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news
Utrecht cyclists (picture credit Visit-Utrecht.com)Dutch neurologists and surgeons call on people to wear helmets while cycling
A group of neurologists and trauma surgeons drawn from some of the leading hospitals in the Netherlands are calling on people to wear helmets while cycling, saying it will lead to a reduction in deaths resulting from brain injuries.
United under the banner Arsten voor Veilig Fietsen (Doctors for Safe Cycling), the medics claim that of the approximately 50,000 cyclists who sustain serious injuries each year in the Netherlands, around one in three suffer a brain injury.
“Promotion of bicycle helmets is important for improving road safety and reducing the number of fatalities and injuries among cyclists,” they maintain, saying that there is widespread support for the wearing of helmets among doctors and professional bodies.
As a result, the group has been formed to campaign for the wearing of helmets and highlight the issue at local and national level, with the group pointing out that the number of cyclists killed in the Netherlands last year was, at 229, the highest it has been in two decades, with one in three of the victims riding an e-bike.
Highlighting particular concerns regarding the safety of children and e-bike riders, they pointed out that “serious brain injury is the leading cause of death in cyclists,” and claim that wearing a cycle helmet “reduces the risk of serious brain injury by 60 per cent and fatal brain injury by 71 per cent.”
The group adds that “recovery from brain injury is also very limited because the brain – unlike other organs – has limited reserves. Brains cannot grow or repair with the help of surgery. You have to be careful with your brain.”
One of the neurologists who founded the group, Myrthe Boss, of the Gelderland Valley Hospital in Ede, near Arnhem, said: “We think it is important that the wearing of bicycle helmets is actively encouraged to reduce the risk of brain injury, especially among vulnerable cyclists such as children and e-bikers.
“Our goal is to reduce the number of cycling casualties significantly in the coming years. If this goal is not achieved, then mandatory helmet use should be seriously considered by policy makers. Our message is: Use your head, put on a helmet!”
The Dutch language makes a distinction between sports cyclists, wielrenners, almost all of whom wear a helmet, and everyday cyclists, fietsers, the vast majority of whom do not.
Opponents of helmet compulsion point out, among other things, that research on their efficacy is inconclusive and that they are only safety rated to provide protection from a fall while not moving on the bike, and certainly not for a collision involving a motor vehicle.
They also insist that the deterrent to cycling that any move towards helmet compulsion has been found to bring about in jurisdictions where they have been made compulsory is outweighed by the wider public health and environmental benefits of getting more people riding bikes, particularly for short trips.
As the English-language website Dutchnews.nl points out, speaking last year, Wim Bot of the Dutch cycling union Fietsenbond, said: “It is a bad idea. Just promoting the idea that helmets should be worn strengthens the idea that cycling is not a safe activity in itself.”
Simon joined road.cc as news editor in 2009 and is now the site’s community editor, acting as a link between the team producing the content and our readers. A law and languages graduate, published translator and former retail analyst, he has reported on issues as diverse as cycling-related court cases, anti-doping investigations, the latest developments in the bike industry and the sport’s biggest races. Now back in London full-time after 15 years living in Oxford and Cambridge, he loves cycling along the Thames but misses having his former riding buddy, Elodie the miniature schnauzer, in the basket in front of him.
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43 comments
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Well have you visited yet? No? No-one to blame but yourself then.
I couldn't find the stats, are cycling incidents the leading cause of head injuries in the netherlands?
No - it's walking in to doorways.
Doorframes surely?
I stand corrected (and with a headache).
woudn't that happen when dutch people visit other countries with shorter doors? So not actually in the Netherlands?
Well that was meant to be part of the joke...
Yes - tourists visiting from the UK regularly experience their heads exploding due to cognitive dissonance - "but this isn't possible!"
Probably a few tourists banging themselves on the noggin after coming off bikes after an excess of Amsterdam hospitality too.
It's perfectly understandable to even the most ardent motorist. It is after all the Netherlands. Just proves why it can't happen in UK - it's not the Netherlands. if it was the Netherlands it would happen. Which it does. Thus proving why to doesn't in UK.
