important to remind ourselves that cycle helmet designs were very different in the early 1990s to those currently available, in terms of materials, ventilation, coverage, comfort and even styling.”

TRL said its report raises important questions for the rest of the UK, including “how can cycle helmet wearing rates be increased to help reduce head and brain injuries suffered across all regions of the British Isles?”.

TRL added “the lack of information regarding the size and nature of the cyclist casualty problem” is a challenge….”because the vast majority of single vehicle cycle accidents that result in hospitalisation are not reported to the police and there is limited hospital data available on the injuries sustained”.

Richard Cuerden concluded: “Cycle helmets are effective, but it is equally important to actively identify and improve other casualty reduction measures including road design - especially at junctions, cyclist conspicuity, cyclist and other road users training and behaviour, enforcement, the crashworthiness of other vehicles and new accident avoidance technologies.

“I believe it is clear that cycle helmets are an integral part of a safe system approach, which in my opinion should seek to promote and increase the rate of cycling whilst setting stretching casualty reduction targets, ultimately striving towards zero deaths and serious injuries.”

Deeply divided medical views

Views on mandatory helmets are deeply divided in the medical world. Recently we reported how a consultant paediatric neurosurgeon from Bristol said cycle helmets save lives.

Michael Carter of Bristol Children's Hospital says he treats an average of three children a month who have suffered a head injury while cycling that he believes would not have happened if they had been wearing a helmet.

His views conflict with those of Henry Marsh of St George’s Hospital in Tooting, South London, who as we reported the previous month, who said that helmets had not benefited patients in his care who had been involved in bike crashes.

Mr Marsh told the Hay Festival: “I ride a bike and I never wear a helmet. In the countries where bike helmets are compulsory there has been no reduction in bike injuries whatsoever.

“I see lots of people in bike accidents and these flimsy little helmets don’t help.”

He also cited research by Dr Ian Walker from the University of Bath who found that motorists gave less space to riders wearing helmets, because they perceived them as being safer than those without the headgear.

But Mr Carter insisted that the case against wearing helmets was “weak” and often founded on research that was small in sample size. He also said his experience at work contrasted with that of Mr Marsh.

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43 comments

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giff77 | 10 years ago
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Farrell. I totally agree. There's no way the government will ever implement those few illustrations I made. They're in two much awe of the car and petroleum lobbies. Even the Scottish Executive who like to have firsts won't even pursue strict liability as there is no "credible evidence that it works" in their view. I'm totally against compulsion. I don't want to have to get tooled up to go to the shops/pub/cinema by bike. Look at my ugly bake in my profile pic. I'm San Helmet. If folk wish to wear helmets, by all means. I'm not stopping them. But in 40 odd years cycling I can count on one hand the amount of times I've fallen off. And then at low speed where I sprained my wrist on the worst crash. I've had one high speed crash where I wrote off a pair of tights trying to swerve a iPhone engrossed ped.

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giff77 | 10 years ago
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I'll be quite happy to endure helmet compulsion. But in return I want several MUSTS and MUST NOTS implemented in the highwaycode. Such as: Must not pass a cyclist within 1.5 meters. Must not cut up a cyclist within 25 meters of a junction. Must not cut up a cyclist when exiting a roundabout. Must allow a cyclist to execute a right turn safely. All punishable with a £120 fine and three points. I would also like the police to deal with situations reported and not shrug their shoulders and ask what do you want us to do about it. Finally. If we are to take all these steps to protect ourselves then I want to see a statutory lifetime driving ban on any motorist causing death of a vulnerable road user no questions asked.

Somehow though I can't see this happening so I will continue being anti compulsion.
The helmet compulsion is the easy way out for governments to say they have dealt with road safety.

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farrell replied to giff77 | 10 years ago
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giff77 wrote:

I'll be quite happy to endure helmet compulsion. But in return I want several MUSTS and MUST NOTS implemented in the highwaycode.

And those MUST and MUST NOTS will not be implemented, however, what you would have is a situation where your happiness for helmet compulsion would mean that I am now a criminal because I decided to swing a leg over my bike and nip to the shop or if I was just doing a bit of a loop on the street when fettling.

Helmet compulsion is bullshit and should be fought against.

Wear one if you want, or don't wear one if you don't want to wear one, but don't try and make me a criminal if I make a decision to not perch some polystyrene on my head.

(Just to be clear, although I've quoted part of your post Giff, my response isn't actually aimed at you personally by the way.)

