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RECOMMENDATION ON THE PREVENTION OF THE HEAD INJURIES WHEN CYCLING

RECOMMENDATION ON THE PREVENTION OF THE HEAD INJURIES WHEN CYCLING. THE STUDY OF THE COMMISSION. 1.         What is the part of head injuries among all the injuries suffered by accidented cyclists ?

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RECOMMENDATION ON THE PREVENTION OF THE HEAD INJURIES WHEN CYCLING

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  1. RECOMMENDATION ON THE PREVENTION OF THE HEAD INJURIES WHEN CYCLING

  2. THE STUDY OF THE COMMISSION • 1.         What is the part of head injuries among all the injuries suffered by accidented cyclists ? • 2.        Is the helmet the right answer to prevent those traumas whatever the age of the cyclist (child, adult), the place (in town, in the country), and the kind of practice (leisure/sports, or tranport) ? • 3. What conditions are necessary for a helmet to be an efficient protection in case of impact on the head

  3. OUR OBJECTIVES • 1.         Have more precise data on mortality and morbidity among cyclists • 2.        Have a look on foreign experiences in order to recommend helmets to be compulsory or in order not to recommend them ; • 3.         Evaluate the efficiency of the protection given by helmets through an analysis : • of regulations and standards ; • of the results of tests made by the LNE : on the use of the helmets with a pannel of consumers • of the measures made by the LNE on the resistance of the chin straps and their open/close devices.

  4. THE CONSEQUENCES OF HEAD TRAUMAS • contusions or wounds of the scalp with hematomaand bleeding, fractures, head wounds with haemorrage ,oedema, compression creating conscience troubles, with a more or less deep coma, convulsions, violent headaches and eventually instant or delayed death. • Later and less known manifestations, but the persistance of which can create a real handicap : head spins, headaches, sometimes epilepsy crises, sleep or behaviour or memory troubles such as irritability, agressiveness, depression, anxiety. Those manifestations do not appear in statistics

  5. ACCIDENTOLOGY • Statistical data on cycling accidents are inconsistent and incomplete. • In 2001, the road safety authorities recorded 5,501 deaths and injuries on public roads whereas InVS (health watch institute) put the number between 78,000 and 216,000. • 86 death in the country, 81 in urban regions, 80% during the day. • No information is gathered about the cause and circumstances of accidents (place, factors involved in the occurrence of a head injury,) including whether the injured cyclist was wearing a helmet or not. • Available national and regional information indicates that, while the head is not the part of the body most affected in cycling accidents, a cyclist without a helmet runs a greater risk than a cyclist with one. • overmortality following road accidents for the over 40s, and especially the over 65s and overmorbidity for the under 14s.

  6. THE WEARING OF HELMETS IN LEISURE CYCLING • In France : not compulsory, and not widespread. Debate : • Some leisure cycling associations, like the Fédération Française de Cyclotourisme (FFCT), require minors to wear a helmet for liability reasons and encourage adults to do the same. An effective awareness-raising campaign : 90% of FFCT members now wear helmets. • Deaths among FFCT members : 47 in 2001, 26 in 2004. Half of the fatal accidents are attributable to physical causes (cardio-vascular failure). The over 55 probably most reluctant to wear helmets require members of leisure cycling clubs aged under 18 to do so. • The road safety agency reckons 5 M bicycles in active use in France. over 3.5 million bicycles sold in France in 2004 (in all categories: town bikes, racing bikes, mountain bikes, children's bikes, etc.), 6% more than in 2003. • France has one of the lowest helmet equipment rates, with an average of 1 helmet sold for every 2 bikes and 1 helmet /bike for children. Opinion poll in 2005 : 3% wear a helmet regularly in rural areas, 4.5% wear a helmet in urban areas with over 100,000 hab, 17% always wear a helmet. Although adults generally do not wear helmets, 47% of all children do so at their parents' insistence.

