ER Chief: NYC Needs More Speed Cameras and Bike Lanes to Reduce Traumatic Brain Injuries

The chief of emergency medicine at NYU Langone Hospital-Brooklyn says at least 15 percent of TBIs treated at Brooklyn hospitals annually can be attributed to traffic crashes.

Photo: Christopher Porter/Flickr
Photo: Christopher Porter/Flickr

Following the deaths of Neftaly Ramirez and Alejandro Tello, an emergency room surgeon is calling for more traffic-calming measures, including speed enforcement cameras and bike lanes, to prevent traumatic brain injuries in NYC.

In a Daily News op-ed, Dr. Nicholas Gavin, chief of emergency medicine at NYU Langone Hospital-Brooklyn, says at least 15 percent of 1,200 TBIs treated at Brooklyn hospitals annually can be attributed to traffic crashes.

“With the densest population in New York City, it is not surprising that the borough has the highest number of accident-related head traumas,” writes Gavin. “Its wide avenues are conducive to speeding — which, in turn, leads to serious accidents and horrific patient outcomes.”

Gavin says slowing motorists down should be the city’s number one traffic safety priority, and cites the lowered 25 miles per hour speed limit as an important step. Despite Vision Zero progress, however, reductions in pedestrian and cyclist fatalities have leveled off as the number of speed enforcement cameras allowed by Albany remains static. Gavin says the speed camera program should be expanded, and not just around schools.

There are other steps I would also recommend: We must improve lighting and street signage; create barriers to discourage jaywalking; install more countdown clocks at crosswalks; designate more bicycle lanes; and widen medians where pedestrians caught mid-crosswalk can wait more safely. This is particularly important in the outer boroughs.

Traffic crashes are the leading cause of traumatic injury at some NYC hospitals. Gavin recommends an increase in the number of health care facilities that are equipped to treat TBIs, to reduce the number of victims who suffer permanent damage.

It’s uncommon to hear a medical professional focus on crash prevention as a systemic issue. To the contrary, at traffic safety summits hosted by NYC hospitals in recent years, presenters tended to talk more about the behavior of people who are hit by motorists.

“As capable as ERs are at saving lives,” writes Gavin, “there is no substitute for prevention.”

  • William Lawson

    The pushback against red light and speed cameras from the driving community is completely ridiculous. You hear the same things over and over: “they’re stepping on our rights,” “it’s an overreach,” “they’re just using us as an ATM machine” etc. Not once does it occur to these gasoline addicted bozos that they can avoid bankruptcy by simply driving like civilized human beings. There should be cameras at EVERY intersection.

  • William Lawson

    As an aside, just look at this example of the kind of scum we’re dealing with on NYC roads. Taxi driver photographed laughing after he struck and killed an 80 year old woman on the Upper East Side – making a turn, failure to yield. No charges according to the Daily News.
    http://nypost.com/2017/07/28/elderly-woman-stuck-and-killed-by-taxi-on-ues/
    We need to declare outright war on this filth.

  • kevd

    All good recommendations and its nice to hear a medical expert place the onus on reducing injuries where it belongs – instead of simply recommending bright clothing for pedestrians and helmets for cyclists (though I wear one 98% of the time I’m on a bike).

    But, one quibble. Brooklyn has the highest population, not the densest population. I wonder what the rate of traffic related TBIs is in Manhattan, which is nearly twice as dense
    as Brooklyn, but with a considerably lower total population. And I wonder if the lower overall density (though still second densest county in the country) could be a factor in a higher rate of TBIs in Brooklyn – as traffic on arterials seems to frequently be faster than that on Manhattan arterials.

  • Joe R.

    I agree. Doctors unfortunately are typically the ones who constantly insist cyclists wear helmets. They usually base this on the number of cyclist TBIs they see. Of course, they never bother to collect data on what caused the TBI. I’ll bet 99% of cyclist TBIs are caused by motor vehicles and couldn’t have been prevented with helmets.

    It’s nice for a change to see a doctor recommending going at the root cause of the problem, rather than engaging in victim blaming.

