In helmets we trust? 

Part 2 of Pique's concussion feature

click to flip through (6) PHOTO BY BONNY MAKAREWICZ - Kevin Sansalone
  • Photo By Bonny Makarewicz
  • Kevin Sansalone
 

In last week's feature Pique told the story of several Whistler residents who have suffered prolonged and severe concussion symptoms. All were wearing helmets when they were injured, either skiing or biking, leaving some wondering: what did their helmets do for them? Last year alone the Whistler Health Care Centre dealt with about 800 head injuries. As the media spotlight shines on the issue from high performance sports to recreational sports, Whistler, some would argue, is front and centre in the debate.

Diane Ziff skied for 50 years before she bought her first helmet.

It was admittedly an adjustment. She'd been skiing back east, on the ice she jokes, since she was 10 and never once wore a helmet.

When she moved to Whistler in 2007 and joined the Senior's Ski Team, she met Dr. Brian Hunt, a retired neurosurgeon.

It's one thing when the ski industry "recommends" helmet use, quite another when a neurosurgeon personally "encourages" it.

She took Hunt's encouragement to heart, changed her behaviour, and bought a helmet.

In a sad twist of irony, it was when Ziff was wearing her helmet that she got her first brain injury — a concussion — when skiing.

That first fall sparked a series of subsequent concussions and has left Ziff struggling with the ramifications of the injury.

"You learn to live your life differently," says Ziff with acceptance.

What would have happened had she not been wearing her helmet?

Would the concussion symptoms have been worse? Would she have a different brain injury like a skull fracture or a brain bleed? Ziff will never know.

In the dynamic world of brain research, new helmet technologies, and the impact of sport on the brain, Whistler is sitting centre stage.

In a place where people can have more helmets than shoes — helmets for downhill biking, helmets for road riding, helmets for skiing, helmets for hockey, helmets for snowmobiling — what do we really know about what we're putting on our heads when we hit the slopes?

Not enough, according helmet advocate Richard Kinar.

He is not only pushing for better helmet standards in the industry, a place where Whistler could and should take a leadership role he says, but he also sees Whistler as a potential centre of excellence when it comes to concussion research.

"Whistler is literally the best place in Canada to do it because most people are involved in many high risk sports," says Kinar of his proposed concussion baseline testing program.

"I believe that there is a health crisis in Whistler. I believe that the effects of concussion are far worse than what most people are willing to admit."

Helmets and concussions

Linda Glenday now knows that helmets do not prevent concussions; it took a concussion to find out.

They do, however, prevent other head injuries, as well as facial injuries.

That's why when she recovered from her six-month debilitating concussion, Glenday bought the best helmet she could find for mountain biking and the best helmet she could find for skiing.

Unwilling to live life in a cocoon of fear and terrified about getting another concussion, this was the only thing she could do to protect herself the best way that she could.

"I didn't even ask how much it cost," Glenday says simply. That's how important it is for her to protect her head.

Straight from the horse's mouth as it were, the world's experts on concussions from their latest meeting in Zurich in November issued this as part of their latest consensus statement:

"There is no good clinical evidence that currently available protective equipment will prevent concussion... Biomechanical studies have shown a reduction in impact forces to the brain with the use of head gear and helmets, but these findings have not been translated to show a reduction in concussion incidence.

"For skiing and snowboarding, there are a number of studies to suggest that helmets provide protection against head and facial injury and hence should be recommended for participants in alpine sports."

That's the same message Dr. Pat Bishop has been trying to send for the past decade.

Bishop is a retired professor at the University of Waterloo and his specific area of research is around helmet use.

"People think because you get concussions wearing helmets that the helmets aren't doing the job that they're intended to, which is so far from the truth that it's unbelievable," he says. "They are doing the job that they were intended to... If you're wearing a helmet your chance of survival is way higher than if you didn't have a helmet on. And so, they do the job. They prevent those lethal focal head injuries (injuries localized to one region of the head such as a skull fracture or a brain bleed)."

Gregor Wilson, who has been skiing since he could walk, knows this only too well.

He had one of the hardest wipeouts of his life this year on a 40 centimetre powder day. He presumes he hit some ice underneath or a rock.

He hit the ground so hard there was a hole through the back of his helmet.

Had it not been for the helmet Wilson says the fall would have undoubtedly cracked his skull.

"I've been pro helmets for a long time," he says.

That's why.

When he put his helmet out of commission for good, Wilson was ripping it up at Ski Wentworth in Nova Scotia, where helmets for skiing and snowboarding are now required by the law as of this year. He has since bought another one.

He would have been wearing that helmet that day, with or without the law in place.

