RECOMMENDATION ON THE PREVENTION OF THE HEAD INJURIES WHEN CYCLING

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 hematoma
  and 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.

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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.

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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.

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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)

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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.

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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. 

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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.

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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

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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

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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 impact since 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.

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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

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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

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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.

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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.

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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.

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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.

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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.

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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
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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)
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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
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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.

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USERS 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.

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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.

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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 ?