    BTW, I’ve never worn a helmet while cycling and never intend to. The countries with high rates of cycling seem to agree with this philosophy.

  • kevd

    “I’ll bet 99% of cyclist TBIs”
    I’d love to see some research backing that up which is more rigorous that “I bet”.
    but I’ll grant you, it is certainly some percentage greater than 0 and less than 100.
    “The countries with high rates of cycling seem to agree with this philosophy.”
    The reason for both their high rates of cycling and their low rates of helmet use is probably the same, their high quality cycling infrastructure.

    I didn’t wear one in Germany after day 2.

  • Joe R.

    I know the 99% is anecdotal but I just haven’t seen any cyclist only injuries where there’s TBI. I’m sure it happens sometimes but I just don’t recall it. That even includes the days back in my childhood where there was no such thing as cycling helmets. Lots of kids crashed on bikes, but the injuries were scrapes and cuts. I’d love to see research on this myself but I expect helmet manufacturers would suppress it. After all, the design of helmets means they’re generally only useful in cyclist-only injuries, and then only at speeds under about 10 mph. If data suggested such incidents were exceedingly rare, few people would see the sense in wearing a helmet.

    The reason for both their high rates of cycling and their low rates of helmet use is probably the same, their high quality cycling infrastructure.

    I didn’t wear one in Germany after day 2.

    I don’t doubt that perception of safety strongly influences whether one decides to wear a helmet or not. That said, the usual reason why cyclists say they wear helmets here, but not in Europe, is because they share space with motor vehicles more often. To me this might make sense purely from a perceptional standpoint, but not from a logical one. Helmets offer just about zero protection in a collision with a motor vehicle, which is the number one thing most US cyclists are afraid of. Being that I’m an engineer, the logical part of my brain dominates my decision-making, not the emotional part. Hence my choice to not wear a helmet. There are comfort , hearing, and visibility reasons as well.

    Here’s hoping better infrastructure in the US eventually consigns bike helmets to the dustbin of history.

  • kevd

    In bike-motor vehicles collisions helmets offer protection not from a high speed impact, but from being knocked off one’s bike and hitting the ground (or the vehicle) with one’s head. when bikes and cars mix, those sorts or falls are (anecdotally) more common than when bikes have their own space.
    But sure, if you’re hit by a car going 35, the helmet probably does little to nothing.

    I wear a comfortable helmet, so it doesn’t bother me. I’m not sure how a modern bike helmet could possibly inhibit one’s hearing or vision.

  • A bike helnet cannot possibly impact one’s hearing or vision; frankly, such claims are bizarre. The only thing that a helmet is going to adversely affect is your hairdo.

    No one asserts that bike helnets will protect riders in all situations.
    Certainly there exist many catastrophic collisions in which a helmet will make no difference.

    But, as you have correctly indicated, wearing a helmet protects a bicyclist from a head injury after a fall, which can be caused by a collision or by road defects, gravel, ice, or by any number of other conditions. What’s more, styrofoam is the perfect material for this, because it is lightweight and springy.

    We should acknowledge that any person has the right to risk cracking his/her head in a fall that would otherwise have been harmless. But the danger is that the helmetless rider could potentially normalise bad behaviour. So, for the sake of younger bicyclists, sensible people have the responsibility to denounce helmetless riding and to encourage the use of this simple and effective safety device.

    (Some wiseguy is bound to mention that head injuries can occur in cars, and ask why helmets shouldn’t be worn by auto passengers, as well. To which I can only reply: that’s probably a good idea.)

  • Joe R.

    Never mind auto passengers. Statistically the risk of a head injury is greater while walking than while biking. If we consider that cycling is statistically dangerous enough to wear helmets (something I vehemently disagree with) then it follows logically that pedestrians should also wear helmets given that they have an even higher risk. You can’t have it both ways. If it’s safe enough to walk without helmets, then it’s safe enough to ride without them.