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NeilWyn | 10 years ago
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As ever it's hard to know which statistics to believe. I can understand the wish to protect children, who from memory 'propably' have more collisions when riding bikes than adults, but am against compulsion. There are many activities we do as children where helmet use may prevent some head injuries (skateboarding, climbing trees! running!!), where would we stop. My daughter always wore a helmet when growing up (through our insistence) though now chooses not to as a young adult - fair enough!
Personally after 2 collisions of head with road (poor handling, my own fault) in 12 months I now rarely venture further than local shops without a helmet, but still believe we should choose.

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CommuterCyclist | 10 years ago
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Anyone who thinks that the effect of reduced cycling is temporary should look at what happened after helmet laws in New Zealand. From 1989 to 2011, average time spent cycling (on roads and footpaths) fell by 79% for children aged 5-12 (from 28 to six minutes per person per week) and 81% for 13-17 year olds (52 to 10 mins/person/week).

The graphs show that the helmet law was almost certainly part of the reason for the decline - http://www.cycle-helmets.com/new-zealand-road-users.html

In 1987/88, before the introduction of helmet laws, 4.4% of New Zealanders cycled to work, 11.6% cycled to primary school and 18.6% to secondary school 16. By 2004/08, only 2.2% cycled to work, 4.3% to primary school and 4.9% to secondary school.

A survey of children in New South Wales also showed that the drop in children's cycling is neither small nor temporary: 51% of schoolchildren owning bikes, who hadn’t cycled in the past week, cited helmet restrictions, far more than other reasons, such as safety (18%) or parents (20%). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410838/

In NZ, pedestrian injuries from motor vehicle crashes fell by 42%, but the decline for cyclists was only 27% (from 8.2 to 6.0 per million hours). At the same time, hospital admissions from crashes not involving motor vehicles increased dramatically, e.g. in 15-19 year olds (from 11.6 to 45.9 injuries per million hours).

Other researchers concluded that helmet laws discourage the safest cyclists, so perhaps the large increase in injury rates is not surprising http://cyclehelmets.org/1207.html?NKey=101 There may have been a move away from relatively safe transport cycling to sports cycling and mountainbiking.

Real-life data (as opposed to the selective reporting by TRL) show that the main effect of helmet laws is to discourage cycling and that, if anything, injuries per cyclist increase.

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levermonkey | 10 years ago
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 14 +  2 +  102 +  7
I've just read the report in full. I'm appalled. This report is a case of "This is the answer we want now provide us with the evidence". It's not good science, in fact it's not science at all.

Science is not about knowing the answer but knowing what the question is. This is why sociology is not a science but a humanity.

This legislative procedure is a disgrace. To railroad this legislation through without proper debate is a scandal. The CTC and Sustrans were given less than a day to read and respond.

As you can probably gather I am at a loss to express my feelings about what has occurred. It is beyond belief!

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sean1 | 10 years ago
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The Jersey legislation will do little help the overall health and well being of the population.

From a recent BMA report ;

http://bma.org.uk/transport

The BMA basically recommended a massive shift in transport planning and infrastructure from motor vehices to walking and cycling.

They cited the health benefits and reduction in accidents this would bring in.

However this type of report falls on deaf political ears, much easier to legislate against something that will have minimal effect on head injuries.

Most head injuries in Under 16s are caused by accidents in the home, playground accidents, and as passengers in motor vehicle accidents.

So any politician serious about reducing head injuries in the population would tackle these issues first.

Also lots of sports activities are responsible for many concussion injuries, mainly football and rugby. Helmets here? Thought not.

Michael Carter is quoted saying he sees 3 cycling related head injuries per month. So how many head injuries does he see in total in a month? And from what other causes?

As it often mentioned, countries such as the Netherlands do not have a significant issue with head injuries, and no one wears a helmet for day to day cycling.

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spen | 10 years ago
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I've not read the full report but from this article it appears that the authors are referring to single vehicle incidents, "".....especially in the most common collisions that do not involve motor vehicles, often simple falls or tumbles over the handlebars”".

Where a child is involved these would be likely to below 10mph and within the design limits of the helmet so they may well be effective in reducing head and brain injury

The real question is how effective these helmets would be a few years later when a child is riding more widely, with it's parents reassured by the false sense of security the helmet has given them an the child is hit by a driver (almost put cat (edit - that should be car, unless its a big cat) there, but of course a car is incapable of most movement without instruction from a driver) doing 30?