  7. REGULATIONS • Directive 89/686/EC of 21 December 1989 as amended on the approximation of the laws of the Member States relating to personal protective equipment (PPE) defines three classes of PPE : • Class 1 : PPE of simple design that cover only minimal risks (almost exculisvely in home environment or sphere) • Class 2 : protection against serious mechanical, physical or chemical attack or impacts or vibrations that affect vital parts of the body and are liable to cause irreversible injury (bicycle helmets and all other sporting helmets fall into this category); • Class 3 : protection against mortal danger. • Transposed into French law by texts incorporated into the legislative and regulatory parts of the Labour Code, which constitute the "ordinary law" on PPE, and by decree 94-689 of 5 August 1994 on the prevention of risks resulting from the use of PPE in sport.

  8. COUNTRIES WHERE HELMET IS NOT COMPULSARY • Countries where helmet is not compulstory • Belgium : ISBR campaign (children under 8). « Street Code » in 2004 • Netherlands

  9. COUNTRIES WHERE HELMET IS COMPULSORY • Spain : 2003 decree outside agglomerations • Australia : since January 1990 for all cyclists. 48% decrease of deaths or hospitalizations the 1st year, 71% the second year • USA : • study shows the helmet is as efficient with our without a vehicle • Helmet protects from lacerations and fractures in the high part and middle of the face • Most frequent cause for accident : loss of control by the cyclist • Canada : head traumas represent 80% of cyclists deaths. • Helmet compulsary under 18 in Alberta (May 2002), Ontario (October 1995), • Compulsary for all cyclists : British Columbia (Dec 1995), Prince Edward Island (July 2003), New Brunswick (Dec 1995), New Scotland (July 1997)

  10. STANDARD NF EN 1078 • NF EN 1078 of April 1997, applies to helmets both for cyclists and for skateboarders and roller-skaters ; • The standard defines a number of requirements relating to: • manufacturing methods and areas to be protected, • fields of vision to be preserved, • impact absorption properties, assessed by dropping a standard head from a certain height onto an anvil. An accelerometer measures the deceleration, which must not exceed a certain limit • resistance to penetration, assessed by the impacts on the helmet after it has been dropped onto an anvil, but it takes no account of the effects of a sliding fall • the features of restraint systems. • No requirements for air vents (minimum airflow coefficient, number, size, protection). Lack of specifications for impact points during resistance tests, can lead to approval being given to helmets that are not strong enough. • Warns consumers against the risks of using helmets for purposes other than cycling, skateboarding or roller-skating.

  11. STANDARD EN 1080 • Standard NF EN 1080 as amended in February 2003 (NF EN 1080/A1) lays down requirements and testing methods (the impact absorption capacity requirements in EN 1080 are the same as in EN 1078.)for helmets intended for children engaging in activities in environments where there is a risk of head injury (either cycling in a "home" environment where there are no motor vehicles or engaging in other play or games where the risk of strangling cannot be ruled out). Helmets must be equipped with a self-releasing retention system that will open on violent impact. 

  12. THE STANDARDS IN QUESTION • 2004 : the European Commission, pursuant to Article 6.1 of Directive 89/686/EC, issued a draft formal objection against NF EN 1078 on the grounds that the standard did not fulfil the health and safety requirement set forth at Article 1.2.1, "Absence of risk and other inherent nuisance factors". The standard could not confer the presumption of compliance for helmets intended for children under the age of 7. • After monitoring the market for cycle helmets for young children, the Commission found manufacturers very reluctant to comply with the requirements of NF EN 1080, recommending that helmets for children under 7 should be equipped with a self-releasing retention system. It therefore considered, a contrario, that NF EN 1078, could allow for the design of helmets that represented a risk for children since it did not cover automatic release of the retention system. • The federation of sports and leisure industries, FIFAS, opposed the Commission's draft resolution : it would create a risk (a young child losing the helmet on falling from a bicycle) in order to eliminate another risk (that of strangulation). Helmets that comply with NF EN 1078 are designed not to come off after an initial impact, thus avoiding a secondary impact to the head if the helmet is ejected. For FIFAS, only full and fair consumer information about the functionalities of both types of helmet was justified as recommended by CEN Guide 11 on product information relevant to consumers. No helmets with self-releasing chinstraps on the French market.