Stands to reason dunnit
remember cycling can't happen here because of the weather, this isn't The Netherlands.
although Netherlands has colder winters, hotter summers, about the same amout of rain anually and more rainy days than Edinbugh.
So it's obviously not the weather it must be something else. And yes Scotland is not as flat as Netherlands, but most journeys within towns and cities do not involve that many hills.
If only there was a handy bingo card for all of these and more, available in several languages...
Surely these medics ought to focus their efforts where they will have the greatest return? And yet I don't see anyone calling for mandatory helmets for the 65 and older population whilst upright, nor for them to rank alongside seatbelts in motoring legislation:
Falls. This is the most common cause in adults age 65 and older.
Motor vehicle crashes. This is the most common cause in young adults.
https://medlineplus.gov/traumaticbraininjury.html
If they can't make their argument in those arenas, the greatest causes of traumatic brain injury, what business do they have with cyclists?
Indeed. If you're genuinely interested in evidence-based medicine (which you should be) and your objective is the minimisation of brain injuries, look at the activity that causes the majority of brain injuries.
Clue: it's not cycling
"Serious brain injury is the leading cause of death in cyclists," says the group. Nonsense. I would bet that the frailties of old age cause far more deaths in cyclists, or did they mean people who were actually on a bike at the time of death?
or at least recently on a bike, now lying on a pavement/in a ditch/halfway through a windshield.
As ever the devil is in the detail.
Unlike the UK, e-bikes in the Netherlands consist of typical bikes as are available in the UK with a top speed of 15.5mph when the electric motor is providing assistance.
However, they also have fast e-bikes, capable of achieving 28mph through electric assist. These fast e-bikes are still permitted to use cyclepaths and are a bloody menace to the general fietser, as their silent propulsion, but almost double speed means they are the outlier of urban transport.
While not having any data to back this hypothesis up, I wonder if the increase in fatalities on Dutch cycle lanes could be due to this faster type of e-bike, whether it is the rider losing control, or other cyclists moving into it's silent path?
I suspect that the neurologists and surgeons are exposed to many instances where wearing a cycle helmet would have helped to reduce the injury they have witnessed. If this was your experience you would recommend wearing helmets and there is little doubt in my mind that in certian circumstances a helmet can be life saving. It's a matter of balancing out the risks.
In a road race with increased speeds and the likelihood of crashes a helmet makes a lot of sense. In daily commuting may be not so much. I am convinced that my awareness of what is going on around me is enhanced by not wearing a helmet and, as others have suggested, I suspect my risk taking is reduced. Then there is the research that concluded that drivers take more risks around cyclists wearing helmets.
It's horses for courses. I wear a helmet if it's raining and at night. It's also a handy way to mount a camera if you have different bikes. I'd hate to be told to wear a helmet on a sunny Sunday when I'm out in the lanes enjoying the sights and sounds of the country side with my camera bike mounted. The biggest risk here is being taken out by a speeding motorist and I suspect a helmet would make little difference to the outcome. I am willing to take that risk but may be the surgeon who has to try to piece me back together will have a different point of view and that view needs to be respected.
The article states “Our goal is to reduce the number of cycling casualties significantly in the coming years. If this goal is not achieved, then mandatory helmet use should be seriously considered by policy makers. Our message is: Use your head, put on a helmet!”. I think their goal is to reduce any brain damage which occurs as a result of cyclists coming off their bikes. In my opinion if you want to reduce cycling casualties you need separated infrastructure or a complete change in mindset about who the roads are for. Motorists need to be treated as guests anywhere but on a motorway, not cyclists.
I think your conclusion is correct. The neurologists have their perspective, but it is, in this context, anecdotal: I see lots of brain injuries on cyclists, therefore I think cyclists should protect their brain. This overlooks the fact that of course they see them - they're neurologists!
It remains a fact that a helmet necessarily dissipates certain impact forces. However, it is a contested assumption that that dissipation is sufficiently effective in sufficient numbers of cases - each with unique considerations - that the protection is significant at the population level. It is also contested whether the fact of wearing a helmet introduces new risks and forces, either on the part of the wearer, those around, or even environmental risks (such as rotational injury on impact).
