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Head games, part I
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While people make up their minds and recreational industries way the pros and cons, the number of brain injury victims is piling up

When "Major" Dave Bowers, an up and coming skateboarder from Surrey, died at Lions Gate Hospital in January of 2001 from pneumonia stemming from a brain injury, it sent shockwaves through the community of skaters, snowboarders, BMX’ers and inline skaters – the people who knew who he was and best understood what he was all about.

The major papers picked up on his story, which is a mix of both irony and tragedy.

It was ironic because he sustained the brain injury while trying to avoid being injured. With only a week to go before he was to compete in a major amateur competition in Tampa, Florida, he decided to take time off skateboarding because he was worried he might get hurt before the competition. He went snowboarding at Mount Seymour instead, something he considered low risk. But he landed on his head off a jump.

Although the concussion was technically "survivable," Bowers choked on his own vomit and contracted a staph infection that led to pneumonia. Five days later he was dead.

It was tragic because Major Dave was just 20 years old and on the verge of making his dreams come true. He was touring the U.S. as a member of the Libtech amateur team. He was in skate magazines and videos, and was sponsored by DuFFs shoes, Spitfire Wheels, and Fluid Sports in Langley.

He was also about to come into millions of dollars from a stock option, enough money to allow him to live his life as he chose.

While it can never be known whether a helmet could have prevented the untimely death of Major Dave, the hospital was not shy in attributing his death to the brain injury. Clay Adams, a spokesman for Lions Gate Hospital told the Vancouver Sun that it is not uncommon for people who have suffered head injuries to vomit and then inhale vomit particles that can lead to infection. "It was one of those real tragedies that came about because of the injury."

Skaters around the province have since honoured Major Dave’s memory in spray paint, and with tributes at their local skateparks. An eight-foot quarterpipe at Surrey Athletic Park – Bower’s home turf – has an eight-foot "R.I.P. Major Dave" to commemorate his life.

While a bit of fame and notoriety brought the Major Dave story into West Coast living rooms, the tragedy and irony repeats itself as more and more thrill seekers sustain head injuries.

It’s tragic because in many cases, it’s unnecessary – helmets help to prevent and reduce the severity of head injuries, and are a proven life saver. It’s ironic because we know this, yet too many of us still choose to take part in activities without the proper safety gear.

Despite the fact that it costs taxpayers about $1,000 per day, per patient to treat an acute brain injury – and that lifetime extended care costs run from $100,000 to $200,000 a year for the most serious cases – helmets are still an option in many sports and a matter of personal choice.

That’s slowly starting to change, as the casualties pile up and the question of liability creeps in.

In January of 2000, Vancouver’s Cypress Bowl ski area introduced a mandatory helmet rule for its terrain park, despite the fact that more injuries took place on the Green runs than in the terrain park. Initially there were some grumblings by park users, but the more serious riders complied after a brief adjustment period.

Cypress Bowl was the first park in North America to make helmets mandatory. Lakeridge Resort in Ontario followed last year, and Martok in Nova Scotia will follow in 2001-2002.

No mountains south of the border have followed suit as of yet, but Snow Summit in California has acknowledged the potential for liability by introducing a special second waiver for skiers and boarders who wish to use their "superpark."

No skateboard parks in North America have mandatory helmet rules, although disclaimers are as prominent a feature as quarterpipes. Fredericton, New Brunswick, may be the first municipal government in Canada to implement a mandatory helmet policy for their local skate parks after local emergency room doctors complained that they were treating between 10 and 20 skaters a week, many with serious head injuries. They are currently reviewing the situation, and if they are successful in implementing a mandatory helmet bylaw, there’s a good chance that other municipal governments would follow suit – once one municipality makes helmets mandatory for medical reasons, it could set a precedent or a standard for safety.

Although most skateboarders are generally against the idea of being forced to wear helmets, liability issues have kept skateparks out of major cities in Canada and the U.S., forcing many skaters to build their own alternatives. Cities like Toronto and New York cracked down on skateboarding in public areas, and corporations, fearing lawsuits, hired guards to kick skateboarders out of their parking lots and away from their buildings.

According to Skatepark.org, an advocacy group that promotes the construction of public skateparks, we’ve been down this route before.

"The skateboarding boom that followed the 1973 innovation of the urethane wheel, for example, spurred the construction of commercial skateparks nationwide. But most of these early parks – the majority of them built with gunite – were so poorly constructed that they became dangerous and began to suffer insurance and liability problems. At the end of the seventies they began to close en masse; eighty per cent of them were bulldozed in 1979 alone."

Things have turned around recently, mostly in recognition of the popularity of the sport. In the U.S. alone, there are 6.2 million skateboarders, making it the sixth most popular sport in the country. At the same time, there are relatively few skateparks in comparison to other athletic facilities.

Without parks to go to, those skaters tended to run amok in downtown areas, and with them came the complaints, the noise, the scratched up curbs and benches, and the graffiti. In one of the most famous cases, skaters completely thrashed the new $9.8 million Civic Plaza in downtown Albuquerque in a matter of months, with the cost of restoration being pegged in the millions.