Recommended — yes; Mandatory — that's up for debate

For the safety manager at Whistler Blackcomb, Brian Leighton, the ongoing and oft-emotional topic of helmet usage is "enough to give me a head-ache."

He jests but the statement is testament to controversy around helmets, among his staff and in the wider context.

This, at a time when helmet use has been steadily on the rise in the past decade and there is more buy-in for the use of helmets skiing than ever before.

Leighton says a conservative estimate of helmet use today would be about 80 per cent.

"All you have to do is look in the lift line," he says.

Ski hill operators such as Whistler Blackcomb, as well as the Canadian Ski Council and all regional ski operator associations, all call for recommended helmet use. The Canadian Ski Patrol System also endorses the recommendation.

Stats released by the Canadian Ski Council (CSC) in February 2012, based on its annual National Consumer Profile and Satisfaction survey, pegs helmet usage at 67.3 per cent in 2006. Five years later in 2011 that had grown to almost 75 per cent.

The stats are also broken down by age.

Usage is highest — 96 per cent — in kids 14 and under. Even with youth aged 15 to 17 usage is at a high level — 85 per cent.

Usage is lowest — 60 per cent — in the 25 to 34 year old age bracket.

The CSC report states: "These age segments would be those who began to ski and board before helmets became more widespread in availability and usage and are not used to wearing them. These two age segments should be the focus of future helmet promotional programs."

Programs that would encourage helmet use, not enforce it.

Before the legislation in Nova Scotia came into effect this season, Wilson says there was about 85 per cent voluntary helmet wear.

Speaking personally, and not as a director of Ski Wentworth, he questions the value of making the law, even though a helmet saved his skull this season.

The expense of introducing the legislation and policing it on an annual basis — an expense borne by the province of Nova Scotia — could perhaps be put to better use, Wilson suggests, if saving people from brain injuries is the ultimate goal.

With such a high rate of helmet use already, money could be spent, instead, he says, on policing the late night crowds coming out of the bars in Halifax for example.

It is not mandatory to wear a helmet at Whistler Blackcomb, unless you are taking part in a competitive event or riding in the highest level terrain park on Blackcomb Mountain.

"Why, when we're seeing the percentage going up year over year?" questions Leighton.

"We think it's unnecessary with the trend that's going on."

The key, he says, is to get people using their brains.

"Helmets are a good idea; they are," he says. "But using your head is even more important.

"We would rather have people think about what they're doing and the risks, with a helmet or not."

While that is a good strategy in theory, not everyone agrees that it pans out in practice.

"The one thing we cannot legislate is common sense," says Dr. Pat Bishop. "So you have to legislate other things like it's a requirement to wear a helmet on a ski hill, it's a requirement that you use a seatbelt in your car etcetera.

"I think all these arguments as to why do I have to wear a helmet are spurious; they're quite often knee-jerk reactions, and they're probably a reaction to the notion that government is acting like big brother," says Bishop. "Well sometimes you need a big brother to make sure you're doing the right thing."

Only the province can make it mandatory to wear helmets through legislation.

There are other concerns too — ones that could impact the bottom line.

From an operator's perspective, making helmet use mandatory could be perceived as another barrier to entry in the sport.

"If they don't have a helmet it means they have to buy one or rent one," explains Leighton.

And that could be the difference between choosing Whistler Blackcomb or not.

The single impact rental helmet

About a decade ago Bishop agreed to be a part of the ski and snowboard helmet committee, tasked with developing a standard for snow helmets.

At that time, the committee members representing the ski area operators, voiced concern about single impact helmets and how they relate to their rental programs.

Specifically, they were concerned that the ski helmets didn't provide protection against more than one hit.

Bishop explains that a single impact crushes the lining material in the helmet that protects your head. The liner doesn't bounce back. So, if there is an impact in the same place, the protection has been compromised.

"That (chance) may be remote on the skier wearing the helmet in one day, but it may not be remote for the guy who borrows the helmet the next day," says Bishop.

That's of great concern to helmet advocate Richard Kinar.

"Renting a single-impact helmet in a multi-impact environment, when they're not managed properly, could lead to injury or death," he says bluntly, highlighting his point with pictures of rental helmets stacked one on top of the other in apparent disregard for the arguably delicate product.

"How could you rent out a helmet where you have no idea about care and custody?"

Leighton insists that Whistler Blackcomb's rental helmets are all inspected and sanitized.

"The guys take them out of service as soon as there's any hint (of damage)," he says.

The damage, however, can be hidden, argues Bishop.

Ski and snowboard helmets are, for the most part, made with EPS — expanded polystyrene — foam liners with a hard outer shell.

