Mandatory bike helmet proposal
I’m going to put myself out on a limb and actually advocate for the creation of universal bike helmet mandates for all ages through the AMA. There are definitely problems with such an idea:
1) Selective enforcement by cops can lead to justice issues. Most likely will lead to a salutary neglect situation like driving 5mph over the limit.
2) The “daredevil” theory – helmet will make you feel invincible/do crazy stuff.
3) Will reduce biking due to inconvenience. Can Boston a Velib system work with helmets? Can a carried helmet become a fashion accessory?
Here’s a very rough draft of a resolution I plan to take to Chicago in June. Please advise with comments – I can change it until the beginning of May. Otherwise, enjoy the academic references to a common conversation question.
A Resolution Promoting the Universal Use of Bicycle Helmets
Whereas, recent energy prices and a global economic recession have combined to increase bicycle sales to near-record levels 1; and
Whereas many American cities are integrating cycling into their transportation infrastructures 2; and
Whereas bicycle helmets have been shown to reduce the chance of head injury among cyclists up to 85% 3 4 5; and
Whereas current bicycle helmet laws and education for minors increase helmet use 6; and
Whereas twenty-nine states do not have bicycle helmet laws 7, and of those, fourteen have neither state nor local bicycle helmet laws 8; and
Whereas the incidence of bicycle helmet use is especially low among college students, with estimates ranging between 5% and 27% 9 10; and
Whereas helmets are mandatory for all riders in United States Cycling Federation events 11 ; and
Whereas the American College of Emergency Physicians recommends that state and local governments enact legislation mandating universal bicycle helmet use 12; and
Whereas, our AMA currently limits its advocacy for mandatory universal bicycle helmet use to the preparation of model legislation 13 14; therefore be it
RESOLVED, That our AMA include mandatory universal bicycle helmet laws in our legislative agenda at the state and local levels; and be it further
RESOLVED, That our AMA-MSS research the incidence of helmet use and bicycle-related injury at American colleges and universities; and be it further
RESOLVED, That our AMA-MSS support local chapters in the advocacy and delivery of bicycle helmet and safety education for all ages at their universities and surrounding communities.
References:
1 . Agence France Presse. (2005) “Bicycle sales boom in US amid rising gas prices.” Available at http://www.hubonwheels.org/newsletter3.htm#article7
2. Matlack T. (2009) “Is Boston ready for a revolution?” Boston Globe Sunday Magazine. Available at http://www.boston.com/bostonglobe/magazine/articles/2009/04/12/is_boston_ready_for_a_revolution/?page=1.
Boston is among several US cities considering a Velib-style bike sharing program.
3. Thompson RS, Rivara FP, Thompson DC. (1989) A case-control study of the effectiveness of bicycle safety helmets. NEJM, 320(21): 1361-7.
“Bicycle safety helmets are highly effective in preventing head injury. Helmets are particularly important for children, since the suffer the majority of serious head injuries from bicycling accidents”
4. Berg P, Westerling R. (2007) A decrease in both mild and severe bicycle-related head injuries in helmet wearing ages—trend analyses in Sweden. Health Promotion International 22(3): 191-197.
Available at http://heapro.oxfordjournals.org/cgi/content/full/22/3/191
Similarly, the incidence of concussion and skull fracture decreased. For non-head injuries, there were no significant changes for children. Helmets work.
5. Thompson DC, Nunn ME, Thompson RS, Rivara FP. (1998) Effectiveness of bicycle safety helmets in preventing serious facial injury. JAMA 276(2). Available at http://jama.ama-assn.org/cgi/content/abstract/276/24/1974
“Bicycle helmets offer substantial protection for the upper and mid face in addition to their known protection against head injuries. Helmets do not appear to offer any protection for the lower face.” Don’t fall on your chin.
6. Macknin ML, Mendendrop SV. (1994) Association Between Bicycle Helmet Legislation, Bicycle Safety Education, and Use of Bicycle Helmets in Children,” Arch Pediatr Adolesc Med 148(3): 255-259.
