Effect of Bicycle Helmet Safety Legislation
ABSTRACT & COMMENTARY
Synopsis: Legislation mandating the use of bicycle helmets was enacted in New York state in 1994. Following enactment of the law, there was a 13-fold increase in the use of helmets among children admitted to a regional trauma center after a bicycle crash.
Source: Shafi S, et al. Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma center. J Pediatr Surg 1998;33:317-321.
Shafi and colleagues from the regional pediatric trauma center in Buffalo assessed the effect of New York state legislation mandating helmet use by children younger than 14 years that was enacted in 1994; 208 bicycle crash victims admitted to a regional trauma center from 1993 to 1995 were studied. Overall, only 31 of the children were wearing helmets at the time of the crash. Prior to the legislation, helmet use among the injured children was only 2%. It increased to 26% after enactment of the law. A similar percentage of helmeted and nonhelmeted children suffered head injuries (68% and 61%, respectively). The helmeted children predominantly suffered concussions (20/21); only one child who was wearing a helmet suffered an intracranial injury (a contusion). In comparison, there were a striking number of intracranial injuries in the 107 nonhelmeted children, including 15 hemorrhages, nine contusions, 23 skull fractures, and one case of diffuse cerebral edema. There were three fatal head injuries-all in nonhelmeted children.
COMMENT BY DAVID BACHMAN, MD, FAAP
Shafi et al point out that, each year, nearly 1000 people die from bicycle crashes, and 65% of bicycle-related head injury deaths occur in children younger than 15 years of age. Nearly 90% of fatal and nonfatal head injuries are potentially preventable with the use of helmets. This has led to a number of states enacting legislation mandating the use of helmets by children. The effect of legislation on helmet use in Buffalo is reviewed, with Shafi et al concluding that, by themselves, legal requirements are only a partial solution. To have a greater effect, legislation must be coupled with active and ongoing public education programs. The protective effect of helmet use does remain self-evident.
My own children were indoctrinated at an early age into the importance of helmet-wearing; for them, helmet use is now a subconscious part of bicycling. It is also evident that their use is enhanced by peer recognition and pressure. I did participate in an effort to draft legislation mandating helmet use here in Maine a year or so back. Despite what I thought was compelling testimony, our initiative failed (shot down by arguments such as "I didn't wear a helmet when I was a kid . . . "). A coalition is building to reintroduce such legislation; perhaps our efforts will be more successful this time around. There is no doubt that selected legal requirements can be an important part of injury prevention. Community education and reinforcement are equally important.
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