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Old 2nd December 2012, 02:20   #1
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Default Helmets : Facts you must know about their efficacy

It is after decades, that I have took to some serious motorcycling again.
The main pre-requisite, as any motorcycle enthusiast would unarguably state, is SAFETY.
That being said the main tool in a motorcyclist's gear is a Helmet, which somehow he/she does get associated with, just like his /her motorcycle.

For ease of communication I would just refer to “him”, ”his” without wanting to be labeled as a misogynist.

So my study began with:

1 .“What” constitutes a good helmet, and

2 .Are helmets really effective?.. and

3 . If effective ; to what degree.

I delved the medical literature (easier to me, since I am a Cardiologist) to search for a Helmet Vs No-helmet crash / accident scenario and the various outcomes.
Unfortunately there is no Indian study which I could lay my hand on.
There are studies form the European Union, but the number of accidents and crashes studied were of a small magnitude.

The most notable study on motorcycle accidents is done in the USA, where 18 states contributed data on accidents from 1996 to 2007, which studied a whopping 27,000 motorcycle accidents.
This appears to be a largest single study involved in motorcycle accidents, the hospital outcome and the severity of the injuries.

The Department of Traffic (DOT) undertook this study.

The data was statistically analyzed, using regression models .

( I have attached the .pdf files for those who would want to study them further ).

I am listing the salient features of this study , some features which are very interesting :

1) Majority of those involved in fatal accident were males (97%).

2) Night time motorcycle accidents were more than the day time.

3) The age group 21- 29 and those greater than 59 years used helmets more frequently than those between the 40 -49-age group.

4) Weekends and Weekdays made no difference in the overall incidence of accidents.

5) ENGINE CAPACITY: The maximum number of motorcycle accidents occurred in the 500 to 1000 cc engine group, with the least accidents occurring in the >1500 cc engine bikes. As also the bikes having less than 500 cc engines had less accident rates.

6) This study also makes a mention of a prior study done by Sarkar et al (1995), that states that deaths from trunk injuries were double in those using helmets.

7) Mild to Moderate Traumatic Brain Injuries (T.B.I) were encountered in 8.9 % of unhelmeted individuals Vs 7.0 in those who used helmets. Severe T.B.I was encountered in 7.3 % of non-helmet users Vs 4.7 % in those who used helmets. Using regression analysis the authors found that the efficacy of helmets in preventing Traumatic Brain Injuries is 27 %.

8) Brain is not the only organ damaged in a bike accident: The Upper extremities, lower extremities, chest, neck, abdomen and long bones are also involved which adds to the mortality.

9) 50% bilkers involved in fatal crashes had sever upper and lower limb trauma, 25% had external injuries to the chest, face, neck and spine .

10) There is a very interesting data here: Those wearing helmets had MORE Chest, and Lower limb injuries than those who were not wearing helmets .

11) Another very interesting data: Those wearing helmets had a HIGHER percentage of neck injuries than those NOT wearing helmets.

12) Those wearing helmets had a HIGHER incidence of spinal injuries than those who weren’t.

13) Facial and Head Injuries (this is different from brain injury) were MORE in those NOT wearing helmets. A regression analysis done by the authors reveals a 22 % efficacy of helmets to prevent facial and /or head injuries.

To summarize: Helmets are 27 % efficient in preventing a severe Traumatic Brain Injury and 22% efficient in preventing a sever facial/head injury.
Lower limb, spine, neck and chest injuries are MORE in those who wear helmets, for reasons unexplained.

Its therefore ,that a helmet alone wont prevent me from death and severe injuries in an accident .

More than a helmet it is the restrain by the biker in riding his bike, the use of traffic rules, avoidance of nighttime travel and the abstinence of alcohol is what would make biking safe and pleasurable.

SOURCE ::

helmet.pdf AND

helmet 1.pdf.
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Old 2nd December 2012, 08:37   #2
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Default re: Helmets : Facts you must know about their efficacy

Good to see someone actually analyse this.

We need to look at Helmet as part and not complete by itself. Though not practical in India, the protective Jacket, the Gloves, the Knee cap and other protective gear needs to be accounted for. And finally we do have the person inside, who needs to be aware of his environment while riding.

If all of the above where in place we still could have fatal accidents, but the numbers would be greatly reduced, and these could be parameters beyond the control of the rider.