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Northernbike | 10 years ago
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''The respected centre for transport research''

respected by whom?

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imaca | 10 years ago
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Compulsory helmet law in NZ had many strange effects, none of which increased cyclist safety. Randomly:
Massive reduction in woman cyclists, since many woman will not wear a helmet because it ruins their hair. I was working in a bike shop at the time, and the reduction in sales of child seats was spectacular. A common mode of child transport simply disappeared.
Children started carrying their uncool helmets on handle bars. You can make helmets compulsory, but people who don't already wear them will either stop cycling, carry a helmet but not wear it, or wear it in such a manner (on back of head) to render it completely useless.
The reduction in the number of cyclists left only a hard core of mostly males on the road. These became seen as slightly unhinged, as if they hadn't read the writing on the wall that everyone else had (cycling was at a much higher level in NZ compared to European countries before the legislation). Whenever there is a fatality, the fist questions asked by the media : did they have a helmet? Were they wearing high viz? Because if they weren't clearly they only have themselves to blame.
I think the failure of the bike share scheme in Melbourne (a cycle friendly place by antipodean standards) shows the fundamental truth:
cycling simply cannot exist as a normal and popular activity in places that turn it into an extreme sport requiring protective equipment.

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Initialised | 10 years ago
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The upshot of the report seems to be that helmets protect the novice from damage from the faceplant that usually follows grabbing too much brake. Surely the recommendation should be wear a helmet until you can control the bike properly not that helmets should be mandatory. Perhaps until doing Bike ability (which should be a requirement for a manual driving licence).

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ChairRDRF | 10 years ago
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For the effects of compulsory helmet legislation in New Zealand see this graph http://rdrf.org.uk/2013/12/17/the-effects-of-new-zealands-cycle-helmet-law/ with likely explanations for what it shows here http://rdrf.org.uk/2013/12/27/the-effects-of-new-zealands-cycle-helmet-l...

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dannycarr2k | 10 years ago
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Jersey has a fairly anti cycling stance when it comes to the local politicians.

Every now and again they get all fired up about making it mandatory for bikes to have a number plate.

Go riding, running or walking and every day someone will almost run you over flying round the lanes way beyond the speed limit.

But helmets and number plates will fix all that...

When did we stop being a community? The longest journey is twenty minutes, yet everyone is hell bent on shaving a minute off by flying round blind bends...

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burtthebike | 10 years ago
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The main author of this report, Richard Cuerden, was part of the much more comprehensive TRL report of 2009, which could find no evidence of helmet effectiveness. The new report says that it used the previous report as a reference, but the question has to be why was another report required when a comprehensive review had already been carried out and reached a valid conclusion? Obviously because it reached the wrong conclusion. It seems that TRL might not be quite so as independent as people think.

The report was paid for by Jersey politicians, and the outcome was decided before finger hit keyboard.

TRL used to have standards, now they just count the money.

Yet another report that will be held up as proving that helmets are effective, when it was just an exercise in justifying a decision already taken and has no scientific validity.

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Joeinpoole replied to burtthebike | 10 years ago
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burtthebike wrote:

The main author of this report, Richard Cuerden, was part of the much more comprehensive TRL report of 2009, which could find no evidence of helmet effectiveness. The new report says that it used the previous report as a reference, but the question has to be why was another report required when a comprehensive review had already been carried out and reached a valid conclusion? Obviously because it reached the wrong conclusion. It seems that TRL might not be quite so as independent as people think.

The report was paid for by Jersey politicians, and the outcome was decided before finger hit keyboard.

TRL used to have standards, now they just count the money.

Yet another report that will be held up as proving that helmets are effective, when it was just an exercise in justifying a decision already taken and has no scientific validity.

I'd agree. From reading the report it looks exactly like they started with the conclusion that their client required ... and then worked backwards from there, dismissing all evidence that proved contrary and highlighting anything that supported the conclusion.

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levermonkey | 10 years ago
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This is taken from the reports introduction.

"TRL undertook an independent review of the literature relating to mandatory cycle helmet legislation on behalf of the Jersey Scrutiny Panel. This was undertaken to help inform the policy decision regarding compulsory wearing of cycle helmets under the Draft Road Traffic (No. 60) (Jersey) Regulations 201- ...

... especially in collisions that do not involve motor vehicles; most head injuries to younger cyclists in Jersey result from collisions that do not involve motor vehicles. Further, such legislation seems unlikely to have a major impact on cycling activity in Jersey."

Please note that first sentence. This is a "review of literature", this is NOT new research.

