Should I Wear a Helmet Today?

bakfiets_naparstek.jpgThe Naparstek boys riding last year’s Summer Streets event… wearing helmets.

Sarah’s "Too Much Emphasis on Safety" post yesterday brings up the question in the headline above.

A Canadian Broadcasting TV crew doing a documentary on biking is filming me as I take my two sons to school on our Dutch cargo bike today. While the kids always wear helmets, and I do too when I’m commuting or riding longer distances, I often don’t bother to wear one when I’m taking the kids to school in the bakfiets (also known around our house as the Cadillac Bikescalade). 

There are a few reasons why I tend to go helmetless. First, I’m a pretty careful, slow-riding cyclist in general, and even more so when I’m carrying kids. The ride to school is a short trip on residential streets marked almost entirely with bike lanes in a neighborhood where motorists are relatively respectful and aware of bikes. Walking across a street at an intersection with two young kids in tow often feels more dangerous.

Second, getting the kids out the door in the morning involves quite a bit of schlepping and hassle as it is. My own helmet sometimes just gets lost in the shuffle (as does my four-year-old’s lunch). If the two-year-old is whiny or we’re running late I’m not turning back to get the helmet. It’s all about momentum.

Finally, I just don’t like the way the helmet looks when I’m riding the bakfiets. This is less and issue of fashion (because lord knows I have no fashion sense) and more, I think, an issue of public perception. The bakfiets gets a lot of attention out there. We almost have to build in an extra ten minutes to every trip to account for all the passersby who stop us and ask questions about our unusual bike. Even though I know that I am putting myself slightly more at risk by not wearing a helmet, a part of me likes the idea that I’m showing that it is possible in New York City to walk out your door, hop on a bike and run a neighborhood errand without having to suit up like you’re getting ready to play tackle football.

The first time I ever saw a cargo bike in action was on my U.S.-German Marshall fellowship trip to Copenhagen in 2006. In Copenhagen I saw people using cargo bikes to cart their kids all over the place. I rarely saw an adult wearing a helmet. It made an impression on me. This lack of protective headgear — or any special bike gear, for that matter — is one of the things that, to my eye, made biking in Copenhagen seem so remarkably convenient, casual, safe and part of regular daily life. It didn’t matter what you’re wearing. In Copenhagen you just hop on a bike and go.

The sheer sense of normalcy conveyed by streets filled with helmetless, kid-toting Danish cyclists seemed to me to do more to encourage bicycling and promote safety than any personal equipment or piece of infrastructure I’d ever seen back home. And the numbers back that up. Somehow, despite the lack of headgear, Danish, German and Dutch cyclist injury and fatality rates are a fraction of our own.

We know from the work of Peter Jacobsen
that one of the most surefire ways to make urban bike transportation
safer is to increase the number of cyclists on city streets. There are
a lot of proven and effective ways to encourage more people to get on
bikes. Compelling everyone to strap a styrofoam shell to their head is
not one of them — at least not in the world cities with the safest streets for cyclists.

Yes, I’m still going to continue to wear a helmet on the vast majority of my bike rides and I’d encourage every New York City cyclist to do the same. While cyclists have achieved a real safety-in-numbers effect in Copenhagen and are beginning to do so here, New York City streets are still mostly dominated by aggressive, unskilled nincompoops in overly large motor vehicles.

Still, I’m leaning toward wearing a dignified hat on this morning’s bike ride rather than a helmet.

  • Rick

    Let me first say that I didn’t start wearing a helmet regularly until AFTER I WOKE UP FROM THE COMA. Before I fractured my skull and bled an epidural hematoma the size of a navel orange, I used some of the inane arguments I read above.

    I cringed when I read “I just don’t like the way the helmet looks.”
    I used to joke that helmets messed up my hair. But that was when I was 25, long before I had kids to tote around in a cargo bike. That was before the brain surgeons shaved my head and then closed up the suture with stainless steel staples

    Brain injury is not the abstract concept you juggle in your blog. Arguing that you are some kind of ambassador of the green, spreading the word that cycling is a breezy spin for cool dads is beyond egocentric. It’s tragic, really.

