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Excellent analysis. I'll add one more point: we shouldn't expect helmets to have a dramatic safety effect because they aren't designed to prevent serious injuries.

If you look at the federal standards for bike helmets you'll see that they are designed to provide some cushioning in a slow-speed fall. Unless manufacturers are routinely making helmets that substantially exceed the standards -- and there is no evidence they are -- a reduction in lacerations and contusions is all we should expect. Expecting a bike helmet to prevent serious injury is like expecting your TV remote to control your microwave: it's something it just wasn't designed to do.

I'm particularly disappointed in the American College of Emergency Physicians for feeling they have to mislead the public in order to make their case, I thought they were proponents of science. In their defense, children are particularly succeptible to the type of falls that helmets are most effective against. I'm a firm believer that children should wear helmets.

We want to believe that we can control our own safety, and years of seat-belt education have drummed the idea into us that there are effective steps we can take. Critics of seat-belt education campaigns make the valid point that a far more effective way of saving lives than wearing seatbelts is to operate your vehicle in a safe manner. The same is true of bicycles and helmets.

Obligatory disclaimer: I wear a helmet every time I ride my bike. I make my kids where helmets on their bikes.

Excellent post! Thanks, yet again.

Always refreshing to see critical thinking applied to topics that many consider unassailable.

Whatever the stats may be I just did a face plant on the Mount Vernon trail on Bike to Work day. It was about 5:30 PM. I was going 20+ grabbed my water bottle with my right hand and a squirrel ran in front of me. I tried to evade it with my left hand only on the brake hood. I inadvertantly turning my wheel all the way to right, the next thing I know I was doing a face plant on the asphault. My lips and my helmet visor hit. I think the visor kept me from breaking my nose, my lips are still swollen. I suffered no head trauma, but would likely have had trauma if I hadn't been wearing a helmet. Stats may be debated, but I will never ride without a helmet. I've been bike commuting for 1.5 yrs/18 mls each way about twice/month (Mar – Oct). This is the first time in my life I've ever needed a helmet. I thank God for His kindness and the helmet for the additional protection that kept this accident from being much worst. I was able to get up, check out the bike and myself and ride the 16 remaining miles of my commute.

Surprisingly, I have found not crashing reduces incidents of brain injury 100%. Whether it's seat belts, air bags or helmet (not arguing against any of these) it always amazes me how little attention is given to addressing the cause of head injury inducing crashes. LaHood, Oprah and others focus on distracted driving has been a welcome change. I'd love to see the numbers from a study that looks at the combined effects of proper facility/roadway and maintenance; cyclist and motorist education and proper traffic law enforcement. Maybe doing an overlay of the indexed crash rate in Portland could demonstrate that? http://www.portlandonline.com/transportation/index.cfm?a=185776&c=34811

Yeah, that's why a helmet doesn't even make it into my top 3 safety tools. Anything that helps you avoid a crash comes before a helmet. I rank them like this:

1. An aware and skilled cyclist (you are your own best safety feature).
2. A bike in good working order
3. Lights/reflectors
4. A helmet
5. Gloves
6. Sunglasses/eye protection

I might even put sunscreen in between the lights and helmet.

The field of traffic safety focuses almost entirely on equipment and facility, there is basically a taboo against trying to change driver behavior. When safety officials do talk about changing behavior, it's the behavior of the victims -- pedestrians and cyclists -- they seek to change. For instance, when a MPD officer hit and killed a pedestrian in a crosswalk on Wisconsin Ave recently, DDOT's response was to remove the crosswalk! It's an article of faith that drivers can't be changed.

This is despite ample evidence that behavior dwarfs all other causes of collisions. In "Killed by Auto" Komanoff reports that over 90% of the drivers in collisions that kill pedestrians or cyclists are men. Since men account for only 75% of miles driven this means that men drivers kill people at about three times the rate of female drivers. Just getting the average man to drive like the average woman would reduce the fatality rate for pedestrians and cyclists by a staggering 60%. It's highly likely that there are behaviors associated with the risk of fatal collisions that are present in both men and women, but more common in men. Eliminating those behaviors in all drivers would probably eliminate the preponderance of fatalities.

In this environment the helmet is the ideal cyclist safety device: it's a piece of equipment, and it requires no behavioral change on the part of drivers, only on the part of cyclists. The fact that it is ineffectual is irrelevant.

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