    While we’re talking about this subject, the fact a personal protection device exists doesn’t imply it always makes sense to use it. It depends on the level of risk. We could put seatbelts in trains, and doubtless they might save lives in a train crash. However, train travel is statistically so safe it’s not worth the bother to install seat belts, then try to get passengers to wear them, when statistically at best they might save single digit numbers of lives per year. It’s much the same with bike helmets. There may be a few crashes per year where they might save lives or prevent debilitating injury. This must be weighed against their downsides. That includes the inconvenience of carrying around a helmet. And it includes very real discomfort factors which exist for at least some riders. The very way helmets attach, via a chin strap, is something I find exceedingly annoying. Add to that overheating. That occurred when I tried one in the winter. I would have passed out from heat exhaustion in warmer weather. Then you have the loss of hearing and some peripheral vision. Even if none of those factors existed, the level of risk while cycling is so low that it makes little sense to call not wearing a helmet “bad behavior”. If we ever mandated helmets, I would never set foot on a bike again. That’s how much I loathe them.

  • Joe R.

    See my reply to Ferdinand below. It’s not that helmets offer no protection under any circumstances. Rather, it’s that cycling is inherently safe enough that universal helmet use at best would save a few tens of lives annually in the US (and even that number might be high). There are hundreds of other things which kill more people but we don’t advocate wearing personal protection devices against those things. Lightning strikes are a good example. You could wear a suit which is conductive on the outside but insulated on the inside to channel a lightning strike around your body. If everyone wore those suits when venturing out in thunderstorms then we might save tens of lives. And yet we don’t advocate this.

    Remember any push to get cyclists to wear helmets must be balanced against those who stop cycling because they don’t want to wear helmets. Australia passed a mandatory helmet law. The numbers cycling decreased. Doubtless more people will die from heart disease than might have been saved by helmets. Also, those who still ride are denied the benefit of safety in numbers.

    We often blame the lack of good infrastructure for the small numbers cycling in the US. And yet there are other places with equally bad infrastructure which have higher ridership. Certainly infrastructure is very important but at the same time the constant barrage from all sources advocating helmet use gives people the impression cycling is a dangerous activity like playing football. Doubtless this stops a lot of people before they even start.

    I wear a comfortable helmet, so it doesn’t bother me. I’m not sure how a modern bike helmet could possibly inhibit one’s hearing or vision.

    Everyone is different. Whether or not a helmet causes discomfort depends upon a lot of factors. Your riding position, riding intensity, how much you depend upon subtle changes in sound, and so forth all come into play. I’m personally allergic to aromatic hydrocarbons. “New car smell” makes me nauseous. Any continuous contact with plastics eventually causes a negative reaction. The styrofoam and plastics used in helmets are both aromatic hydrocarbons. They’re also potent carcinogens (I wonder if increased cancer risk from wearing helmets balances out any positive effects).

    Hell, i’ve hit the pavement more than a couple times and exactly zero of those involved me also hitting (or being hit by) a motor vehicle. I’m glad I was wearing one in each of those instances.

    This seems to be a common theme from people extolling the virtues of wearing a helmet. They seem to regularly have falls, and therefore are glad they were wearing a helmet. I’m curious as to why it seems (anecdotally anyway) that helmeted cyclists seem to fall so frequently. Maybe helmets really do block enough vision and hearing such that things which might have been easily avoided aren’t. I’m saying this because I had fewer than a dozen falls, mostly in my first few years cycling. They became less common as I gained experience. I haven’t fallen off my bike for any reason for 21 years and counting. It isn’t for lack of not riding fast or even aggressively. I’m just keenly aware of every sight, sound, and smell around me. Not sure that would be the case if I was wearing a helmet. A helmet creates a lesser version of the “cocoon” we often say exists for motorists.

  • kevd

    I’ll let you and the pro helmet zealots fight this one out.
    I don’t even have time to read that treatise, let alone respond.

  • Joe R.

    I’m not looking for any fights. I stated my piece, and any further argument on my part would just be reiterating the points I’ve already made. I don’t have time for any further back and forth on this. As I stated earlier, I’m just glad a doctor came out for the right things for a change instead the usual worthless suggestions.