None of these is the domain of a neurologist, per se. It is a public health policy matter, which is necessarily bound in population-level statistics and which considers wider impacts, behaviours and ethics than simply how many patients a neurologist happens to see from a non-random sample of a particular population (and to what extent/for whatever reason the neurologist focuses on a particular subset of his patient list). It is also part of a transport strategy matter, because, as any H&S expert will confirm, PPE is the bottom rung of priority after elimination, substitution, engineering controls and admin controls. Rather like the "cyclists dismount" sign, helmets are a symbol of the failure so far of those in charge of the environment to shape that environment satisfactorily.
We should indeed respect neurologists: they know lots of things. But they are not necessarily authoritative experts on the whole issue.
Personally, I think cyclists should consider wearing helmets; but that doesn't mean I think they should wear helmets - just that they should consider it and make their own informed decision.
It is broader than that too. If these folk are crashing on their 28mph ebikes then they will be suffering other injuries such as collar bone, rib, wrist, hip and possibly without hitting their head.
Where the problem is crashing and the outcome is various injuries, then the reasons for this should be considered as an overall strategy. Simply going for PPE as the answer fails to consider the wider problem. And where PPE is considered the answer, why would you go for a bicycle helmet as opposed to m/c helmet or even 'we need a new design completely'.
Ebikes in the Netherlands are limited to 25kmh as with everywhere in the EU. There are "speed pedelecs" that can do 45kmh but they have to carry reg plates and the rider has to have a moped licence, helmet and insurance, so I'd imagine the vast majority of accidents on ebikes in the country are on 25kmh ones.
I put 28 mph because of
Would these be the same as the speed pedelecs you mention ?
Yes. I think your point survives whether faster, registered ebikes are around. Other injuries can be life-changing or incompatible with life, too, even if the head is not directly hit. A neurologist may not see these injuries, so concentrate a solution on their more limited experience, ignoring the fact that the problem is not being hit on the head, it's coming into conflict with other vehicles that may or may not result in a collision that may or may not cause injury that may or may not be serious or fatal (or in some cases, just falling off your bike without anybody else involved).
On that last, parenthetical point, I cycled to the off-licence last night and bought a bottle of whisky. I then reflected on my purchase, and the fact that, if I fell off my bike with the bottle in a pocket or in my hand, the broken glass might cause me severe injury. So I drank it instead and disposed carefully of the bottle.
Good job I did: I fell off my bike 5 times on the way home!
[image of possible cycling safety-bib PPE]
We don't need PPE at all. We need to put getting-hit-on-the-head lessons in the school curriculum, and head injuries will soon become a thing of the past.
https://getyarn.io/yarn-clip/4e8f490c-26cc-4736-919e-a32cfbcd9c88
No news. Ask some medics about a non-medical issue* and you'll get a medical solution (PPE). Foot surgeons would probably want to mandate steel toecaps for daily use (don't forget to put them in slippers too).
*Treating head injuries - medical issue. But "preventing head injuries" could equally be improved by staying in bed. It's not just a medical picture because most people are also concerned with "preventing injuries on the roads in general" as well as getting from A to B, improving their life and health as a whole etc.
Actually the Netherlands is probably the one place in which such discussions are sensible given that they have a) done more to mitigate road danger that about anywhere else b) a very high proportion of the general population cycling at all ages and c) much better data about this (or at least they ought to...)
I suspect if the expert commentariat of road.cc were set the task of designing a hospital bed lots we'd have mostly have suggestions about reducing weight, discussion about disc or rim brakes, whether to make it from carbon or steel for minimum vibration and how aero it could be.
"How much?? The price of hospitals is ludicrous these days. I can get one just the same for £35 on Alibaba..."
"I ask the endocrinologists at the hospital about my diabetes, then nip on the internet and get my insulin for a quarter of the price!"
Any such initiative would soon be diverted into a discussion about why some hospital bed users couldn't be more courteous to people who exercise their rights to drive through the wards...
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