2006 Helmet Law Category Archive

Bicycle Helmet Laws in Austin (a personal take), by Mike Librik

Monday, January 7th, 2008

The Shady Origin of the 1996 Helmet Law
10 years ago I was participating in the newly formed Austin Bicycle Program’s Bicycle Advisory Council, where I sat around the table with various bike advocates. When we learned from one of the members, Doug Ballew, that he was working on bring a helmet law proposal to council there was some groaning all around, and I mentioned privately to him that there would be a divisive fight if he insisted on that course. That mention was all the warning the community got, and I wish I had the foresight and political savvy to organize an opposition then. Naively, I figured there would be a public hearing.

But the next I heard, it was a done deal. Ballew and his cohorts from some medical lobby groups, along with Mayor Bruce Todd (who was apparently gung-ho on the idea) convinced most of the council of the importance of it, and simply brought it straight to vote. The one councilmember who would have likely opposed it, Max Nofziger, was out of town on the day it came up, so it passed unanimously. Normally, it takes three readings of a motion to create an ordinance, but the council used an "emergency measures" provision and passed it on just one. So we had an all-ages helmet law with a $50 fine.

The Citizens For Cycling Freedom
So, naturally, all Hell broke loose. Hundreds of bicyclists descended on the council chambers the next week, and they kept showing up week after week. They had been disrespected by their government, which denied them due process and gave them no say in a law that affected them directly. That disrespect came right back, and they decided to have their say anyway.

The Bicycle Advisory Council broke up, with some of us putting the defeat of the helmet law as #1 priority for advancing the cause of cycling. Others supported it, and the moderates wanted to keep working on facilities while trying to ignore it.

The Citizens for Cycling Freedom formed at these meetings to begin the effort of repealing the law. We soon changed our name to the slightly shorter "League of Bicycling Voters" (it was a mouthful getting the full name of the CFCF out when identifying oneself on the telephone). The only avenue of immediate redress was a petition to repeal the law, which meant getting 35,000 signatures, so we buckled down to it. There was a civil lawsuit launched by an independent activist affiliated with the LOBV, but it eventually foundered on some bureaucratic error (the pro-bono lawyer apparently filed the wrong document, or missed a deadline, or something).

In the meantime, the city celebrated its new law with a swirl of citations. Various grumpy cyclists were hauling their tickets into court, some of which were thrown out by judges who considered the helmet violations a giant waste of time. Cops pulled cyclists over, got occasional attitude from them, and hauled the cursing and spitting cyclists off to jail. I got my ticket too, riding at 6 mph past the play scape at Zilker Park by a parks officer who was standing around handing out helmet tickets. The officer actually showed up to the court hearing and my $50 ticket stuck. Ten years later I still get recorded messages from some company, working on contract for the municipal court, telling me to pay the thing and "take this seriously."

Even though I wore a helmet prior to the law, the helmet had become less an item of "bike pride" for me ("I wear it because I am a cyclist") and more a symbol of repression. Not wearing one, thereby telling the city where to stick it, became more important. Was this irrational? Maybe so. But for me that was all the more reason why helmet laws are such a bad idea. If you really want people to adopt the helmet habit then you cannot make it a symbol of bad government. It was like "the mark of the beast," stamped on your head by the evil emperor, Bruce Todd, whose contempt for what he called "the coalition for wind in the hair" was growing with every city council meeting.

The League of Bicycling Voters
The petition eventually failed. The LOBV just did not have the staff for it, and we did not have much money. The initial group of activists gathered about 15,000 signatures in the first half of the petitioning period, but when we started to burn out on the work there was no second wave of recruits to pick up the slack. The next move came with the city elections. The LOBV took a cue from its name and pressed candidates for a commitment to repeal the helmet law, and we worked to oppose those council members who voted it in.

The change in council opened the way for a change, but it still took work. The council tends to resist repealing any ordinance before at least a year, so they kept delaying. One advocate (the one who started the lawsuit), famously marched uninvited into the office of the new mayor (Kirk Watson) and began to harangue him about it. The security guard at the front door appeared right after that. More restrainedly, a core group of LOBV members began to meet with council members to get a repeal motion placed on the agenda. Exactly one year after its passage, the new council voted to amend the all-aged law down to under-18 (they passed it as another "emergency measure," by the way). This fell short of our demands, but it took the wind out of our sails. Many supporters, tired after a year of being pissed off, fell away since they were no longer directly threatened.