  • kevd

    completely agree about the doctor.
    i’m never give anyone a hard time for not wearing a helmet and I firmly believe their safety benefits are wildly overstated. but, having scraped my helmeted head on the asphalt a couple times, i’ll be keeping mine on (most of the time).

  • reasonableexplanation

    Agree with all your points.

    Regarding helmets in cars; there already exists something soft and squishy for your head in a car; the front and side airbags! Modern cars are remarkably safe for the occupants as long as you’re buckled in. Many crashes that would have been fatal in older cars now result in nothing but bruises for the occupants.

    In cases where no airbags are available (like cars on a track), full face helmets are the norm.

  • reasonableexplanation

    overheating? loss of hearing? peripheral vision?

    As Ferdinand mentioned elsewhere, “A bike helmet cannot possibly impact one’s hearing or vision; frankly, such claims are bizarre. The only thing that a helmet is going to adversely affect is your hairdo.”

  • Joe R.

    I’m calling BS on that because the one time I tried a bike helmet all those things were factors. Add to that the annoying chin strap which was distracting me from controlling the bike. The fact is all bike helmets use styrofoam which is a great insulator. Hard to see how that won’t cause you to overheat if you ride vigorously. And as I mentioned, the plastics in helmets are potent carcinogens which I would rather not have in contact with my head. I don’t use plastic food containers or cups for the same reasons.

    Whether or not helmets are uncomfortable is moot. I don’t care if someone chooses to wear one but I hate the preachiness from people like Ferdinand who insist not wearing one constitute bad behavior. You want to wear a helmet, fine. But it’s none of your business if other people choose not to wear one. I don’t tell people who wear helmets not to. I expect the same courtesy in return.

    Some things worth reading:

    http://www.sarahwilson.com/2010/12/if-you-dont-like-wearing-a-bike-helmet-you-might-like-to-read-this/

    http://www.bikinginmpls.com/im-done-wearing-helmet/

    http://www.howiechong.com/journal/2014/2/bike-helmets

    http://www.freerangekids.com/enough-with-the-smashed-watermelons-helmet-mania-is-scaring-kids-away-from-biking/

    https://www.cnet.com/news/brain-surgeon-theres-no-point-wearing-cycle-helmets/

  • Joe R.

    You do know that the five point harnesses used in racing would probably save people in all but the most horrific crashes. I’m totally impressed when I see an Indy car smack the wall at 200 mph and the driver walks away. Unfortunately we don’t mandate five-point harnesses in passenger cars, probably for comfort reasons. I personally think we should give people the choice. Have five point harnesses and regular seat belts.

  • reasonableexplanation

    Here’s a modern bike helmet being worn:
    https://uploads.disquscdn.com/images/eb563af2c6f8e411e97a8268365d342886c0df73f2f821615e33584f0d240a0c.jpg
    Notice how it’s far above the eyeline (no peripheral vision issues), Note how it does not cover the ears (no hearing issues). Notice how it’s full of holes to let your hair breathe (these work quite well).

    Here’s a photo of the 5 boro bike tour where thousands of everyday people wear helmets with no issues:
    https://uploads.disquscdn.com/images/42882f8e3b0eb7baf1e4f953ad749f8f89f80dc90393744a1dc65243f7ab4875.jpg

    As for riding vigorously? Every single professional cyclist who rides far more vigorously than you or me wears a helmet during races.

    As for the chin strap being uncomfortable? Seatbelts are uncomfortable too. Suck it up.

    I would never support a law requiring helmets for adults, because how you live your life is your problem. Doesn’t mean I won’t think you’re being an idiot if you choose not to wear one. Same way you might judge a motorcyclist riding in nothing but a helmet, t-shirt, and flip flops; legal, but dumb.

  • Even if there shouldn’t be any helmet law for adults, that does not mean that riding helmetless should go un-commented-upon.