Last edited by raghu.t.k : 2nd December 2012 at 08:38.
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Old 2nd December 2012, 08:48   #3
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Default re: Helmets : Facts you must know about their efficacy

Can the data be somewhat different in India? After all most of the crashes here happen at a lower speed and on lower powered bikes. This study shows helmets to prevent death by 37% among riders and 41% among pillion riders.

http://www.cdc.gov/features/MotorcycleSafety/

Last edited by Gansan : 2nd December 2012 at 08:49.
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Old 2nd December 2012, 10:24   #4
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Default re: Helmets : Facts you must know about their efficacy

There is a very nice helmet rating study by the UK govt. This study analyzed and rated various brands on a 5 point scale.
http://sharp.direct.gov.uk/

In India, anything other than a helmet and gloves becomes impractical in day to day running. I was once wearing my kneeguard inside the jeans and was not allowed into a movie theater as it became a security threat
The movie theater had no cloak room and i left, fuming.
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Old 2nd December 2012, 10:26   #5
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Default re: Helmets : Facts you must know about their efficacy

@ Raghu and Gansan , what startles the reader when studying the data-sheet is the significantly more incidence of spine , neck and extremities injury in the "helmet" group than in the "no helmet " group . The authors are also at a loss to explain what circumstances lead to a higher peripheral injury rate in the helmeted category .
I am also trying to gather data about the efficacy of "half helmets " Vs "full helmets " . There are many blogs and forums having individual opinions , however is there any study which has data pertaining to half faced helmets.
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Old 2nd December 2012, 19:50   #6
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Default Re: Helmets : Facts you must know about their efficacy

I am simply copying gsferrari's comments from FB & posting it here
Quote:
Originally Posted by gsferrari
While the study may show results contrary to our expectations, the purpose of the study isn't obvious. Does it suggest riding without a helmet?

Why aren't ocular trauma results shown in the study? This is eye injury without any other injury...just debris getting into the eye with velocity and causing irreparable damage.

What about injury caused by untrained paramedics or roadside do-gooders removing the helmet without due care? Top helmets come with removal straps that allow you to release the head without any strain on the neck.

Does the study take into account the quality of the helmet being used? I think the weight of the helmet and crash test ratings need to be factored I to the results of the study.

Most riders who don't wear helmets ride slower machines like commuter bikes and V-twins like Harley's. The results directly compare accidents that might have occurred at slower speeds with high speed accidents involving superbike riders who do wear helmets!

So...take these results with a pinch of salt. It is irresponsible to publish half baked results that could cause more harm than good. I know Dr.Mohan well and I am sure he has seen quite a few road accidents but probably not as many bike accidents as I have.

More than 90% of accidents I know of, the helmet was instrumental in the survival of the rider. There are images with helmets split in two but that has saved the rider from serious head trauma.

At high speeds it is a game of poker...restraint and judgement is everything. This morning for example, on my "gnat's cock away from 200 horse power" Hayabusa, I chose to ride at 100-120 speeds with the slowest rider in the group.

The return leg of a ride is often the most dangerous...go slower than usual and just get back home!
At the end of it, if someone is putting up whatever study/stats in favor of riding lidless is plain wrong.
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Old 2nd December 2012, 20:26   #7
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Default Re: Helmets : Facts you must know about their efficacy

Quote:
Originally Posted by mohan View Post
6) This study also makes a mention of a prior study done by Sarkar et al (1995), that states that deaths from trunk injuries were double in those using helmets.
....
10) There is a very interesting data here: Those wearing helmets had MORE Chest, and Lower limb injuries than those who were not wearing helmets .
Could this be interpreted as
'You have died of an injury. Because the helmet has saved your head (to some extent), the most severe life threatening injuries are now those sustained on the trunk'?

Regards
Sutripta
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Old 2nd December 2012, 21:03   #8
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Default Re: Helmets : Facts you must know about their efficacy

Quote:
Originally Posted by Sutripta View Post
Could this be interpreted as
'You have died of an injury. Because the helmet has saved your head (to some extent), the most severe life threatening injuries are now those sustained on the trunk'?

Regards
Sutripta
and that is exactly what I felt when reading this article.

In my order of preference:
A helmet at the barest minimum.
Armor to protect the upper body.
Knee guards.
Armored shoes and gloves.

Head injury is either fatal or can leave you as a vegetable.
I don't think we have armor for the upper body than can protect against crushing and punctures. But it sure can help prevent road rash and blunt trauma.
Broken knees mess up your ability to run/walk.
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Old 2nd December 2012, 21:49   #9
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Default Re: Helmets : Facts you must know about their efficacy

ABOUT THE STUDY AND DATA :

This publication is distributed by the U.S. Department of Transportation, National Highway Traffic Safety Administration, in the interest of information exchange.
The analysis is based on data from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS) over the years 1997-2006.
The study is multi-centric , involving 18 states hospital registries over 10 years time .
It studied fatal accident cases in excess of 27000.
Its cross-linked ,retrospective, CODED and uses Logistic Regression Analysis and multivariate analysis .
This study has no commercial gain and/or conflict of interest.
The report is available free of charge at: www.nhtsa.dot.gov


MY TAKE ON THIS STUDY ( As a Medical Scientist) :
It’s an extremely well designed study and one ,which I will not “ Take with a pinch of salt “ as someone pointed out, no matter how much baseless criticism one might make .