10 years Later
The LOBV stuck together for a while, monitoring the enforcement of the law. By obtaining police records, we found that most of the tickets were being handed out to minorities, probably by police using probable cause to detain and question suspicious looking characters. Helmet law proponents prefer to use court records to show that enforcement was evenly distributed racially, but those records showed only those cases that went to court. We don’t know how many fines were actually paid.

Then, in early 2006, ex-mayor Todd went out on his drop-bar racing bike and crashed. He has no recollection of how it happened, but he survived, touting the protection afforded by his helmet. There was an outpouring of sympathy from the bike community, who answered his call for donations to buy helmets for poor kids. Too bad he did not leave it at that. Shortly after he began his own crusade for a new all-ages helmet law. (This seems to be his baby.)

And now here we are. Several things are different this time, though. The city council is acting more responsibly, and we are getting our public hearing up front. While the original LOBV had disbanded, we quickly reconvened. Many members had stayed in politics and built upon their experience fighting the first helmet law. Others had been working and prospering, and had more funds to support the effort.

We are confident that this proposal can be defeated, but we need a big volume of public response. We need your "no thank you" letter to council, and we need you to encourage your friends, family, co-workers, and other associates to sound off as well. This is something that affects all cyclists, both non-helmet wearers and helmet advocates alike. Folks like me who want to see helmet use increase know that this law will have the opposite effect. This law is less about cyclist’s safety and more about one guy’s personal will and his expression of personal clout.

We beat this before and we can beat it again, together, as the Austin cycling community.

News Surrounding the No Helmet Law campaign

Monday, August 7th, 2006

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Helmet Fashion Show and Rally

LOBV will hold a Helmet Fashion Show and Rally at Scholz’s
Beer Garden patio, 1607 San Jacinto Blvd, on Sunday, Aug. 20, from
5 p.m to 10 p.m.

Click here for details. Mark your calendar now.

Helmet Law Debate

LOBV’s Patrick Goetz and Former Mayor Bruce Todd squared off at the The Dionysium event on August 1 at the Alamo Drafthouse South to debate the mandatory bicycle helmet law for adults, and Goetz’s arguments won over the crowd, which voted to oppose the proposed ordinance.

Goetz, a member of the Urban Transportation Commission and co-founder of The League of Bicycling Voters, highlighted an impressive collection of statistics showing that more bicyclists and safer roads are the key to greater safety.

LOBV members also handed out fliers and collected petition signatures to educate the crowd.

KVUE TV online article

News 8 Austin online article and video

IN THE MEDIA

No Helmet Law Campaign Press Releases

Sunday, August 6th, 2006

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LOBV Press Releases

April 17, 2008 (City Council Endorsements)

April 4, 2008 (Candidate Forum)

Aug. 1, 2006 (Campaign Kick Off)

Aug. 10, 2006 (Helmet Rally Flier)

Aug. 19, 2006 (Helmet Law Rallly and Fashion Show)

Oct. 11, 2006 (Mayor Breaks Truce with Bicyclists)

March 26, 2007 (Safety Task Force Kickoff)

Position Statement on the Helmet Law

Saturday, August 5th, 2006

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1. Helmet laws distract from bicycle safety. Real safety

means training for cyclists and motorists, and good facilities.

2. Helmet laws discourage cycling. Studies have shown that

helmet laws reduce bicycle use by as much as 35%. We need

to encourage cycling, and this won’t help.

3. Oddly enough, helmets don’t seem to help bicycle safety. Though bike helmet use in the US has risen dramatically, head injuries have increased anyway. Furthermore, countries with the lowest helmet use have the lowest head injury rates.

4. Helmet laws are a violation of personal liberty. Far more head injuries occur in automobiles, so why pick on bicyclists?

5. Helmet use should be voluntary. Helmets work best that way.

6. The Austin Cycling Association, which donates hundreds of helmets to local kids, does not support the helmet law.

Differences between bicycle helmets and seatbelts

Mandatory helmet law proponents like to compare MHLs to seatbelt laws in cars. But there are some significant differences:

  1. Seatbelts come with the car – When you get into the car, the seatbelt is right there, for every seat. Bicycles do not have a helmet dispenser, so it takes extra effort and investment to get the helmet.
  2. Unbelted passengers pose a risk to other passengers – In a crash, an unbelted passenger will go ballistic. This means a 200-pound object ricocheting around the cab. While a cyclist can hurt themself in a crash, they are not likely to injure others. Wearing a seatbelt can protect others.
  3. It is difficult to defeat a seatbelt’s protection – All you have to do is fasten the seatbelt and it is working a full capacity. Indeed, new cars fasten the belt automatically so it is difficult to avoid wearing it. Bike helmets must be adjusted properly and re-adjusted often. A poorly fit helmet does not work crash. In other words, you must have a personal interest in wearing a helmet, and keep fussing with it, for it to protect you in a crash. And it has to be tight, not loose and comfy. Wearing a helmet just to satisfy the law does not mean it is going to work, and if the otherwise non-helmeted cyclist wearing one just to avoid police harassment then it will probably be loose (and comfortable) to do any real good.
  4. Seatbelt use is less visible to police scrutiny – While The DPS is on a "Click it or Ticket" campaign now, seatbelt violations usually only occur when a motorist is stopped for some other reason. Helmet violations are fully visible and will be used as cause for a traffic stop. It is much easier to conceal a seatbelt violation than a helmet violation.
  5. Last, but most far reaching… We are trying to encourage cycling – For most motorists (but not all), automobile use is essential. If forced to wear a seatbelt they will do so to keep driving. For most cyclists (but not all), biking is discretionary. If they don’t want to wear a helmet, then they use a car, or a motorcycle. Everyone and their dog will loan you the money to get a car if you don’t already have one. But even the most tepid sort of government will say that they are trying to encourage bicycling in the city. They may not do much to discourage motor vehicle use, but all agree that the volume of traffic is creating problems and it would be good we reduced automobile use. Unlike a seatbelt law, a helmet law will work counter to many other stated transportation goals.

15 Reasons to Oppose the Helmet Law

Friday, August 4th, 2006

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Bicycle helmet usage is rare in societies with large numbers of transportation bicyclists

(See, for example, The City of Cyclists Video)

Copenhagen is known far and wide as the "City of Cyclists". This is due to its longstanding and lively cycling tradition. Cycling is a socially acceptable means of transport and it is not uncommon to see Danish ministers or mayors cycle to work. Bicycle traffic in Copenhagen has grown in recent years. Currently, one out of three Copenhageners cycle to work.

The thing to notice in this video is how few bicyclists are wearing helmets. This is the norm: bicyclists in countries with large numbers of transportation bicyclists (Denmark, Holland, Japan) do not wear bicycle helmets. At the same time, the bicyclist mortality rate in these countries is 6 – 11 times lower than it is in the US.

The #1 reason to oppose a mandatory helmet law is that forced helmet use is foreign to and inhibits the establishment of a transportation bicycling culture like the one enjoyed by Copenhagen.

Helmet Laws divert attention from real safety considerations.

Bicyclists agree that by far the most important safety considerations are:

  • Education — of bicyclists and motorists
  • Defensive bicycling
  • Safe Facilities (bike lanes and bicycle-friendly roadways)
  • A properly equipped and functional bicycle

Helmet laws are often touted as a "cheap way" to improve bicyclist safety; however, there is no substitute for spending money on roadway repairs and bicycle lanes, and the best way to avoid a head injury is to not fall on your head in the first place. Education, safe facilities, defensive biking, and educated motorists prevent head injuries, not bicycle helmets!

Helmet Laws are divisive and hurt community spirit.

Transportation bicyclists feel insulted by mandatory helmet laws (MHLs) because such laws suggest that bicyclists are incapable of managing their own personal safety. Furthermore, in a car-oriented city, bicyclists are already a beleaguered minority, and MHLs represent a heavy-handed swipe at them. Far from having the effect of "people getting used to wearing helmets" as helmet law proponents have suggested, the 96-97 Austin MHL was controversial and bitterly divisive for the entire 10 months it was in place. In 1997, underdog city council candidates Bill Spelman and Willy Lewis were elected on the campaign promise that they would repeal the helmet law. Of the minority of bicyclists who supported the helmet law in 1996, most are now either opposed or neutral after witnessing the negative impact it had on the community.

An Adult Helmet Law is a particularly bad fit for Austin (no pun intended)

Austin strives to be a "creative class" city where weirdness is embraced, not criminalized. Repressive personal safety mandates are completely incompatible with attracting creative class types to live and work here in addition to sending the wrong message. The measure of the sophistication of a society is the extent of the freedoms it grants its constituents. Transportation bicycling encourages better land use because bicyclists like to live close to where they work and have shopping nearby. The city has been going to great lengths recently to promote density, mixed-use, and alternative transportation. An all-ages MHL ordinance would take us in exactly the opposite direction by discouraging bicycling.