    Helmets are not going to save you from every accident. Nothing can. There is some risk that we all accept. But your “I’m a pretty careful, slow-riding cyclist” take on reality is going to protect you from very little. Helmets can save you in a lot of accidents, maybe even most of them. If I had been wearing one on Dec. 2, 1988, I might not be taking anti-seizure pills every day, twice a day, for the rest of my life. If I had been hit by a truck, I might be dead. But I wasn’t hit by a truck. I fell off my bike. I wasn’t dodging cars on 5th Avenue. I was riding up a hill. Many, many life-changing, even life-ending head injuries occur at low speed to people who are being “careful.” I fell off my bike. That’s all it takes.

    I got back on that same bike and rode up that same hill four weeks after my accident, three and a half weeks after coming out of a coma, with my hair still growing back from emergency brain surgery. That was 20 years and 120,000+ miles ago. I have hit the pavement since, hard, with a helmet on. I got up and I rode home.

    Wear the helmet. It’s all the inconvenience of an elaborate hat. It might save your life. It might not. But the chance that it will is all the reason you need to wear it.

  • Ian Turner

    Rick,

    There is no question that helmets can save lives and prevent serious injury in certain kinds of accidents. However, there are at least three side effects that mitigate the public health value of helmets:

    1. Although helmets are great on impact injuries, they can worsen torsional injuries. If your head is smacked on the side by a passing car, it’s not the impact that hurts you but rather the resulting rotation of your neck. Helmets make the profile of your head larger, resulting in more and more serious torsional injuries.

    2. The health benefits of cycling mean that cycling without a helmet is better for your health than not cycling at all. If helmets discourage people from cycling (they do), then they are a liability from a public health perspective.

    3. Wearing a helmet makes one more likely to be involved in a crash in the first place, because of safety compensation on the part of drivers (and perhaps cyclists too). Although not a big difference, wearing a helmet cuts the clearance given by passing drivers by around 3″.

    The jury is still out on whether wearing a helmet improves an individuals’ safety, but the evidence is clear that mandating helmet usage results in worse, not better, public health. It’s less clear, but still possible, that even evangelizing helmet usage results in worsened public health.

  • Rob

    1) I can’t imagine anyone saying that they feel driving is too risky because of all the fuss people make about wearing seatbelts.

    2) More importantly, in the long run wearing a helmet can increase visibility and encourage cycling. When I take the long escalator down to my metro stop in DC carrying or wearing my helmet, I’m seen by literally hundreds of people (scores of whom actually notice admittedly). When I bring my helmet in to a fast food joint or retail store, it’s seen by dozens of customers who are reminded of all the people who bike everywhere, and if management sees me, they might give some thought as to how they can encourage more cyclists to come in (I’ll also occasionally comment “you know, you guys sure don’t have any bike racks out there”). Sure the effect of the above is small, but I’d say it’s larger than the effect of making people think biking is unsafe because of a helmet. I carry my helmet with pride. It identifies me as a member of a community I’d like to see expand, and it helps combat the “irresponsible cyclist” myth.

  • You have to understand, Rob, that not everyone wants to be that guy.

    For a long time it turned me off to riding a bicycle at all, not wanting to be Mr proud helmet sporting activist whatever. Maybe that makes me a bad person in some circles, but now I’m a person riding a bicycle every day of the year. (I notice a higher concentration of ‘gear’ on nice weekend days like today, incidentally.) It’s hard not to be visible on a bicycle so I’m pretty sure I’m helping spread the good news, even if I shed that part of my identity when entering a bar, a restaurant, a store, a “broadway show.” I did ride a bicycle to a show in February, oddly enough. I ride the thing everywhere, wear whatever I feel like wearing, and encourage everyone else to do the same.

    As for seat-belts, I think you made the distinction pretty well yourself. Drivers don’t proudly wear dayglo driving harnesses into the McDonald’s.

  • Rick

    (For those of you just tuning in, I wrote about my no-helmet bike crash and the resulting epidural hematoma a few comments back. Ian wrote a response, also above. My apologies for the length, there was a lot to cover)

    To Ian,

    I am tempted to quote you here – “There is no question that helmets can save lives and prevent serious injury in certain kinds of accidents” and rest my case. As I wrote: “It might save your life. It might not. But the chance that it will is all the reason you need to wear it.”

    However, as you might expect, it is hard for me to let it rest.