    We need not be so concerned about adults cracking their own heads open as about the danger of normalising helmetless riding to impressionable young people. (This is the same reason that depictions in movies of smoking or of unprotected sex are increasingly frowned upon.)

    Just as sensible people advocate eating a healthy diet as opposed to a diet that contains an excess of salt or sugar or fats, sensible people also legitimately advocate protection of one’s head. Of course, this message will never influence those who practice a mindless and reflexive contrarianism. But the more people who are moved to change their behaviour and to take appropriate safety precautions, the better.

  • Joe R.

    If you’re riding in an aerodynamic tuck then the helmet interferes with both seeing and hearing. The wind passes over the helmet before hitting your ears, changing the sound.

    The helmet I tried had vents. I still overheated.

    As for professional cyclists, they’re allowed to remove their helmets during ascent stages when they’re likely to be exerting the most effort and have the least amount of wind speed for cooling. The rest of the time they wear helmets because they have to, not because they want to. There has been a movement to repeal the UCI mandatory helmet rules both because of the comfort issues, and also the fact that annual deaths during racing have gone up since helmets started being worn.

    As for the chin strap being uncomfortable? Seatbelts are uncomfortable too. Suck it up.

    Suck it up? First off, seat belts are far less uncomfortable. Second, anything which causes discomfort distracts me from my primary goal of safely piloting the bike. That actually makes me more likely to crash. So what exactly is gained here? A very minor improvement in safety only under a limited set of circumstances which don’t apply to me (i.e. speeds under 10 mph and solo crashes) combined with an increased likelihood of crashing. Sounds to me like this makes me less safe, not more safe.

    Doesn’t mean I won’t think you’re being an idiot if you choose not to wear one.

    I can’t control how others think. I happen to think anyone who owns or drives a car in NYC is an idiot but that’s just my opinion.

    Apparently judging by your and Ferdinand’s quick responses neither of you bothered to read all those links.

  • Joe R.

    For what it’s worth during the last 5 or so years there seems to be a decided push back against bicycle helmets. Maybe I’m not so contrarian after all.

    I’ll ask you again why don’t you advocate pedestrian helmets, and consider walking without one to be an equally bad example for impressionable young people? One of my links above ( http://www.onestreet.org/resources-for-increasing-bicycling/136-bicycle-helmets ) gives 325 cyclist deaths from TBIs versus 1825 pedestrian deaths. Seems to me the potential exists to save a lot more people by advocating pedestrian helmets. Moreover, most of those 1825 pedestrians were likely going at speeds where a helmet would have saved them. That’s not the case for the 325 cyclists.

  • reasonableexplanation

    The difference between a 5 point harness and a regular 3 point seatbelt is somewhat like the difference between a partial face motorcycle helmet and a full face helmet; it’s a thing, but effectively meaningless if compared to no helmet at all.

    The 3-point seatbelt does it’s job very very well. It keeps you inside the car and lets the other lifesaving tech do it’s job. You can walk away from a vast majority of previously fatal accidents if you wear your seatbelt and have functioning (non-Takata) airbags. See this video, called ‘room to live’: https://www.youtube.com/watch?v=73D8kMbWn6E

    And you do have an option to install a 5-point harness if you like; some of my friends that take their cars to the track have them installed.

  • reasonableexplanation

    I can tell that for some strange reason you really can’t stand bike helmets, and that’s fine, you do you.

    The chin strap thing is especially weird to me, much like a seatbelt, I forget about it as soon as I put it on, and I’d wager so do most people.

    The visibility thing is a stretch: you often go into “an aerodynamic tuck” when biking among traffic? A bike helmet sits well above your eye line on the sides, so you can’t be losing any vision there, so you must be talking about the area above your brow? Modern helmets are about as thick as the width of your index finger there, and sit somewhere at your forehead line. Again, it won’t be blocking anything.

    I have a feeling the last helmet you tried were those big guys from the 80’s that were heady, big and had no venting. Try a modern giro helmet. You might be surprised.

    As for the sound:

    The wind passes over the helmet before hitting your ears, changing the sound

    Eh, what? Your argument is the wind will sound different? Sure, but the things you need to hear when biking, like cars, people, etc. are not the wind…so that’s good?