  13. SUPERVISION OF REGULATIONS • Regulations broadly respected : • Of 326 helmets tested, 11 failed to comply with certain requirements and test methods of the NF EN 1078 standard, 9 of them because of lack of impact absorption capacity or insufficiently strong retention systems. Two helmets were deemed dangerous • instructions for use rarely accompanied the products displayed on the shelf: "the notice attached to the helmet often gets caught in the display when the customer takes the helmet and is torn off." The notices are also not often in French

  14. THE PROPER USE OF HELMETS • From a physiological standpoint, a "good" helmet must at the very least protect the fragile areas of the cranium (face, zygomatic arch, occiput at the mid-mastoid) at speeds corresponding to reasonable traffic conditions (between 10 and 30 kph on average. Provided these conditions are met, the two helmet designs found on the market are acceptable

  15. HELMETS CLOSELY SURROUNDING THE PARTS TO BE PROTECTED • The aim is to minimise the effects of an impact on the head either by giving the materials of the shell uniform thickness ("aggressive" rollerblade or BMX helmets) and few vents, or by strengthening just the parts corresponding to the most fragile bone regions. For Dr. M., however, the only guarantee of real protection for the face and neck was a visor and good close protection of the occiput, which is not always to be found in these models;

  16. HELMETS WHERE PROTECTION IS BASED ON THE MASS OF THE HELMET ALL AROUND THE CRANIUM • The rim of the shell avoids direct impact to the face, temples or back of the neck from still or moving objects. This type of helmet is now the most common. The vents may or may not have protective webbing against insect bites

  17. CONCLUSIONS ON THE PROPER USE OF HELMETS • Even though Article 4.4 of NF EN 1078 states that the back of the cranium must be protected, Dr. M considered that few helmets give sufficient protection to the occiput and even wondered whether certain systems for adjusting the head size might not be dangerous • Chinstrap resistance measurements were satisfactory for the expected use to prevent the helmet from being torn off in the event of a violent pull or impactsince they showed that the chinstraps resisted a pull of 250N. Measurements of the fastening system itself showed considerable differences in the amount of force needed to open clips or buttons. However, it remained below a limit which guarantees that a child – and hence also an adult – can manipulate the fastening system if necessary.

  18. CHARACTERISTICS OF THE HELMETS AVAILABLE ON THE FRENCH MARKET • Adjustment of the size of the helmet to the head • Although NF EN 1078 requires the head size to be marked in centimetres, the criteria for defining the size of helmets differ from one manufacturer to another and from one model to another. Thus, there are age ranges, ranges by size in centimetres and American sizes (XS/S/M/L • Dr. MEYER considers that beyond a range of two sizes and for a head corresponding to the stated minimum, the use of adjustment systems on their maximum settings can reduce the level of protection. For example, with foam strips or a repositionable velcro strap, reducing the head size raises the helmet, which then leaves sensitive areas like the temples and the back of the neck uncovered. Dual-clip ratchet systems increase the risk of unsymmetrical adjustment

  19. CHARACTERISTICS OF THE HELMETS AVAILABLE ON THE FRENCH MARKET (1) • Adjustment of the size of the helmet to the head • Although NF EN 1078 requires the head size to be marked in centimetres, the criteria for defining the size of helmets differ from one manufacturer to another and from one model to another. Thus, there are age ranges, ranges by size in centimetres and American sizes (XS/S/M/L) • Dr. MEYER considers that beyond a range of two sizes and for a head corresponding to the stated minimum, the use of adjustment systems on their maximum settings can reduce the level of protection. For example, with foam strips or a repositionable velcro strap, reducing the head size raises the helmet, which then leaves sensitive areas like the temples and the back of the neck uncovered. Dual-clip ratchet systems increase the risk of unsymmetrical adjustment

  20. CHARACTERISTICS OF THE HELMETS AVAILABLE ON THE FRENCH MARKET (2) • Adjustment of the chinstrap either side of the head • There are two methods for attaching the side straps of the chinstrap to the shell of the helmet. In one case, the chinstrap consists of a single strap that goes into the shell of the helmet or the headband and is held by a single anchor point.The strap slides inside the helmet on adjustment. In the other case, the chinstrap has one or two straps but two anchor points which, in Dr. M.'s opinion, is better for the even distribution of pressure on the cranium.