Helmet Laws are a barrier for beginning transportation bicycling.

A lot of people get into transportation bicycling by making short neighborhood trips to the grocery store or coffee shop. A helmet law can serve as a barrier to these kinds of short rides on quiet neighborhood streets. Rather than risk being stopped by the police, and not wanting to bother with a helmet, potential bicyclists will elect to drive instead, consequently never making the transition to substantive transportation bicycling.

Nationally, increased bicycle helmet use is correlated with an increase in head injuries. [ref]

Claims that "helmets reduce the incidence of serious head injuries by as much as 85%" are almost all based on a series of studies that gathered data from Seattle-area emergency rooms in the late 1980’s and early 1990’s. Even the authors of these studies admit that these studies suffer from serious methodological flaws. For example, the same data can be used to show that "helmets reduce the incidence of leg injuries by as much as 72% [ref]". Most studies like these showing a positive impact of helmet use are hopelessly compromised by confounding variables, such as the fact that helmeted riders tend to be more cautious by nature than riders who refuse to wear a helmet. When writing about the effect of MHLs, many authors fail to take into account reductions in the number of bicyclists and other safety measures implemented at the same time (lower speed limits, etc.). When these factors are taken into account, the safety impact of MHLs is, at best, negligible. [ref]

A far more reasonable way to measure the effectiveness of helmet use is simply to look at the raw numbers on a large scale. By this measure, helmets fair rather poorly. According to an article published in The New York Times July 29, 2001, from 1991 to 2000 — at the same time that voluntary helmet use in the United States went from 18% to 50% — the number of bicyclist head injuries increased by 10%. However, during this period bicycle use actually declined by 21%, so that the effective increase in head injuries was 51% — a strong linear correlation between increased helmet use and increased head injuries.

Locally, Austin’s juvenile helmet law is correlated with an increase in bicycle-related juvenile head injuries.

The National Highway Traffic Safety Administration (NHTSA) published a five year study profiling the effectiveness of the existing juvenile Austin helmet law using 1995 as a baseline:

1995 1996 1997 1998 1999
5 6 9 7 9

Increase in juvenile helmet use: 316%.

Although statistically insignificant, juvenile head injuries did increase an average of 35% over the baseline year before the helmet law was in effect.

The only statistically significant trend associated with Mandatory Helmet Laws is a general decrease in bicycling.

Mandatory helmet laws have been shown to decrease bicycle use by as much as 44% when imposed statewide in Victoria, Australia [ref]. Proponents claim that similar reductions have not been measured in the US — this is not true: hospital data for non-head injuries suggest that youth cycling declined by around 14% across California as a result of a statewide 17 and under MHL [ref]. Many people will simply elect to stop using a bicycle for short transportation trips if burdened with wearing a helmet at all times

Mandatory Helmet Laws create the impression that transportation bicycling is unsafe.

When I encourage people to try using a bicycle for transportation, the #1 reason I get for refusal to do so is "bicycling on the street is not safe". Actually, nothing could be further from the truth. Per hour spent, bicycling is safer than walking and riding in or on a motor vehicle [ref]. Only transit is a safer way to get around on the ground. A helmet law creates the impression that bicycling is much less safe than driving, walking, or even riding a motorcycle, since only bicyclists are required to wear helmets when an MHL is in affect.

The cost of bicyclist head injuries is negligible compared to head injuries due to other causes, particularly motor vehicle accidents.

Causes of Head Injury Pie Chart

Source: http://www.cdc.gov/ncipc/tbi/Causes.htm

Per hour, driving is almost twice as deadly as bicycling and at least as likely to cause a serious head injury [ref]. Last year there were over 2.5 million injuries due to motor vehicles, and the direct cost of motor vehicle accidents is over $10 billion per year in Texas alone. If we really want to save lives and money, the key is to get more people out of cars and onto bicycles and transit. This means encouraging, not discouraging bicycling by implementing punitive laws.

The effectiveness of bicycle helmets under any circumstances is severely limited.

By design, bicycle helmets are only effective only at very low speeds (< 14mph). Any deviation from this and a bicycle helmet can actually increase the severity of injury [ref]. For example, an off-center impact on the oblong surface of a helmet or having the air vents catch on something can violently twist the head and neck, leading to a potentially fatal neck injury (pp. 173-174, The Art of Urban Cycling by Robert Hurst). Recent research on brain injury adds further confusion, suggesting that the major causes of permanent intellectual disablement and death may well be torsional forces leading to diffuse axonal injury, a form of injury which helmets cannot mitigate (The efficacy of bicycle helmets against brain injury, Curnow, WJ. 2003. Accident Analysis and Prevention: 2003,35:287-292).

