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From the British Medical Journal

Helmets Significantly Reduce Head Injuries Among Skiers and Snowboarders

Media coverage of tragic deaths of celebrity skiers spurs increased helmet use but more education, public awareness needed

Ever wonder if media exposure can have a positive effect on sports safety? One has to look no further than to what happened after the deaths of two celebrities in skiing accidents in Europe and North America during the winter of 2008-9, the first, a German politician, wearing a ski helmet, who suffered a traumatic brain injury but survived a collision with a helmet-less mother of four on a ski slope in

Natasha Richardson in 1999

 Austria on New Year's Day 2009 in which the woman died; the second, involving actress Natasha Richardson, who died after a traumatic head injury while skiing without a helmet on a beginner's slope in Quebec in March 2009.

As an editorial in the British Medical Journal notes:

  • During the weeks after Richardson's death, visits to the emergency room at the Montreal Children's Hospital increased by 60%;
  • 15% of neurosurgeons in Germany, Switzerland, and Austria bought a helmet after the fatal collision involving the German politician;
  • The use of helmets by skiers and snowboarders in Austria jumped from 44% in December 2008 to 57% in April 2009; and
  • Most Austrian provinces have made helmets mandatory for children under 16 years since the winter season of 2009-2010.

Helmet advantages

  • Head injuries account for between 9 and 19% of all injuries reported by ski patrols and emergency departments.
  • Traumatic brain injury is a leading cause of death among winter sports participants.
  • A recent meta-analysis showed that skiers and snowboarders with a helmet were significantly less likely than those not wearing a helmet to suffer a head injury.1
  • Recent studies have not confirmed the suggestion that head-neck-helmet bio-mechanics may increase the risk of cervical spine injury when wearing a helmet, especially in children, who have a greater head to body weight ratio.

The bottom line: wearing a ski helmet seems to make sense to prevent head injuries in all age groups.

Disadvantages

Encourage risk taking?

  • Wearing a helmet may provide a false sense security, resulting in riskier behavior on the slopes; one study of self-reported behavior, however, found that although skiers and snowboarders who were risk takers, not surprisingly, skied faster than cautious people:
    • the use of helmets was nearly equal in both groups (59.2% v. 59.7%);
    • significantly more skilled skiers wore helmets (76.9% v. 59.0%);
    • similar proportions of those who did and did not wear helmets exhibited risky behavior (29.8% v. 30.2%).
    • Other studies have also shown that helmet use is higher in more skilled skiers than in less skilled ones.
Snowboarder grabbing board

Again, the bottom line: the use of a helmet is not necessarily associated with a higher level of risk taking but primarily with a higher level of skill.

Impair hearing and limit field of vision?

  • A recent study showed that ski helmets could raise the hearing threshold of frequencies between 2 kHz and 8 kHz, which is characteristic of the hissing caused by a skier or snowboarder passing closely by or breaking behind, but that sound was not reduced at frequencies characteristic of the human voice, so that warning shouts should be heard.
  • Rules of the International Ski Federation (FIS) require skiers to use their sight to avoid collisions.
  • Most (74%) head injuries occur when skiers hit their heads on the snow, with only 10% and 13% of injuries coming when the skier collided with other skiers or fixed objects (like trees), respectively.
  • A randomized controlled pilot study found no differences in reaction time between people wearing a ski helmet or ski cap.  Ski goggles increased the reaction time, however, so they may limit the field of vision.

Education and other preventative measures.

As the British Medical Journal editorial suggests, education about brain trauma "can have a positive effect on attitudes towards wearing a helmet." 

Some other of authors' suggestions:

  • helmet loan programs
  • routine inclusion of helmets in rental packages
  • future studies to evaluate public health strategies focusing on individual skiing behavior in response to different educational (for example, web based, like MomsTeam) and behavioral change models.

Source: Ruedl G, Kopp M, Burtscher M. The protective effects of helmets in skiers and snowboarders. Br. Med. J 2011;342:d857

1.  Russel K, Christie J, Hagel BE. The effects of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta analysis. CMAJ 2010;82:33-40.

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