Please note that final sentence - "unlikely to have a major impact" - So why enact it then?

It is probably less important to see what literature was included than to see what literature was excluded.

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bikebot | 10 years ago
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Sounds like an interesting report.

Does the report itself contain any suggestion that such use should be mandatory? It seems unnecessary considering that the voluntary rate is already so high.

I wear a helmet 95% of the time. Sometimes I don't because my journey is short and safe, and I can make a pragmatic and informed choice.

That seems to be what most cyclists are doing in the UK and it's working rather well.

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jacknorell | 10 years ago
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So, if the Australian study was so flawed, why do they given the very nice climate have such very low modal share for cycling?

My a**e could come up with a better study than these clowns, yet they're hired by TfL. Go figure.

Yes, I'm annoyed by these cr*p-spouting 'think tanks'.

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antonio | 10 years ago
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Riding my bike in the current heat wave with the breeze whistling around my bald head is a true delight, it's pretty good at any time actually!

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CXR94Di2 | 10 years ago
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In Holland the majority of cyclists don't wear helmets whether they be old or young. The only cyclists that I saw wearing helmets were the more dedicated cyclists on race bikes who were travelling faster than casual cyclists who were doing shopping, travelling to work etc.

Dutch statistics will disprove TRL assertion.

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CXR94Di2 | 10 years ago
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In Holland the majority of cyclists don't wear helmets whether they be old or young. The only cyclists that I saw wearing helmets were the more dedicated cyclists on race bikes who were travelling faster than casual cyclists who were doing shopping, travelling to work etc.

Dutch statistics will disprove TRL assertion.

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kie7077 | 10 years ago
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Mandatory helmet laws “prevent head and brain injuries”

Except some studies have shown the complete opposite, the science is really unclear on this. I'm not saying that helmets won't help your head if it hits the road/curb etc at just the right speed, but a study has shown that drivers drive more dangerously around cyclists that are wearing helmets. It it also thought that cyclists compensate for wearing a helmet by cycling more dangerously. Of course TRL conveniently ignore these facts.

TRL found that current evidence “does not support the assertion that cycle helmet legislation leads to large reductions in cycling participation that outweigh any potential injury reduction benefits through a corresponding reduction in health benefits”. It adds that any reductions in cycling activity “are likely to be small and short term”.

Wrong, completely demonstrably wrong.

Cycle helmets - CTC

These idiots (TRL) actually say that cycling could have a net health "disbenefit", and the obvious conclusion of that would be that it doesn't matter if less people cycle. (Page 33, middle of third paragraph).

Also note these people have been helping TFL with the cycling infrastructure over the last 20+ years, great job eh!

They just did a study for TFL, not to see where good cycling infrastructure from Netherlands and Denmark could be put in London but instead to see if it was feasible to put good cycling infrastructure in London, FFS. Along with TFL I'd say that the Automotive Transport Industry funded TRL have a bit of a anti-cyclist bent.

Where they have found evidence of helmet compulsion causing a drop in cycling, they mention those studies but dismiss them!

Are all of these people wrong? Groningen: The World's Cycling City

And these: rush hour in Utrecht

And what about car passengers and pedestrians, should they be forced to wear helmets too? No, why not?

Of note, the CTC report is against helmet compulsion, it cites 127 references.

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Mart | 10 years ago
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Helmets do save lives, if you wear one you are invincible and can bounce of cars and get run over by lorries all day with no head injuries.

They may help in some circumstances at some angles but to make them sufficient they would need to be designed in the same manner as motorcycle helmets. I'm sure they would be comfortable when hot. Do they really think some polyurethane foam is effective against a car at 60 mph?
A report into motorcycle death's when helmet' laws were introduced showed a reduction in death associated with head injuries but an increase in deaths from organ damage / failures and other injuries.

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drfabulous0 | 10 years ago
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How on Earth is this organisation "respected" when they release reports without evidence or citation?

I don't particularly care whether helmets are effective or not, as I understand it you are some 17 times more likely to receive a serious head trauma while in a car than on a bike, so why are people always banging on about bike helmets and not car helmets? It makes no sense at all, there is obviously a hidden agenda here.

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Bez replied to drfabulous0 | 10 years ago
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drfabulous0 wrote:

How on Earth is this organisation "respected" when they release reports without evidence or citation?

Have you read the report? It cites 68 references and includes evidence.