Helmet Laws are only selectively enforced.

The Dallas Helmet Law appears not to be enforced. Here is a photo from a weekly ride in central Dallas.

In many weekends spent in Dallas over the past 6 months, I have yet to see even one transportation bicyclist wearing a helmet. For the roughly one year (1996-1997) that the Austin adult helmet law was in place, 70-80% of all tickets were issued to minorities. No tickets have been issued for the Austin juvenile helmet ordinance since 2002. Prior to this, over 90% of all tickets were issued to minority youths.

Helmet Laws are a completely inappropriate way to encourage helmet use.

Even under the assumption that helmets are extremely effective, coercion is not the way to encourage helmet use. Helmets must be properly fit and correctly worn in order to have any chance of being effective at reducing the severity of injury. According to one study, individuals whose helmets were reported to fit poorly had a 1.96-fold increased risk of head injury compared with those whose helmets fit well (Fit of bicycle safety helmets and risk of head injuries in children. Rivara FP, Astley SJ, Clarren SK, Thompson DC, Thompson RS. Injury Prevention. 1999; 5:194-197). Improperly worn helmets result in all the hazards outlined above with none of the protective benefits. An individual who wears a helmet simply to avoid getting a ticket is not going to suffer the discomfort of a properly worn helmet. The best and only effective/appropriate way to encourage helmet use is through education.

Helmet Laws are becoming less, not more popular.

The test of time has not been kind to bicycle helmet laws, particularly all-ages MHLs. With the exception of Washington State, only one all-ages MHL has been passed in this decade, in Creve Coeur, Missouri [ref]. If one excludes Washington State, only 12 cities and 1 county have all-ages MHLs, and most of these are small. Municipal governments which ignore the hype and take the time to look at the actual data reject even juvenile MHLs [ref]. No state has adopted an all-ages MHL.

Local and state bicycling organizations do not support an all-ages mandatory helmet law for Austin

  • The Austin Cycling Association (ACA) does not support the proposed mandatory helmet law.
  • The Texas Bicycle Coalition (TBC) does not support the proposed all-ages Austin mandatory helmet law.
  • The League of Bicycling Voters was organized to oppose a mandatory bicycle helmet law.

Statistics Surrounding the Helmet Law

Thursday, August 3rd, 2006

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We’re not sure which is more absurd, the ongoing unwarranted belief in the effectiveness of bicycle helmets at preventing injury/death or the exaggerated claims regarding the cost that bicyclist head injuries pose to society

Whenever someone states that "helmets reduce the incidence of serious head injuries by 85%" or something similar, they are basing this claim on a series of studies that gathered data from Seattle-area emergency rooms in the late 1980’s and early 1990’s. Even the authors of these studies now acknowledge that these studies suffer from serious methodological flaws. The same data, for example, can be used to "show" that bicycle helmets significantly reduce the risk of leg injuries, too. All such studies are hopelessly compromised by confounding variables, hidden factors which affect the outcome, such as the fact that helmeted riders tend to be more cautious by nature than riders who refuse to wear a helmet, hence will be less likely to have an accident in the first place.

There is no statistically significant evidence suggesting that increased helmet use decreases the rate of bicyclist injuries/fatalities. On the contrary, in the US, increased helmet use is actually correlated with an increase in head injuries! According to an article published in the New York Times July 29, 2001, from 1991 to 2000, at the same time that voluntary helmet use in the United States went from 18% to 50%, the number of bicyclist head injuries increased by 10%. However, during this period bicycle use actually declined by 21%, so that the effective increase in head injuries was 51% — a strong linear correlation between increased helmet use and increased head injuries.

G.B. Rogers [Rodgers, G.B., Reducing bicycle accidents: a reevaluation of the impacts of the CPSC bicycle standard and helmet use, Journal of Products Liability, 11, pp. 307-317, 1988]
studied over 8 million cases of injury and death to cyclists over 15 years in the USA.
He concluded as follows: "There is no evidence that hard shell helmets have reduced
the head injury and fatality rates. The most surprising finding is that
the bicycle-related fatality rate is positively and significantly correlated
with increased helmet use."