WHAT THE STUDY ACTUALLY SAYS ( THE “TAKE HOME MESSAGE “);

1. Helmets don’t render the user a fool-proof guarantee against fatal Brain injury .
2. Helmets are efficient and must be used and made compulsory ,since they have 35- 45% efficacy ( quoting various other studies too ) in preventing an head injury and has an efficacy of 27 % in protecting the user from facial injuries ( which includes eye injuries too).
3. Brain injury is THE leading cause for deaths in a fatal motor cycle accident but not the only.
4. Helmets cant protect the biker from peripheral injuries , albeit for causes unknown ,they seem to worsen in helmet users. Trunk crush injuries and long bone fractures are some of the debilitating aftermaths of a mobike accident

I was under the impression just as many forum members were and still are , that wearing a helmet can totally alleviate a brain injury during a crash ,which unfortunately is not the case . A fact remains a fact ,whether one likes it or not .

Hence what I have understood from the study ( which I prefer, since it is the largest single study available for an assessment ) is to try and prevent a head injury by wearing a helmet ,but not depend on it totally and use extremity protectors , restrain, judgment and maturity while riding a bike.

A REQUEST : Before you pounce on a member with sarcastic comments about something being crap at least please read ,totallythe references ,sources which he/she is quoting to make a valid and intelligent comment/judgment . At least the member would have the guts and the inclination to post and share something of any use in the future .
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Old 3rd December 2012, 09:54   #10
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Default Re: Helmets : Facts you must know about their efficacy

Quote:
Originally Posted by mohan View Post
It is after decades, that I have took to some serious motorcycling again.
Hi Dr Mohan, good to see you convert from 4wd to 1wd!
Quote:
2 .Are helmets really effective?.. and
3 . If effective ; to what degree.
I think you chose the wrong article and set of data to analyse the above. The NHTSA study includes ONLY FATAL motorcycle crashes - and the purpose is to find out whether or not riders used a helmet while riding, at the time they died.
Quote:
This appears to be a largest single study involved in motorcycle accidents, the hospital outcome and the severity of the injuries.
The article specifically includes only people with injuries that proved to be fatal, then or later.
Quote:
3) The age group 21- 29 and those greater than 59 years used helmets more frequently than those between the 40 -49-age group.
One can deduce that people in the age group 21-29 & 40-49 were more prone to death DESPITE wearing helmets. Perhaps it has to do with their riding skills. Younger riders tend to be more rash, while older riders may be overconfident.
Quote:
...the least accidents occurring in the >1500 cc engine bikes. As also the bikes having less than 500 cc engines had less accident rates.
I would reword that to read: ...the least deaths due to accidents occurring in the >1500 cc engine bikes. As also the bikes having less than 500 cc engines had less accident rates causing deaths.
Quote:
7) Mild to Moderate Traumatic Brain Injuries (T.B.I) were encountered in 8.9 % of unhelmeted individuals Vs 7.0 in those who used helmets. Severe T.B.I was encountered in 7.3 % of non-helmet users Vs 4.7 % in those who used helmets. Using regression analysis the authors found that the efficacy of helmets in preventing Traumatic Brain Injuries is 27 %.
Severe TBI causing fatality = 7.3% in unhelmeted dead riders, but 4.7% of helmeted dead riders. Therefore chances of severe TBI are up 55+% if not wearing a helmet.
Quote:
10) There is a very interesting data here: Those wearing helmets had MORE Chest, and Lower limb injuries than those who were not wearing helmets .
Again, I think the interpretation should be: Those wearing helmets BUT WHO STILL DIED IN THE CRASH had MORE Chest, and Lower limb injuries than those who were not wearing helmets AND DIED. Wouldn't that be expected - that the trunk injuries killed them because the severity of the crash was so high? In a lesser crash, with lesser trunk injuries, the helmeted rider's probability of survival would have been higher than the one not wearing a helmet.
Quote:
Those wearing helmets had a HIGHER percentage of neck injuries than those NOT wearing helmets.
Those wearing helmets had a HIGHER incidence of spinal injuries than those who weren’t.
A mild to moderate TBI didn't kill the riders wearing helmets, but a broken neck did. This, IMO, would be in keeping with a higher severity of crash, wherein their trunk injuries are also higher.
Quote:
13) Facial and Head Injuries (this is different from brain injury) were MORE in those NOT wearing helmets. A regression analysis done by the authors reveals a 22 % efficacy of helmets to prevent facial and /or head injuries.
From what I can gather after going through the documents you put up, I think the authors derived this on a fallacious presumption.
Quote:
To summarize: Helmets are 27 % efficient in preventing a severe Traumatic Brain Injury and 22% efficient in preventing a sever facial/head injury.
Lower limb, spine, neck and chest injuries are MORE in those who wear helmets, for reasons unexplained.
Its therefore ,that a helmet alone wont prevent me from death and severe injuries in an accident .
To arrive at this conclusion, the authors would have needed to include data from ALL motorcycle crashes, both fatal and non-fatal, who needed to attend a hospital or seek medical help otherwise, or were DOA at a hospital. If we analysed such data and differentiated riders into 2 groups, helmeted and non-helmeted, I am sure the numbers would give us a better understanding of the efficacy of helmets.