    Let me go through this:

    > Helmets make the profile of your head larger

    I can interpret this in a couple of ways.
    One scenario you may be suggesting is a cyclist being sideswiped by a car and the cyclist’s head/helmet combination being 1.5 inches wider on either side increasing the target size, that somehow the injury would have been avoided somehow if the cyclist’s head were smaller. I’m sure that this scant 1.5 inches has made the difference in some case, somewhere, but I suspect the number of such incidents strays into the minuscule. You may also be talking about the larger profile creating a greater fulcrum and thus your torsional effect. I’ll address this below but either way it’s the equivalent of saying whitewater kayakers shouldn’t wear life vests because a strap might snag on a low-lying branch, a danger entirely eclipsed by the benefits of wearing flotation gear. The bigger risk for your noggin than being sideswiped is hitting the ground. The earth is a large impact zone, extremely difficult to dodge, and almost all of the parts you’d be riding on so much harder than your head. If you think the earth is going to open up and let your bare head, with its smaller profile thread the needled into some spongy material below, I suppose the point of rational discussion has been passed.

    > If your head is smacked on the side by a passing car, it’s not the impact that hurts you but rather the resulting rotation of your neck.

    Again, the ground, very hard. When I hit the asphalt, a sore neck was the least of my problems. The fracture running down the left side of my skull and the burst meningeal artery were a far greater concern. But when you talk about the torsional stresses, you may be alluding to the conjectures made by motorcyclists about the effects of the increased weight of a helmet. I am not going to argue about motorcycle issues here but I will tell you my helmet weighs 10 ounces. It is also possible that the slick hardshell on all helmets manufactured today is less sticky than your bumpy bare head and may thus decrease the torsional stress in your increasingly difficult to imagine sideswipe accident (How do you get hit hard enough to worry about torque-ing your your head without falling onto the ground? Is it the side mirror on a truck that’s precisely high enough to hit your head without hitting your body? Are you a gymnast with the ability to flip off the bike and land on your feet?),

    > The health benefits of cycling mean that cycling without a helmet is better for your health than not cycling at all.

    Tell that to my neurosurgeon. If you are talking about fitness, those unwilling to wear a helmet might seek a multitude of other exercises. And, get this! They could also ride their bike with a helmet! I admire your sense of self sacrifice and your willingness to risk brain injury to promote cycling and maybe get Joe Couch Surfer out on a bike but there may be an easier way. If you are talking about better air quality from everybody riding their bikes instead of driving, your assumption is that these people who might bike commute, but for the embarrassment of wearing a helmet, would never use public transit, or walk. I imagine most of the people who would commute by bike are already open to these options.
    In addition, education about the risks of brain injury can do a lot. Look at seatbelts. If you can find it, there is a well-researched/fact-checked New Yorker story about the air bag technology and how it was developed, at least in part, because automakers and auto safety proponents believed they would never get ordinary people to wear seatbelts. Now seatbelts are more or less universal, at least in the United States. And they save lives, every day.
    There are many head injury survivors, including myself, who would say “Had I known …” Believe me, brain injury is more serious than most people even begin to comprehend. I was lucky, extremely lucky. I woke up. I returned to my job, my life, with amazingly few deficits, basically a slight case of epilepsy. I would have been far luckier if somebody had taken the time to explain to me the true risks and educated me about helmets.

    > “Wearing a helmet makes one more likely to be involved in a crash in the first place, because of safety compensation on the part of drivers (and perhaps cyclists too). Although not a big difference, wearing a helmet cuts the clearance given by passing drivers by around 3″.”

    As you can imagine, my experience has led me to follow the studies and developments closely. If new evidence emerges, I typically know if it. The 3 inches figure you cited most almost certainly comes from a study in England by Dr. Ian Walker (is this you Ian?) that was highly questionable in its protocol. Read this from the BBC account: “To carry out the research, Dr Walker used a bike fitted with a computer and an ultrasonic distance sensor to find drivers were twice as likely to get close to the bicycle, at an average of 8.5cm, when he wore a helmet.”

    So it was one guy, in one country where they drive on the left and have an entirely different car culture. As I understand it, he did not fit this sensor on anybody else’s bike. Did he ride differently when he was wearing a helmet? His compensation for road types has also been questioned. It’s hardly enough evidence on which to base the sweeping statement you made. Read more of the study and you will find that drivers gave him more clearance when he wore a blonde wig and when he was sitting upright -the basic finding being that drivers give you more room if you look like you don’t know what you’re doing. We are all one blond wig, a pair of chopper –style handlebars and a clown nose away from better safety.