Helmet use increases with legislation and education; effects are most significant with both in place.
7. Current US motorcycle and bicycle helmet laws – April 2009. (2009) Insurance Institute for Highway Safety. Available at http://www.iihs.org/laws/mapbicyclehelmets.aspx.
8. Helmet laws for bicycle riders. (2009) Bicycle Helmet Safety Institute. Available at http://www.helmets.org/mandator.htm.
9. Kafefuda I, Henry KL, Stallones L. (2009) Associations between childhood bicycle helmet use, current use, and family and community factors among college students. Family & Community Health 32(2): 159-166.
10. Rodgers GB. (1995) Bicycle helmet use patterns in the United States: a description and analysis of national survey data. Accident Analysis and Prevention 27: 43-56.
11. Road, track, cyclocross rulebook. (2009) United States Cycling Federation. Available at http://www.usacycling.org/forms/RdTrkCx_rulebook.pdf .
12. Universal Bicycle Helmet Use. (2006) Ann Emerg Med., 47:306.
13. H-10.977 Helmets and Preventing Motorcycle- and Bicycle-Related Injuries
14. H-10.985 Bicycle Helmets and Safety
Relevant AMA and MSS Policy:
H-10.977 Helmets and Preventing Motorcycle- and Bicycle-Related Injuries
It is the policy of the AMA to: (1) encourage physicians to counsel their patients who ride motorized and non-motorized cycles to use approved helmets and appropriate protective clothing while cycling;
(2) encourage patients and families to inform and train children about safe cycle-riding procedures, especially on roads and at intersections, the need to obey traffic laws, and the need for responsible behavior;
(3) encourage community agencies, such as those involving law enforcement, schools, and parent-teacher organizations, to promote training programs for the responsible use of cycles;
(4) urge manufacturers to improve the safety and reliability of the vehicles they produce and to support measures to improve cycling safety;
(5) prepare model state legislation for cyclists’ mandatory use of helmets while cycling; and
(6) advocate further research on the effectiveness of helmets and on the health outcomes of community programs that mandate their use. (CSA Rep. 3, I-93; Reaffirmed: CSA Rep. 6, I-98; Reaffirmed: CSAPH Rep. 2, A-08)
H-10.980 Motorcycles and Bicycle Helmets
Our AMA (1) encourages efforts to investigate the impact of helmet use by riders of motorcycles and all bicycles, in order to establish the risk of major medical trauma from not wearing helmets, the costs added to the health care system by such behavior, and the payers of these added costs (i.e., private insurance, uncompensated care, Medicare, Medicaid, etc.); and (2) will explore ways to ensure the wearing of helmets through the use of disincentives or incentives such as licensing fees, insurance premium adjustments and other payment possibilities. (Res. 423, I-92; Modified and Reaffirmed: CSA Rep. 8, A-03)
H-10.985 Bicycle Helmets and Safety
It is the policy of the AMA (1) to actively support bicycle helmet use and encourage physicians to educate their patients about the importance of bicycle helmet use;
(2) to encourage the manufacture, distribution, and utilization of safe, effective, and reasonably priced bicycle helmets;
(3) to encourage the availability of helmets at the point of bicycle purchase; and
(4) to develop model state/local legislation requiring the use of bicycle safety helmets, and calling for all who rent bicycles to offer the rental of bicycle safety helmets for all riders and passengers. (Res. 7, I-90; Modified by Sub. Res. 208, A-94; Reaffirmed: CSA Rep. 6, A-04)
H-10.987 Use of Helmets in Bicycle Safety
Our AMA (1) supports appropriate efforts to educate parents and children about bicycle safety, including the use of bicycle helmets, and (2) supports working with the American Academy of Pediatrics and other appropriate organizations to ensure widespread distribution of information and educational materials about bicycle safety, including the use of bicycle helmets, to both medical and non-medical audiences. (Sub. Res. 72, I-89; Reaffirmed: Sunset Report, A-00)
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