I think the "Take home message" would be: Just a helmet doesn't make a rider invincible.

You can conclude the rest based on my signature!

Last edited by SS-Traveller : 3rd December 2012 at 09:56.
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Old 3rd December 2012, 11:42   #11
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Default Re: Helmets : Facts you must know about their efficacy

Dr. Mohan - This thread is indeed very informative and many thanks for bringing this to the forum. I believe, over a period of time, we in India, have come to look at the Helmet as a one-stop solution to motorcyclist safety, which indeed it is not!

The outcomes of this study, may point out to the fact (though still debatable and needing more data to ascertain conclusively) that helmets alone can, in some situations, cause worse injuries, than would have been the case, if the rider was not wearing a helmet.

The helmet, when used in conjunction with a number of other restraints, pads and protectors, can fully protect a rider. This however, is not the case in India, where our climate and equipment costs combined, prove to be a detractor for people, from such extensive safety equipment. This however, is my PRIMARY TAKE-HOME from this thread!

By the way, which motorcycle have you taken to?

Last edited by roy_libran : 3rd December 2012 at 11:44.
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Old 3rd December 2012, 12:07   #12
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Default Re: Helmets : Facts you must know about their efficacy

Hi,
Its interesting to note the statistics quoted in the study. My take is, even the best of the gears can save you from minor injuries only. If its a head on or high speed crash no amount of safety gears can save a person. Being a doctor and also a enthusiast who loves to tour on a bike i am not going to ride without safety gears and even with all the safety gears i will restrain myself from pushing myself or my bike outside the comfort zone. Two of the people i know had crashes in the recent past, one involving high speed and a bicycle guy who jumped into his lane and the other experienced microsleep and crashed into the divider. Both of them walked away only because of the helmet and safety gears they were wearing. Unless we develop a disciplined riding style, safety gears amounts to nothing.
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Old 3rd December 2012, 12:37   #13
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Default Re: Helmets : Facts you must know about their efficacy

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Originally Posted by roy_libran View Post
The outcomes of this study, may point out to the fact (though still debatable and needing more data to ascertain conclusively) that helmets alone can, in some situations, cause worse injuries, than would have been the case, if the rider was not wearing a helmet.
Please read the entire post by SS-Traveller.

This is a completely wrong assumption because of the (inadequate ) sample size.
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Old 3rd December 2012, 13:06   #14
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Default Re: Helmets : Facts you must know about their efficacy

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This is a completely wrong assumption because of the (inadequate ) sample size.
Not because of sample size, but because of sample type. The sample includes only DEAD riders, so where is there a comparative analysis about whether or not helmets save lives?
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Old 3rd December 2012, 13:58   #15
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Default Re: Helmets : Facts you must know about their efficacy

Quote:
Originally Posted by bblost View Post
Please read the entire post by SS-Traveller.

This is a completely wrong assumption because of the (inadequate ) sample size.
The keywords in my opinion above, were - "Helmets Alone". I do believe that riding mandates a lot more protective gear than just a helmet.

Moreover, I have a bit of a direct experience of this. Years back, wearing a Studds Motocross, I had crashed into a tree, and suffered minor whiplash injuries apparently because the Chin Section of the Helmet scraped something and caused my head to twist backwards. I had no other injuries anywhere else on my body. Yes, the same helmet probably saved my jawline but since then, I have chosen helmets with a much lesser chin protrusion.

So, however, inadequate or inappropriate the study quoted by Dr. Mohan might have been, or the reasoning of SS-Traveller, it IMHO, does not conclusively establish either point of view.

Last edited by roy_libran : 3rd December 2012 at 13:59.
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