    You can read a discussion of additional challenges to his work and Dr. Walker’s response here:
    http://www.bhsi.org/walkerstudy.htm

    I should point out here that not every bike accident involves an automobile. The accident that earned me a brain surgery scar didn’t. Also – though I do not have a citation at hand, I have been told by a traffic planner who studies bike accidents that most bike/car collisions, and certainly the most serious collisions, involve oncoming cars or cars entering the roadway ahead of you, not the close shave/sideswipe you talk about and the overtaking automobiles in Dr. Walker’s study. As I tell my friends – almost all the stuff you need to worry about is in front of you. The cars coming up from behind are scary because you can’t see them, but they are a small slice of the risk.

    > The jury is still out on whether wearing a helmet improves an individuals’ safety, but the evidence is clear that mandating helmet usage results in worse, not better, public health.

    Really? Check out this study of deaths before and after a helmet law was passed for children in Ontario – “The mortality rate per 100,000 person-years decreased 55%.”
    Read it here: http://pediatrics.aappublications.org/cgi/content/abstract/122/3/605

    The idea that helmets keep people off bikes is better addressed through education rather than, as you do, discouraging helmet use to somehow promote cycling. By the way, I never wrote anything about making helmets mandatory. You, on the other had, are against even talking about it – “evangelizing” in your loaded vocabulary.

    So again, helmet is nothing more than a complicated hat. It is not going to protect you from every accident. It might protect you from a lot of accidents. Go outside. Put on your helmet. Take a 2×4 and smack yourself on the head. Your helmet will be ruined. It will have done its job. You might be dazed. Take the helmet off. I dare you to do it again. Now think about that 2×4 as the ground, only bigger, much bigger.

    I will say it again – A helmet might save your life. It might not. But the chance that it will is all the reason you need to wear it.

  • gecko

    If you want to really make cycling safe use recumbents that are lower to the ground with a much shorter distance to fall; and, much less likely to fall over the handlebars.

    Of course, you’ll have to be protected from cars, truck, and buses.

    Which would be ideal, since your granny could use them also.

  • gecko

    Roughly equivalent to the trauma caused by many of the modern weapons of war, the horrific level of brute force trauma visited by transportation vehicles is a treatable and preventable disease with the solution equivalent in simplicity to having physicians and healthcare workers wash their hands.

    The equivalent solution is to have transportation vehicles that are the size and weight of human beings and optimally much less and with auxiliary powering the same or much less than the amount of power that human beings can produce.

    Of course, full body armor will save a lot of lives in current situation, but really!?

  • Gecko, there you go again: “…The horrific level of brute force trauma visited by transportation vehicles is a treatable and preventable disease with the solution equivalent in simplicity to having physicians and healthcare workers wash their hands. The equivalent solution is to have transportation vehicles that are the size and weight of human beings.”

    If you have figures showing biking to be safer than rail or bus, I challenge you to produce them. In the meantime, here are figures for passenger deaths per billion kilometers by mode, from the U.K. Dept. of Transport, 2002:

    Motorcycle 111.3
    Walk 44.8
    Bicycle 29.5
    Car 2.8
    Van 1.0
    Bus or coach 0.4
    Rail 0.3
    Water 0.0
    Air 0.0

    These numbers indicate you’re much safer in a bus or train than you would be on a bike. The only forms of transport more dangerous than biking are walking and motorcycles. You could of course argue that reducing car traffic would make biking and walking safer. But the best way to stay safe is to favor transport modes that are, in the imperfect world we live in, currently the safest ones.

    In absolute terms (total deaths, not per mile) biking and rail seem roughly equivalent in the U.S., though bus travel is much safer:

    Rail (includes grade crossings) 845
    Rail (does not include grade crossings) 510
    Biking 698
    Bus 37

    Bus occupants seem pretty safe. But these figures are for deaths in absolute numbers, not deaths per mile, so their relevance is limited.

    Can anyone find per-mile stats for the U.S.?

  • To complete the thought, I should note that biking and walking have positive impacts not reflected in the death stats: They make the biker or walker healthier, spare the lungs of other people in the vicinity, and have a low carbon impact. Too bad there isn’t a way to figure these mitigating factors into the mortality rates to arrive at some kind of ultimately more enlightening numbers.

  • gecko

    Which cause the most death? I suspect it is easy to argue that the number of people killed by walkers and cyclists in this city annually is a big fat zero.

    A fellow from NYC DoT at the Municipal Arts Society said this regarding cyclists about two or three years ago.