The EPS liner deforms upon impact, absorbing the hit and reducing the transfer of energy to the head.

The issue is that the EPS liner does not form back into its original state, leaving the area of impact exposed.

"EPS is a good liner material, however, it crushes on impact and doesn't rebound so it has no memory," says Bishop. "So it's like taking a Styrofoam coffee cup and if you crush it in your fingers, it doesn't rebound, so you've got a dent now in your coffee cup. Or, you'll have a dent now in your ski helmet.

"The problem is you can't see that dent."

It's hidden between the bottom of the outer shell and the top of the inner shell.

That was a good starting off point in the developing of the new made-in-Canada standard.

The Made-in-Canada helmet standard

In 2009 the Canadian Standards Association (CSA) announced the first recreational snow helmet standard, intended to reduce head injuries.

Kinar was instrumental in uniting the medical community and lobbying government to join in developing the standard.

Bishop is on the CSA's ski and snowboard committee; he is also the chair of the CSA technical committee of equipment and facilities for ice hockey.

"I can tell you that the (Canadian) standard is different than any other ski and snowboard helmet standard in the world," says Bishop.

At the heart of the standard is a requirement that the helmet can withstand three consecutive hits to the helmet in the same location. That makes it different from anything else on the market.

"Well, we think it's better because first of all the standards that come from Europe and the United States (CEN and ASTM), they're single-impact helmets."

Hockey helmets are able to withstand multiple hits, he says. They are made with vinyl nitrile foam or expanded polypropylene foam (EPP).

"We know that there are materials that have memory and that have rebound capability in the sense that they will return to their original shape, and we use those in hockey helmets," says Bishop.

The helmet standards may also require the helmets to be bigger because the standard calls for more of the head to be covered.

Does it make a safer helmet?

That's hard to tell.

Four years since the release of the date and there has yet to be a helmet manufacturer making CSA standard helmets.

Local helmet manufacturer Kevin Sansalone, founder of Sandbox Helmets — now selling the number one snowboard helmet in Canada despite being in the market for less than a decade ­­— weighs in on the CSA standard.

"I think bringing in new standards is always tough for a manufacturer because we have moulds and tools in place and that tooling is hundreds of thousands of dollars," he says.

"To enforce a new standard for Canada would mean a lot of retooling, which would be a huge financial burden and time constraint on all manufacturers."

As a helmet manufacturer, Sansalone takes the matter seriously. When people are out on the snow with his brand emblazoned over their heads, he knows that he's putting himself out there.

"We're protecting people's heads and brains," he says.

All Sandbox snow sports helmets meet either the European safety standards or the American safety standards.

"I've been in the testing labs," adds Sansalone. "I've seen the tests that they go through. I've been to the certification labs where they actually certify a helmet and they do some very rigourous tests."

Sandbox snow helmets, like almost all mass recreational helmets on the market, are made with an EPS liner.

"Polystyrene is cheap," explains Bishop. "It's cheap to manufacture. It's cheap to buy... What they (the helmet manufacturers) are telling the public when they say 'we can't meet the standard unless we have this big, bulky helmet which we don't think we can sell' is: we don't want to change the lining material. We want to keep using polystyrene and we want to make it thick enough so that it will withstand three impacts."

Sansalone is all for a multi-impact helmet. But it has to make sense in the marketplace.

If the Canadian standard is calling for bigger, potentially bulkier and potentially more expensive helmets, who is going to put them on their heads? That's the crux of the issue.

"How are we going to have a safe helmet that is going to protect our kids, or our skiers, or our participants, that they are going to want to wear and that is at a price point that they are going to want to buy?" he asks.

Discussion continues

Leighton says helmets are seen as "the magic pill" in terms of safety.

"It's really the way that you behave out there that'll make the difference," he adds.

And so Whistler Blackcomb continues to push the message that helmets are recommended when riding and skiing on the mountains. It's a message reinforced in all promotional campaigns and materials.

Helmets are one part of the equation. Kinar sees baseline testing as another tool in combating and treating head injuries. Most high performance sports organizations already use baseline testing for their helmets.

But Kinar is calling for a baseline testing program in Whistler aimed at all youth with a goal of developing a standardized concussion education and management program that could be taken country-wide.

It's aimed at those kids who are getting repeatedly concussed on the mountains, on the ice, on their bikes and are continuing unwittingly in their sport.

"They don't know it," says Kinar. "And their parents don't know."

This program, in part, would help them realize it.

But at a ballpark half-million dollar cost to get it off the ground, Kinar has yet to find the financial support.

His work, crusading to make snow sports safer, as he campaigns from the local level to the federal government level, continues.

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