We ask a neurosurgeon and T&O consultant for their views on the importance of helmets in cycle safety
'Yes' - The neurosurgeon’s personal view
I am a neurosurgeon and a cyclist, and I am also married to a dedicated cyclist. I wear a cycling helmet and encourage cyclists to wear one. I don’t find that wearing one impedes me in any way. I am under no illusion that it will save me in the event of a high speed collision with a car or lorry (nothing will), but most cycling accidents aren’t of the high-speed variety.
Cycling has very substantial health and other benefits, whereas the risks of cycling are not especially high. Road safety policies should prioritise measures that reduce the risks that deter people from cycling – traffic speeds, hostile roads and junctions, dangerous or irresponsible driving, and lorries – and offering quality cycle training for people of all ages, to give them the confidence and skills to ride safely on the roads.
Most of the head injuries I have seen in cyclists are the result of low velocity crashes or simple falls due to ice or wet roads. There is no doubt in my mind that a well-fitting cycle helmet will reduce the incidence of scalp laceration and open fracture and will help to reduce the energy transfer to the brain.
It is right for sports governing bodies to make the wearing of cycle helmets mandatory, given the different types of risk to which sport cyclists are exposed.
The Highway Code Rule 59 says, “A cycle helmet which conforms to current regulations, is the correct size and securely fastened, should be worn.” I do note that does not make cycle helmets compulsory. However, in my department all neurosurgeons, neurologists neurointensivists and neuroanaesthetists wear cycling helmets when cycling – we can’t all be mad!
Ms Lynn Myles
Consultant Neurosurgeon, Western General Hospital, Edinburgh, and keen cyclist
'No' - The orthopaedic surgeon’s personal view
I am a consultant Trauma orthopaedic surgeon working in Edinburgh and have many years of experience treating cyclists after serious road traffic, cycle sport and commuting cycle injuries.
I believe there is no justification for helmet laws or promotional campaigns that portray cycling as a particularly ‘dangerous’ activity, or that make unfounded claims about the effectiveness of helmets. By reducing cycle use even slightly, helmet laws or promotion campaigns are likely to cause a significant net disbenefit to public health, regardless of the effectiveness or otherwise of helmets.
The effectiveness of helmets is in any case far from clear. They are (and can only be) designed to withstand minor knocks and falls, not serious traffic collisions. Some evidence suggests they may increase the risk of cyclists having falls or collisions, or suffering neck injuries. Whilst there is a correlation between helmet guidelines and reduced cyclists’ injury numbers, the evidence suggests this is wholly or mainly due to reductions in cycle use, not improvements in safety for the cyclists who remain.
Reduced cycle use may itself explain why the remaining cyclists are more at risk, due to the loss of the benefits they previously gained from ‘safety in numbers’. Government and other bodies concerned with health or road safety should simply aim to encourage people to cycle, regardless of whether or not they choose to wear helmets when doing so. Enforced helmet laws cause deep and enduring reductions in cycle use, undermining its very substantial health and other benefits. Given that the risks of cycling are low – they are not greatly different from those of walking or other forms of active recreation – even a very small reduction in cycle use would be counter-productive to health and other public policy objectives.
Cycle helmets have, in any case, not been shown to be an effective way to reduce cyclists’ injury risks. Indeed, they might even be counter-productive, by encouraging drivers or cyclists to behave less cautiously, and/or by increasing the risks of neck and other injuries.
Enforcing helmet laws would require levels of policing that would be grossly disproportionate to any possible benefits. Conversely, unenforced helmet laws make no long-term difference to helmet use, and therefore cannot provide benefits in any case.
Individuals should be free to make their own decisions about whether or not to wear helmets, with parents making these decisions in the case of younger children. Their decisions should be informed by clear information about the uncertainties over helmets.
Schools, employers and the organisers of non-sporting cycling events (e.g. sponsored rides) should not seek to impose helmet rules for their pupils, staff and participants. These rules are not justified in terms of health and safety, they are likely to reduce the numbers and diversity of people who take part in cycling, and they may in some circumstances be illegal.
There is limited evidence on the risks involved in different types of off-road recreational cycling (from family riding to downhill mountain biking) and cycle sport. Likewise, evidence on the potential for helmet use to mitigate (or exacerbate) these risks is equally limited. These are, in any case, not matters for road safety policy.
Mr Chris Oliver
Consultant Trauma Orthopaedic Surgeon, Edinburgh Royal Infirmary and Chair of the Cyclists’ Touring Club Scotland