Also,

drfabulous0 wrote:

as I understand it you are some 17 times more likely to receive a serious head trauma while in a car than on a bike

That probability isn't one I recognise. Normalized by what? Where are *your* citations or evidence?

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FluffyKittenofT... replied to Bez | 10 years ago
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Bez wrote:
drfabulous0 wrote:

How on Earth is this organisation "respected" when they release reports without evidence or citation?

Have you read the report? It cites 68 references and includes evidence.

Also,

drfabulous0 wrote:

as I understand it you are some 17 times more likely to receive a serious head trauma while in a car than on a bike

That probability isn't one I recognise. Normalized by what? Where are *your* citations or evidence?

I'm doubtful that that is the correct statistic. What I think _is_ true is that the most common cause of head injury is being a car occupant in a car accident. That's not the same thing of course because you have to account for how many car journeys there are compared to bike journeys. _Per journey_ the result is presumably rather different.

e.g. a quick google search shows:
http://www.forbes.com/sites/jimgorzelany/2012/04/02/forget-football-car-...

However, that its only true in an absolute rather than per-journey sense, doesn't really change the fact that you could reduce head injuries more in absolute terms with compulsory car helmets than with compulsory bike helmets.

What I wouldn't mind seeing is a careful health-and-safety analysis of, for a given short journey, the total health impact (on everyone, not just those travelling) of choosing to drive vs choosing to cycle without a helmet vs cycling with a helmet. The first would have to take into account _all_ the health effects, including pollution and physical inactivity.

I'd be interested to see how the difference between the first two compares to that between the last two.

(Did this super long report with all its annexes and references actually do that? Because if not its not much use to me)

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kie7077 replied to FluffyKittenofTindalos | 10 years ago
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What I wouldn't mind seeing is a careful health-and-safety analysis of, for a given short journey, the total health impact (on everyone, not just those travelling) of choosing to drive vs choosing to cycle without a helmet vs cycling with a helmet.

People who cycle on average live a whopping extra 2 years. The CTCs report says that this benefit far outweighs any potential benefit of helmets, IIRC by a factor of over 30 to 1.

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Bez replied to FluffyKittenofTindalos | 10 years ago
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FluffyKittenofTindalos wrote:

I'm doubtful that that is the correct statistic. What I think _is_ true is that the most common cause of head injury is being a car occupant in a car accident. That's not the same thing of course because you have to account for how many car journeys there are compared to bike journeys. _Per journey_ the result is presumably rather different.

Yes, you have to normalize by something and it pans out a little differently for each. In-vehicle trauma is by far the biggest total contributor, but normalize it by mile, journey or hour and risk-wise it's fairly low. (Note that per mile or per journey are the most appropriate for transport, whilst per hour is often more appropriate for leisure.)

Relative risks are something I went into on this one, which contains a few links to the relevant data:

http://beyondthekerb.wordpress.com/2014/01/06/the-brick-wall/

FluffyKittenofTindalos wrote:

What I wouldn't mind seeing is a careful health-and-safety analysis of, for a given short journey, the total health impact (on everyone, not just those travelling) of choosing to drive vs choosing to cycle without a helmet vs cycling with a helmet. The first would have to take into account _all_ the health effects, including pollution and physical inactivity.

It's virtually impossible to analyse that accurately, obviously, but this is the closest attempt I've seen, published in the New Zealand Medical Journal:

http://journal.nzma.org.nz/journal/125-1349/5046/

levermonkey wrote:

Please note that final sentence - "unlikely to have a major impact" - So why enact it then?

"Unlikely to have a major impact on cycling activity in Jersey." They're saying that they don't believe passing the legislation would have a major impact on the number of people cycling or the amount they do it. Given the very high existing rates of voluntary helmet use, their view on that point seems reasonably justified (in the context of Jersey specifically, and assuming the gathered data is accurate; there is another figure given later in the report that suggests it may not be).

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dazbert replied to drfabulous0 | 10 years ago
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"So why are people always banging on about bike helmets and not car helmets?"

+1 for car helmets. And pedestrian helmets. There's little justification in arguing against it - such a law will undeniably "prevent head and brain injuries".

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Some Fella | 10 years ago
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Im no conspiracy whack job but would be interesting to delve a little deeper into the TRL (a once government agency and now a private company) and clarify who their 'partners' and clients are and if there is any conflicts of interest or factors that may 'influence' their findings.
Im always sceptical of reports from private consultancy firms, who often file reports which tell the clients,who are paying them, what they want to hear as opposed to what is actually the reality.

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