  21. CHARACTERISTICS OF THE HELMETS AVAILABLE ON THE FRENCH MARKET (3) • Closing the chinstrap • Article 4.6.2 of the standard states that the chinstrap must not include a chinpiece. None of the helmets found on the market had one. • Markings on almost all the helmets complied with NF EN 1078. However, the lettering of the markings is often too small to be read easily. • Some manufacturers affix warnings not provided for by the standard, relating to use of the helmet on motorised devices. There are two main types of warning: "This helmet is designed for cycling only. It is not for use with mopeds or motorcycles" and "This helmet is intended only for non-motorised sports: cycling, roller-skating, skateboarding." • 5 helmets out of 12 did not include any instructions at all, contrary to the provisions of Chapter 7 of NF EN 1078. Only three sets of instructions complied fully with the standard.

  22. TESTS IN USE • 24 cyclists divided into two groups of 12 (4 children and 8 adults) were recruited to test cycle helmets in use. • The cyclists in the first group, all of them helmet users, were each given several models which they tested for several days. They then gave their impressions to the LNE (National Testing Laboratory) coordinators (ease of use, comfort, etc.). • The second group, all of them not helmet users, were asked during tests at the LNE to put on a helmet and take a short ride. Each participant tried three helmets according to the same protocol and each helmet was used by three different people. An LNE coordinator fitted the helmet and asked the users for their first impressions.

  23. ASSESMENT CRITERIA FOR THE PROPER USE OF HELMETS • The criteria for the proper fit of a helmet were determined by Dr. Meyer according to physiological factors.

  24. ASSESMENT CRITERIA FOR THE PROPER USE OF HELMETS (1) • Once adjusted to the circumference of the head, the helmet must not show too much slip movement from front to back or sideways, spontaneously, under light pressure or in the event of a violent impact, and must be uniformly in contact with the cranium.

  25. ASSESMENT CRITERIA FOR THE PROPER USE OF HELMETS (2) • The helmet must be worn horizontally, the head must be covered to the mid-mastoid and above the line of the eyebrows Helmet too backwards and chistrap not adjusted

  26. ASSESMENT CRITERIA FOR THE PROPER USE OF HELMETS (3) • The chinstrap must be vertical. With the straps forming a "Y", the point of the "v" must be located under the ears but must not cover them. The V of the chinstrap is too high (covers the ears)

  27. ASSESMENT CRITERIA FOR THE PROPER USE OF HELMETS (3) • The chinstrap must not slide onto the throat. Properly adjusted, there must be room only for a single finger between the chinstrap and the skin. Chinstrap too tight

  28. THE TESTS • The perception of risk depends on the type and frequency of cycle use. The risk of falling or hitting a blunt obstacle seems real when mountain biking or racing and justifies wearing a helmet. On a bike ride or on the road (urban or country), consumers see the risk as minor. • Many cyclists do not give the matter of wearing a helmet any thought: it is not a reflex. People who have never or rarely worn a helmet do not think of buying one or, if they have one, forget to wear it. Without a parental model, children become more reluctant to wear a helmet after the age of 8. • Image concerns dissuade cyclists from wearing a helmet. The image must be as positive as possible for everyone, adults and children alike, and reflect the person's membership of the community they identify with.. In all events, the helmet must not detract from the person's self-image and look.   • For the average user, the feeling of safety is mostly linked to the way a helmet surrounds the head. The need to protect the face and back of the neck with extensions of the shell beyond the cranium is not felt spontaneously.Polystyrene and plastic do not have the image of sufficiently impact-resistant materials. At this level, cycle helmets are seen in exactly the same way as helmets for motorised two-wheelers. Comfort did not seem to be a major obstacle to wearing a helmet.

  29. USER’S PERCEPTION OF HELMETS • no user, whether child, accompanying parent or adult, correctly adjusted the helmets to the cyclist's head, whatever the adjustment systems or combinations of systems. • No method • They do not read the instructions before the tests.