When one combines this with the fact that the entirely unhelmeted bicyclists in Holland, Denmark, and Japan have per capita (or per billion km. traveled) fatality rates that are 6-12 times lower than bicyclists in the
US, the evidence is rather clear: bicycle helmets play at best a negligible
role in increasing bicyclist safety, and compelling evidence exists that
they might actually reduce safety.

Additional statistics and other useful information can be found here:

http://www.cyclehelmets.org/mf.html?1052

http://www.vehicularcyclist.com

http://en.wikipedia.org/wiki/Bicycle_helmet


The Cost of Bicyclist Head Injuries

According to the National Safety Institute, the odd of dying

of Heart Disease 1 in 5
in a Motor vehicle accident 1 in 84
in a Pedestrian accident 1 in 626
in a Bicycle accident 1 in 4919
from a legal execution 1 in 62,468

In other words, one’s chance of dying in a bicycle accident is much closer to the probability of being executed than it is to the probability of dying in a motor vehicle accident (and surely it must be clear that regular bicycling helps to reduce the incidence of heart disease, the leading cause of death).

Even when we restrict our attention only to head injuries, the impact of bicycle accidents is negligible: only 3% of head injuries are due to bicycle accidents. Over 20% of all head injuries are due to motor vehicle accidents

If we really want to reduce the cost burden of accidents, we should be looking at motor vehicles, not bicycles. Last year there were over 2.5 million injuries due to motor vehicles, and the direct cost of motor vehicle accidents is over $10 billion per year in Texas alone. If we really want to save lives and money, the key is to get more people out of cars and onto bicycles and transit. This means encouraging, not discouraging bicycling by implementing punitive laws.

Open Letter to Dr. Crocker

Wednesday, August 2nd, 2006

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The email below, reprinted verbatim, was sent to city council and city officials on or about August 10, 2006 by one Patrick J. Crocker, D.O., director for the Brackenridge Hospital Department of Emergency Medicine. Crocker’s message is confused and confusing in many different ways, but what I particularly like about it is that it neatly illustrates the canonical statistical flaw that all helmet law proponents make. Case control studies demonstrating that helmets decrease the severity of head injuries and fatalities fail to take into account a number of factors, most importantly fundamental differences between those bicyclists who elect to wear a helmet and those who don’t [ref].
This is why the same studies that show that bicycle helmets are 85% effective at preventing head injuries also show that bicycle helmets are (using the example of the most frequently cited study) 72% effective at preventing leg injuries. Whenever such data is correctly analyzed, the advantages of helmet use disappear.
Moreover, population studies uniformly show no statistically significant reduction in either severe head injuries or fatalities when bicycle helmets are used. One large scale study of over 8 million bicyclists in the USA indicates that wearing a bicycle helmet actually increases the risk of fatality (see http://lobv.org/statistics.html).

But back to Crocker’s letter. The red text and superscripts have been added in order to facilitate the subsequent discussion.

August 10th, 2006

To: Austin City Council Members , Toby Futrell, City
Manager , Rudy Garza, Assistant City Manager , Mike McDonald, Assistant City Manager

Re: Bicycle Helmets and Injury Prevention

Dear Mayor Wynn and Council Members,

As you may know a part of our activities as a certified Trauma Center have been centered on injury prevention initiatives. One particular area of interest has become the prevention of disabling head injuries, especially for recreational bicyclists1. Of note, a recent review of our trauma registry reveals that only 5% of patients under the age of 17 years were helmeted at the time of the bicycle accident.2 5%!! Of the 39 children and young adults3 with injuries serious enough to be transported to the Trauma Center and admitted for care, 46% sustained head and brain injuries3. In the significant majority of cases these injuries were life altering events with risk of long term disability.

Most interestingly, during this study period no patient in this age range who was helmeted suffered a serious head injury. NO PATIENT WHO WAS HELMETED SUFFERED A SERIOUS HEAD INJURY!4 Read that line again.

As a physician involved in the care of trauma patients for now more than twenty years as Chief of Emergency Medicine, at Brackenridge and Children’s Medical Center, I have witnessed countless lives needlessly altered by preventable trauma. This is one area where a helmet law could provide a significant safety factor for our children.5 Accidents aren’t predictable. You don’t need to be going either fast or far toneed protection against head injury. My best advice to patients is to buy a helmet, and then wear it, EVERY time you are on your bike.