    The overheating thing… Maybe you have a strange medical situation, I don’t know your deal, but the fact that many, many people wear helmets with no issue on rides more strenuous than yours, even in the middle of the summer points to this not being a common issue.

    On to your numbers:

    One of my links above gives 325 cyclist deaths from TBIs versus 1825 pedestrian deaths.

    You know as well as I do that presenting raw numbers without accounting for say, the number of walkers vs bikers, age, etc. means very little. For example you could start with 60 million bikers vs 320 million pedestrians, then look at time spent doing each activity, age of those biking vs everyone else, etc. Raw numbers are not an apples to apples comparison and you know it.

    I can’t think of any recent cyclist deaths where a helmet might have helped. In fact, in most of those cases the cyclists were wearing helmets but it didn’t help.

    This is almost like the inverse of survivor bias; do you know any people that fell off a bike and hit their head? I’m sure most bikers here do, and it’s quite possible that a helmet worn in those situations helped at least prevent a concussion, if not something far more serious.

    It’s not even clear at this point that bicycle helmets improve safety overall

    That’s where you’re wrong friendo: Here’s an actual study (not from a blog or advocacy organization ,but from the NIH) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598379/

    This review included five well conducted case?control studies and found that helmets provide a 63–88% reduction in the risk of head, brain and severe brain injury for all ages of bicyclists. Helmets were found to provide equal levels of protection for crashes involving motor vehicles (69%) and crashes from all other causes (68%). Furthermore, injuries to the upper and mid facial areas were found to be reduced by 65%, although helmets did not prevent lower facial injuries. The review authors concluded that bicycle helmets are an effective means of preventing head injury.

  • Joe R.

    The chin strap thing is especially weird to me, much like a seatbelt, I forget about it as soon as I put it on, and I’d wager so do most people.

    A seatbelt isn’t pressing right against your skin. Also, a secondary issue for me besides the annoyance is my allergies to aromatic hydrocarbons. Prolonged contact with a chin strap will eventually mean a rash in that area from both the allergy and sweating. The styrofoam will eventually cause a rash on my scalp. Styrofoam is known to be a very potent carcinogen. I’d rather not have it in contact with my scalp while doing an activity which tends to open up my pores.

    As a child I immediately lost interest in any sports which required protective gear. I always found such gear physically annoying, to the point it cancels any potential joy from the activity. I even hate wearing gloves when riding in the winter as it deadens my feel of the controls but the alternative is frozen fingers. Not getting frostbite is an immediate benefit of dealing with the discomfort from gloves.

    The visibility thing is a stretch: you often go into “an aerodynamic tuck” when biking among traffic? A bike helmet sits well above your eye line on the sides, so you can’t be losing any vision there, so you must be talking about the area above your brow?

    Yep, in a tuck you can’t see above your brow, and that happens to be the area right in front of you. I go into a tuck a lot when I’m trying to keep up with traffic. Hard to go 20 or 25 riding upright.

    Eh, what? Your argument is the wind will sound different? Sure, but the things you need to hear when biking, like cars, people, etc. are not the wind…so that’s good?

    It changes ALL the sound. When you ride the wind is part of what you hear but other sounds are mixed in. I key on very subtle changes in sound sometimes. I don’t want anything which deadens certain frequencies.

    You know as well as I do that presenting raw numbers without accounting for say, the number of walkers vs bikers, age, etc. means very little.

    Raw numbers are very relevant here because you should weigh every safety campaign on how many potential lives it will save. Numbers of deaths can be low for two reasons. One, lots of people do an activity which is very safe. Two, only a few people do an activity which is very dangerous. In the latter case you might have the groups doing this activity recommending safety equipment to those who engage in it but it makes no sense to have a widespread public safety campaign. You could use mountain climbing as an example. There are tons of safety equipment for climbers but there are no laws requiring it, nor are there public safety campaigns to use safety equipment, because few people engage in mountain climbing. In this case it’s left up to the individuals to train and use appropriate safety equipment.

