Helmet Use in Preventing

Injury in the Alpine

Environment
Advocacy Morning Report, Feb
2010
Dr. Gleich, Dr. Zimbric
 Skiing is not new.
http://history.fis-ski.com/

• 6300-5000 BC- Oldest (wood) skis found in Russia

• 1206 The Birkebeiners (Norway) rescued the 2-year-old
Prince Hakon Hakonson, heir to the throne, skiing over the
Dovre mountains from Lillehammer to Osterdalen.
• 1800s Ski troops fought in the war over Finland between
Sweden and Russia.
• 1812- Russian ski troops take on Napolean
• 1866- First ski school (Norway)
• 1860s First known ski competitions (Norway)
• 1908- First ski lift (Switzerland)
• 1928 Nordic skiing in winter olympics
• 1936 Alpine events in winter olympics
• 1959 First death in official Alpine championships causes FIS
to rule that helmets must be worn.
 Skiing is fun.
• Avg 10 million US people skied > 1/yr
from 1993-1997 (household survey,
Nat. Sporting Goods Assoc.)
 Skiing can hurt.
• 84,200 ski-associated injuries in US
EDs 1997 (Xiang 2004)
• 600,000 estimated total ski/board
injuries per year in US (Cusimano
2010)
 Ski/Snowboard Injuries
H Jiang et al. Downhill Skiing Injury Fatalities Among Children. Injury
Prevention 2004; 10:99-102

• Fatal injuries at CO ski resorts 1980-2001

• Info via death certificates
• Total 149 fatalities assoc w/ downhill skiing
• 21/149 (14%) <17 yrs old
• 24% were 18-24 yrs old
• TBI was COD in 67% of all deaths
• Collision = leading mechanism (76% in kids),
usually w/ tree (52%)
• 30% pronounced dead at scene
 Helmets
• First mandated in ski competitions 1959
• 2002 Lids on Kids (http://www.lidsonkids.org/home.asp)
– Goal is to get kids to wear helmet but ski as though they are not
• 2008/09 National Ski Areas Association (NSAA) National
Demographic Study (130,000 interviews of skiers and riders
nationwide), helmet usage among skiers and riders in the U.S.
increased 12 percent over the previous season.
– 77% <9 yrs
– 66 % 10-14 yrs
– 63% > 65
– 32% 18-24
– helmet usage increases with the skier's ability level: 26% beginners
wear helmets, 38 % of intermediates wear helmets while 55 % of
advanced skiers and riders wear helmets.
• In April 2009, Vail Resorts announced that from 2009/10, they
would require helmet use for all their employees on the snow
 Do helmets work?
Russell et al. The effect of helmets on the risk of head and neck injuries
among skiers and snowboarders: a meta-analysis. CMAJ 2010
• 1st meta-analysis examining effect of helmets on
head & neck injuries for skiers & snowboarders
• Methods:
– Search of electronic databases, conferences,
reference lists
• “Head injury or head trauma”
• “Helmet”
• “Skiing or snowboarding”
– Studies included:
• Used a control group
• Compared skiers/snowboarders with & without helmets
• Measured at least 1 objectively quantified outcome (head
injury or neck/cervical injury)
 Do helmets work?
Russell et al. The effect of helmets on the risk of head and neck
injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010

• Results:
– 10 case-control, 1 case-control/case-crossover,
& 1 cohort study included
• Use of helmets by skiers/snowboarders significantly
reduced risk of head injury by 35%
• 2-5 of every 10 head injuries could be prevented
with use of ski/snowboard helmets
– Pooled OR 0.65 (95% CI 0.55-0.79)
– 6 studies examined association between
helmet use and risk of neck injury
• No significant increased risk of neck injury
– Pooled OR 0.89 (95% CI 0.72-1.09)
 Do helmets work?
Russell et al. The effect of helmets on the risk of head and neck
injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010
 Do helmets work?
Russell et al. The effect of helmets on the risk of head and neck
injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010
 Do helmets work?
Russell et al. The effect of helmets on the risk of head and neck
injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010

• Limitations:
– Moderate methodological quality of included
studies
• Insufficient adjustment for potential confounders
• 5 studies required crude OR calculations
– Different definitions of head injury
– No examination of design, quality, or fit of
helmets
• If helmets were of poor quality or worn
incorrectly, effect of helmet would be
underestimated relative to their true potential
Possible Downsides to
Helmets
• Provides false sense of security
– More aggressive/dangerous skiing
– Faster speeds
– Increased risk of injury to other parts of
body
• Evidence mixed
– Several studies showed increased risk-
taking among helmet users
– Others showed helmet users were more
cautious group
• After adjustment, meta-analysis
(Russell 2010) showed no relation
between helmet use and injury or
severity of crash
 Barriers to Helmet Use
Finnoff et al. Barriers to Bicycle Helmet Use. Pediatrics 2001; 108

• Perception it doesn’t help

• Perceived discomfort
• Coolness factor 
• Cost
• Availability
• Sizing 
 Lids on Kids

• Picabo Street
"Over 300,000 Americans suffer brain injuries a year. Don't be a
statistic, wear your helmet. During my career the doctors fixed my
body several times. Luckily I never hurt my head because you only
get one chance with your brain. Wear a helmet.“
• Bode Miller
"When I was little, 6-years old, I got my first helmet. I've never had
a more trusty or invaluable piece of equipment. Now that I'm racing
and helmets are a requirement, it seems like I never go skiing
without one. They're warm and comfortable, and they can save your
life if you have an unlucky slip. When you see the pictures of the
racers these days, one of the coolest parts are the lids. Some of the
decorations are awesome.“
• Gretchen Bleiler
I wear a helmet when I'm riding a halfpipe because I would rather
not risk it. There are too many things that could go wrong, so why
take a chance? It just makes sense to protect your head.
 Advocacy in the works…
• Legislative Efforts: Several states considered
mandatory helmet laws for youth
– MA, MI, NJ, NY
– No laws passed yet
• Insufficient public support
• No enforcement agency
– Need to institute further education & incentive
programs – well-rounded approach allows
recognition of protective value of helmets
• Similar to mountain biking (80-90% helmet use rate,
Kronisch 2002).
 What Can We Do?
• Letter to ski resorts
– Encourage employees, ski patrol to wear helmets
– Consider free helmet use w/ rentals
– Consider free helmet use for ski schools
– Coupons for helmet with season pass?
– Helmet design/decorating competition
• Wear a helmet yourself
• Compliment kids on helmets on slopes
• Discuss in WCC
• Encourage fellow boarders/skiers to wear them
Works Cited
• http://alhazan.com/gallery/career/sonny_b
• www.gawker.com
• http://www.nsaa.org/nsaa/press/08
09/helmet-safety.asp
• H Jiang et al. Downhill Skiing Injury
Fatalities Among Children. Injury
Prevention 2004; 10:99-102
• Russell et al. The effect of helmets
on the risk of head and neck
injuries among skiers and
snowboarders: a meta-analysis.
CMAJ 2010
• Finnoff et al. Barriers to Bicycle
Helmet Use. Pediatrics 2001; 108
• Kronisch et al. Mountain Biking
Injuries: An Update. Sports Med
2002; 32
• http://history.fis-ski.com/
• Facebook stalker tool
• http://www.ski-injury.com/prevention/helm
• http://www.lidsonkids.org/home.asp
• http://news.dipag.it/photo-Bode-
Miller-in-action-0000016716.html