    I guess this excludes stampedes and crazy stuff like that.

    In any case: So there!

  • gecko

    #59 Mark Walker,

    There probably should be mortility studies of people who sleep in loft beds who have to climb down off them to walk to the bathroom during the night.

    Maybe they should sleep with helmets?

  • LN

    I have gone over the handlebars and hit my helmeted head 3 times. All three were in protected bicycle spaces, only one had anything to do with a car (door).

    I had lots of bruises and scrapes, but no head damage thanks to my helmet.

  • LN, did you replace your helmet after each crash?

  • I wear a helmet when I bike, even though most of my commute to work is on off-street bike paths. I know from experience — my own and friends’ — that there are lots of ways to fall off your bike, and many of them do not require the involvement of a motor vehicle. If you hit some bad pavement, or a patch of ice or mud, or if you run into another bicyclist who isn’t paying attention, your head can hit the ground, and that kind of fall can cause some real brain trauma.

    I know a co-worker who was riding alone in the country last year. He woke up in the brain trauma ward, and stayed their for several weeks. Nobody knows exactly what happened, but apparently he had a run-in with farm dogs — no cars were involved. I guess he’s OK now, but he’s still kind of spacey.

    I don’t suppose there are many farm dogs in New York City, but there are lots of other surprises along the safest routes that may lead to a fall and head trauma. If you do fall, your head will fall further than Natasha Richardson’s, and onto a harder surface. So there is a risk, and it has nothing to do with cars.

    Actually, it is my (totally unscientific) impression that helmets are more likely to protect you in crashes that do not involve cars. A lot of car-bicycle collisions — especially the ones reported in Streetsblog — involve speeds and impact levels that make helmets irrelevant, and they affect body parts that are not protected by helmets. If a car runs over your midsection, or throws you 15 feet in the air, the helmet won’t help you much. Ironically, in a world with more bikes and fewer cars, a helmet might be more useful than it is now.

  • gecko

    #64 Mitch, ” . . . in a world with more bikes and fewer cars, a helmet might be more useful than it is now.”

    In a world of minimal threat from cars, trucks, and buses, serious bike rapid transit using hybrid human-electric recumbents will quite possibly dominate; having real comfortable seats and higher comfort, better performance, higher accessibility to all with recumbent tricycles, and greatly improved safety since the falling distance is much shorter (often measured in inches) where it is much more difficult to fall head first over the handlebars.

    Encapsulating vehicles with on-demand airbag safety equipment could further enhance safety.

  • sf rider

    I’ve heard the argument that not wearing helmets will change the perception of cycling, but have there been any studies that back up that assertion?

    Whenever I see someone with no helmet in San Francisco, my #1 thought is I hope for their sake that they have good health insurance. If I saw someone with a child, I would wonder why they would put their health at risk with a young person depending on them. It does not make me want to stop wearing mine, or think that by somehow by not wearing a helmet, cycling is more normal or safer. It makes me think the wearer is unwise.

    One thing that does change my perception of cycling in the manner you describe: seeing people commuting by bike in work clothes, and not in shorts or jeans or (God forbid) lycra. Suits especially make an impression on me. I love seeing regular people who happen to ride a bike the way others get on a bus or train. They make me feel that even I can use cycling as my primary mode of transportation in the city.

    Stay safe.

  • A. Parent

    The main reason I wear a helmet is so that no one will think I’m irresponsible for not wearing one.

  • Sam Gardner

    The question is not: Should I wear a helmet? but: should I wear a reflective vest?

    The bright spot on the road really contributes to safety, preventively, and gives you a “taller” status in the traffic, while the Helmet is only after the facts…

  • Sam Gardner

    http://www.bmj.com/cgi/content/full/328/7444/857

    on visibility of riders.
    With Motorcycles, 37 % lower risk with conspicuous clothing.

  • zach

    Great article. Great debate. People tend to have really knee-jerk reactions to this issue, and it’s great to see a two-sided discussion.

    Jackie (#18) brings up an interesting point, trying to find a middle-ground: Is there a helmet designed for people riding at jogging speeds?

    I have often ridden an aggressive geometry bike quickly dodging traffic, something I wouldn’t do without a real helmet. On the other hand, if I’m riding a cruiser around a mellow neighborhood below 7mph, maybe there’s something in between an approved helmet and a baseball cap? Are there newer synthetic versions of those cool classic leather helmets? I’ve always wanted one of those.

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