    It’s pretty obvious cycling isn’t a niche activity like mountain climbing. Lots of people do it occasionally. At least 10% do it fairly regularly. So basically it falls into the first category-it’s a safe activity which lots of people do but which causes relatively few deaths. Therefore, it makes no sense to have the ongoing campaigns to get people to wear helmets once you dissect the numbers.

    Let’s start with the raw number of 325 deaths. About 90% of cyclist deaths involve a motor vehicle, so it’s reasonable to say a helmet wouldn’t have changed the outcome of 90% of those 325 deaths. That leaves about 30 deaths. If we assume none of those 30 cyclists were wearing helmets, and helmets could have prevented their deaths with 100% certainty, then at best your helmet campaigns will save 30 lives per year. In reality helmets aren’t 100% effective, and some number of those cyclists in solo incidents probably were wearing helmets, so you might be looking at saving less than 10 lives per year. It seems to me maybe we should focus on bigger causes of death.

    It would probably be equally ridiculous to start a campaign to get pedestrians to wear helmets given the relatively low numbers killed compared to other causes of death. I just mentioned it for the simple reason that walking has more deaths from TBI per hour of exposure than cycling, so if we think cyclists should wear helmets, then it follows pedestrians should also.

    This is almost like the inverse of survivor bias; do you know any people that fell off a bike and hit their head?

    Only one, and the guy is a complete clutz who hardly ever rides. I don’t know any regular cyclists who hit their heads. I don’t remember any of playmates from my childhood hitting their heads while riding other.

    That’s where you’re wrong friendo: Here’s an actual study (not from a blog or advocacy organization ,but from the NIH)

    Why are you linking to a ten year old study? More recent studies show a neutral to slightly negative effect. Here’s something more recent: http://www.cycle-helmets.com/elvik.pdf

    Incidentally, me and several other people wrote letters a few years ago which convinced the CDC to remove from its website the statement that says helmet use reduces head injuries by 80 percent.

    I can tell that for some strange reason you really can’t stand bike helmets, and that’s fine, you do you.

    As an engineer I hate anything which is either redundant or unnecessary. For most types of cycling a helmet just isn’t necessary. Cycling solo is an exceedingly low risk activity. Cycling in motor traffic is slightly more risky but here a helmet generally won’t help you if something occurs. The only type of cycling where I would personally wear a helmet if I absolutely had a reason to do it would be mountain biking on trials. Here speeds are usually within the range for which helmets are effective AND it’s somewhat likely even a very experienced rider will fall and hit their head. In other words, in this case the risk is somewhat higher and the protection is usually somewhat effective. For regular road cycling the risk is exceedingly low and the protective is mostly ineffective against things which might actually kill you.

    Now just for full disclosure, I have fallen but not for over 21 years. I only fell about a dozen times, mostly while I was gaining experience, but never hit my head or had any serious injury. Ditto for others I know. Even people with plenty of spills rarely suffered anything worse than road rash. Cycling has a very low potential for serious injury, and even less for serious head injury. As for the types of falls, they were all at high speeds (well above the effective range of helmets). About half involved dooring but I quickly learned to keep a buffer to avoid that. The other half involved pavement defects combined with excessive speed. I never fall, even on really bad pavement, if I’m doing about 15 mph or less. My mistake in these case (again before I gained experience) was to go fast on a road whose condition I wasn’t aware of. Nowadays I only go fast if I’ve been on a road recently.

    My worst injury didn’t even involve a fall or high speeds. There was some slick stuff on the street from workers dumping liquid from a restaurant. I was going maybe 20 mph and the front wheel starting to break loose. I put out my left leg to counter and prevent a fall. I was successful, but I pulled a ligament doing it. It took a good 6 months for that leg to feel normal. In retrospect I should have just let myself fall and did my usual putting my arms forward to cushion my head. Given my fairly low speed, at worst I would have gotten minor road rash. I may well have even just slide along on whatever was on the street without injury.

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