Sincerely,

Dr. Patrick J. Crocker, FACEP

Chief, Emergency Medicine

Brackenridge and Children’s Hospital of Austin

Commentary on this email:

1 From the beginning, Crocker reveals a lack of familiarity with this issue, as most serious recreational bicyclists (mountain bikers and road racers) already use bicycle helmets. The ACA, for example, requires the use of a bicycle helmet for allrides already. The group that would be most affected by a mandatory bicycle helmet ordinance are transportation bicyclists, and the biggest effect would be to dramatically reduce the number of people who use bicycles for transportation. The only proven statistically significant impact of MHL’s has been to reduce the number of bicyclists in places that implement them, in some cases by as much as 44% [ref, ref].

So why does Crocker focus on recreational bicycling when an MHL in Austin would be squarely aimed at transportation bicyclists? Perhaps it never occurred to Crocker that some people actually use a bicycle for basic transportation!

2 Is Crocker trying to shock us with how few juveniles are actually wearing bicycle helmets or is he implying that those who do wear bicycle helmets are not showing up in the emergency room?

If the former, then one must wonder just how out of touch Crocker is, as Austin already has a juvenile mandatory bicycle helmet law. If juveniles are not wearing helmets, then clearly the existing law is not effective. Surely Crocker can’t be saying "The mandatory helmet law is not working. We need a mandatory helmet law to solve this problem!" That would be pretty dumb.

So, let’s assume that Crocker is implying that juveniles wearing bicycle helmets simply don’t appear in the emergency room, presumably because their helmet protected them from serious injury. Well, then—onward through the fog.

3 Now things are starting to get just a bit confusing. Is Crocker saying that the total number of all children and young adults "with injuries serious enough to be transported to the Trauma Center" over some unspecified period of time (1 year? 2 years? 5 years?) is 39, or is he referring only to children who had bicycle accidents? Since talking about all traumatic injuries seems rather irrelevant, and since we already know that only 3% of all head injuries are caused by bicycle accidents [ref],
I think we can safely assume that Crocker is restricting his comments to children who suffered an accident while riding a bicycle.



OK, then let’s start crunching some numbers. Earlier (2), Crocker informed us that only 5% of these kids were wearing bicycle helmets. 5% of 39 is …… 2. Crocker’s total sample size of helmeted juvenile bicyclists appearing in the trauma ward is 2. Remember this number for later.

4 Well, that certainly settles
the issue of how effective helmets are at preventing serious head injury!
Or maybe not? Recall that only 2 juvenile bicyclists of the 39 injured
were wearing helmets, and slightly less than half suffered head injuries.
Even if bicycle helmets are 0.0% effective at preventing head injuries, there
is a 29% probability that neither had head injuries simply by chance.



However, that’s neither here nor there. The data I want to focus on is the
100%-46% = 54% of juveniles who didn’t suffer a traumatic head injury.
These are the kids who suffered a broken leg or a broken arm, for example.
Observe that of these 21 children, only 2 were wearing bicycle helmets.

Conclusion: according to
Dr. Crocker’s "data," bicycle helmets are 90% effective at preventing leg
injuries and broken arms!!

5That’s right, folks.
The chief of emergency medicine at Brackenridge hospital, Dr. Patrick J.
Crocker, D.O., sent an email to city council inadvertently implying that
bicycle helmets are over 90% effective at preventing juveniles from
suffering a broken leg*, and that’s why Austin needs a mandatory bicycle
helmet law for adults, by golly. As is often the case, one would
be hard pressed to make up anything more absurd than this.

Follow Up:

It was never our intention to publicly embarrass Crocker with his own
misinformation. Before even considering publishing this letter, we asked
Crocker to either clarify or retract his comments. The text of Crocker’s response appears
below:

August 23, 2006

Hi —.

This request already finds me at home as since
I work weekends I usually take Wed afternoon off. I am
unable at this late date and time (Wed 8/23 at 5:37PM)
to provide you with detailed answers to your
questions. I would also caution as I did
in the letter to council this trauma registry review was not
intended to provided publishable type data
, rather
simple frequency data, and to some degree severity
data. The data were based on the most recent calendar
years data from the trauma service at Brackenridge
Hospital. I will be presenting the 17 yo and over data
at the council meeting tomm. After over twenty years
as chief of Emergency Medicine at Brackenridge and
Children’s Hospitals I believe helmets save lives,
just as seat belts do, but you have to wear them to
reap the benefits. I also believe as you do that other
bicycle safety training can reduce injuries and
training is highly desireable.