  30. THE MOST FREQUENT ERRORS • Adjusting the size of the helmet to the cranium was sometimes overlooked and some users merely tightened the chinstrap to apply the top of the shell to their cranium. • The chinstrap was wrongly adjusted (too tight or too loose) in half of all cases. Over-tightening the chinstrap, despite the predictable discomfort, is due to the fact that the chinstrap is seen intuitively as the only way of fastening the helmet to the head • Only one user understood where and how to adjust the side straps (in a Y with the buckle under the ears). The others did not understand the point of this adjustment in balancing the helmet on the head and distributing the protection over the entire surface of the cranium • the adjustment is easier to make when the straps are fixed at two points at the front and back of the helmet rather than at just one point, either at the front or at the back. It is doubtless one of the main reasons for the users’ difficulties On closing the chinstrap, the retention straps were twisted on several occasions because, the ratchet system being perfectly symmetrical, the two male and female parts lock whatever their position in relation to each other and there is nothing to enable the wearer to notice • Ratchet and button systems, though effective because very precise when it comes to adjusting the chinstrap, are uncomfortable for the throat (risk of pinching and rubbing) and cyclists do not like them.

  31. RECOMMENDATIONS TO THE PUBLIC AUTHORITIES • improve statistics on cycling accidents, whether in terms of the number, causes and circumstances, injuries suffered and behaviour of equipment (cycle, accessories, helmet) • make wearing a helmet compulsory for minor cyclists and, at least initially, for cyclists under the age of 15 and for carried passengers, every time they ride or are carried on a bicycle • continue campaigns to raise awareness of helmet-wearing and the prevention of specific risks associated with cycling directed at other categories of cyclists than those for whom wearing a helmet would be compulsory, especially senior citizens • give particular emphasis in such campaigns to the importance of adjusting the helmet properly.

  32. RECOMMENDATIONS TO THE CONSUMERS • wear a helmet whenever they ride a bicycle; • choose the size of helmet best suited to their head size, in particular so as to limit adjustments with the various adjustment systems with which the helmet is equipped; • seek advice from a professional, since choosing the right helmet and adjusting it properly are essential safety elements when cycling; • ensure that instructions for using the helmet are provided with the product and read the operating instructions before adjusting the helmet to their head; • use all the adjustment systems (headband, side straps) to ensure uniform pressure over the entire cranium; • regularly check the state of their helmet and change it systematically after a violent impact or after any accident and in accordance with the manufacturer's recommendations even if the helmet is used normally and is not involved in an accident.

  33. RECOMMENDATIONS TO THE STANDARD BODIES • start work on a revision of standard NF EN 1078, especially the following points: • limit the range of head size adjustments of each helmet, especially for children's helmets, which may impose a position that provides less protection, • Fix the chinstrap retention system to the shell of the helmet so that on adjustment it ensures that the helmet presses evenly on the head; • not use buckles, buttons or press studs that do not work if the side straps are twisted; • stop using adjustment systems (head size and chinstrap) that require the user to take the helmet off in order to adjust it; • give consideration, in terms of safety, to air vents, visors and the need to provide the best possible protection to fragile areas of the cranium, back of the neck and lower face; • improve impact tests; • consider whether it would be appropriate in the standard to distinguish between the specific requirements of cycling, skateboarding, roller-skating and scootering.

  34. RECOMMENDATIONS DU HELMET DESIGNERS AND MANUFACTURERS • fulfil the requirements of NF EN 1078 while integrating ergonomic concerns into the design of helmets and their adjustment systems so that consumers can be offered products that are effective and easy to understand and use, including by children; • with cycle manufacturers, study secure arrangements to ensure that the helmet is immediately available whenever the cycle is used. This would mean that cyclists would always have their helmet to hand, avoiding the risks of loss or impact if they have to carry it with them; • take appropriate steps to improve protection to the back of the neck and lower face, also ensuring that adjustment systems do not cause injury; • clarify the wording and presentation of manufacturers' instructions in order to encourage users to read them.

  35. RECOMMENDATIONS TO HELMET DISTRIBUTORS • train staff so that they are able to advise and better assist consumers when choosing and adjusting cycle helmets; • systematically propose the acquisition of a helmet to consumers when they buy, maintain or repair a bicycle; • offer free help with adjusting any helmet purchased in their stores.

  36. CONCLUSION • Recently, the « Velib » in Paris showed : • Great success for urban consumers • Helmet not compulsary : question will be raised in the future years • Will it be the same in other European countries ?

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