We invite the reader to identify where in the original letter to
city council Crocker explains that his information was not intended to
be "publishable" — unfortunately, we can’t find it. Further, Crocker did
not appear at the August 28, 2006 public hearing to clarify his comments,
as promised. What Crocker has done is
persist in helping Bruce Todd and Elizabeth Christian in their efforts
to criminalize bicycling in Austin, most recently by proposing a case control study which will result in the collection of information
similar to what he has already provided in his email to city council
.
As mentioned previously,
case control studies suffer from serious methodological flaws and have been
widely discredited in the literature. Crocker and his cohort,
Steve Berkowitz, are a good 20 years behind the times.

Our letter to Dr. Crocker was intended
to be a gentle suggestion that he’s in way over his head on this issue, and
should study the literature and talk to some actual bicyclists before
proceeding.

With the endorsement of most members of the Austin City Council,
the Department of Public Works, the Urban Transportation Commission,
the Austin Cycling Association, the Texas Bicycle Coalition,
and the League of Bicycling Voters,
a Bicycle Safety Task Force was proposed which Crocker and other
members of the medical community were invited to participate in.

Rather than work within the framework of the safety task force, however,
Crocker chose
to join Bruce Todd in making an end run around the task force concept, using
his position to endorse a study almost guaranteed to produce misleading and
inaccurate information, the only purpose of which would be to strong-arm
city council into passing an adult bicycle helmet law. From this, one can
only conclude that Crocker and Todd couldn’t care less about promoting
bicycling safety and are really only interested in promoting their own
narrowly defined political agenda for reasons that are their own. Bruce Todd is a lobbyist, who most recently tried to brow-beat the county into privatizing property tax collection,
a move which would have cost Travis county taxpayers millions
of dollars a year while dismantling a county agency that is 99% efficient
at revenue collection. In short, we can count on Todd to do anything that will
either make him money and/or increase his stature as a mover and shaker.
Crocker, however, is a physician. By promoting a measure which will likely
decrease, not increase, the safety of bicyclists, Crocker is in clear violation
of the Hippocratic oath.

We urge Dr. Crocker to reconsider his actions with regard to this
issue and invite him to work with the community to create a truly safe
environment for pedestrians and bicyclists. We strongly agree that we
should focus on injury prevention initiatives such as safety education
and training — for both bicyclists and motorists,
safer roads and bicycle lanes, and, above all, promoting bicycling
as a safe, healthy, and community-friendly activity.




* The mathematically astute reader will
observe that the author of this analysis has himself made a mathematical
error by not taking into consideration the percentage of juvenile bicyclists
who actually use a bicycle helmet. Statisticians would refer to this as the
underlying population distribution, and it is one of the factors frequently
overlooked in case study analyses of the effectiveness of bicycle helmets.
This information is required in order to
actually make the assertion that "bicycle helmets are 90% effective at
preventing broken legs", for example, since the 2/21 computation assumes equal
numbers of helmeted and unhelmeted juvenile bicyclists. Let me illustrate
why this information is critical by way of an example:
suppose we ascertain that only 2 out of every 100 bicyclists admitted to a
trauma center suffering a severe head injury were wearing a helmet at the time
of the accident. From only this information, it would appear that helmets
are extremely effective at preventing head injuries; however, if only 1 out of every 100 bicyclists in the population ever wears a helmet, then the data actually indicates bicycle helmets double the likelihood of a serious head injury!

Getting back to the percentage of
juvenile bicyclists in Austin who wear a helmet: Unfortunately, a
good estimate of this number is not known, but, given that Austin has a
juvenile mandatory bicycle helmet law in place,
it’s a reasonable assumption that
the number of juveniles using bicycle helmets is 50% or greater. The
larger the percentage, the more ridiculous the numbers get. For example, if
75% of all juvenile bicyclists wear a bicycle helmet, then Crocker’s claim is
that bicycle helmets are 96.5% effective at preventing broken legs. Again,
not paying careful attention to the underlying population
distribution is precisely the kind of mistake that the "case study" helmet
zealots make all the time. The proposed Crocker/Berkowitz study makes no attempt to
even consider the underlying population distribution, hence is completely
invalid from a statistical perspective. Oh, and I exaggerated a bit.
Even given the assumption of a 50-50 helmet/no-helmet population distribution,
Crocker is only implying that bicycle helmets are 89.47% effective at
preventing broken legs. Since Crocker rounded up, I did, too.

This page was written by
Patrick Goetz. Any and all mistakes are the sole responsibility
of the author. Last edited 27-Oct-2006