Faced with a decision of either trying to chase down and confiscate every skateboard in town or bringing the parks back, a lot of towns and cities went with the park option. They’re coming back slowly to give these kids a place to go, and disclaimers were posted in the parks in an attempt to head off any liability issues.

In California, a law was passed proclaiming skateboarding a dangerous activity, along with rock climbing and surfing, which protects cities from being sued for injuries by anyone 14 or older.

Head injuries are the main concern. The big question is whether you can convince people to start wearing helmets on their own, or whether it’s up to the resort operators and cities who supply the venues to mandate and enforce helmet regulations.

Helmet use has increased dramatically in recent years, especially among the younger generations that have grown up with helmets. As they become more accepted in some mainstream sports, notably cycling, so do they become more accepted in sports like skiing and skateboarding.

Education and positive role models have also helped to get more people into helmets, teaching people the risks and showing kids that it’s okay to wear padding.

Helmet designers are taking care to make their products fashionable, resorts are making them mandatory for kids taking lessons, and rental companies are offering helmet for free or for a nominal charge with bike and skate rentals.

At the same time, too many people are still getting hurt.

"It’s just common sense to wear a helmet to protect yourself," says Dr. Brian Hunt, a neurological surgeon at Lions Gate Hospital and a Whistler skier for years.

"What’s really frustrating is all this business of ‘Why should I wear a helmet?’ How many examples do we have to give? What about the story of the little Japanese girl in Calgary who fell backwards on her (inline skates), hit her head on the cement, and died the next day? That’s a good example. How many stories do you need? There are too many stories, that’s the problem."

About 56,000 stories a year

According to statistics compiled by Webster & Associates, a Richmond, B.C. based law firm that provides legal services for survivors of brain injury caused by negligence, every year in Canada there are approximately 56,000 cases of Traumatic Brain Injury (TBI), or head injuries serious enough to require extra medical attention.

For some 36,000, the injury is severe enough to require hospitalization; 2,500 will die, 9,000 will require long-term rehabilitation, and 6,000 will live with a disability.

TBI is also the leading cause of death and disability in children and adults.

About half of all brain injuries are the result of motor vehicle collisions, with the remainder divided among work-related injuries, falls, illness, sports injuries, firearms and assaults.

British Columbia accounts for approximately 6,000 TBI cases each year, of which 600 cases will be serious enough to require lifetime support and services "which are difficult to obtain and often are not available," according to the B.C Brain Injury Coalition.

Between April of 1998 and September of 1999, Whistler contributed 2,787 head injury cases to the provincial load. Locally, head injuries are the second most commonly treated medical emergency, behind orthopedic emergencies. That’s an average of 164 head injuries a month, although numbers are significantly higher during the winter.

Nationally, approximately 70 per cent of brain injury survivors are young adults between the ages of 18 and 28, while young males between 14 and 24 have the highest rate of injury out of any demographic, nearly twice that of females.

Preventing the initial injury is critical because once you’ve sustained a brain injury your vulnerability increases exponentially. After your first brain injury you are two to three times more likely to sustain a second injury. After a second injury, the potential for a third increases to eight times the normal average.

There are numerous different types of brain injury, resulting in the bruising, bleeding, twisting or tearing of brain tissue, and victims of TBI often have more than one type. The damage may occur at the time of the injury, or may develop later as the result of swelling or bleeding.

There are two major mechanisms of injury, acceleration-deceleration and rotational: Acceleration injuries occur when the immobile head is struck by a moving object; Deceleration injuries occur when the head is moving and hits an immobile object; Rotational injuries occur when a blow to the side of the head causes the brain to swivel on the spinal column causing injury to the spinal cord.

The severity of a brain injury can either be classified as mild or traumatic, based on the severity of the symptoms. Sometimes surgery is required to relieve pressure built up inside the brain as the result of swelling or bleeding, to remove foreign objects or pieces of skull, or to remove the clots that can form as a result of the injury. Sometimes the person affected does not even know that they’ve sustained a brain injury, or confuses the symptoms with something else.

There is no rule as to how much force is required to bring on a concussion, and as a result doctors don’t rate the force when grading concussions. Instead they measure the symptoms, adding them up to grade the concussion from one, being the least serious, to three, being the most severe. Then they determine what course of action to recommend. Children of any age and people with weak genetics are generally more susceptible to head injuries, and sometimes all the force that is necessary to produce a concussion is a shake or a mild contact with something like a soccer ball.

Mild symptoms include headaches, lightheadedness, falling, dizziness, blurred or double vision, nausea, vomiting, short-term memory loss, insomnia, fatigue, irritability, sadness, slowed thinking, impaired reading skills, inability to carry out routine tasks or learn new facts, disorganization, and a diminished attention span.

Traumatic symptoms include headaches, spasticity, dizziness, reduced co-ordination, sensory dysfunction, memory loss, concentration problems, perception/sequencing difficulties, impaired judgment, impaired communication skills, fatigue, loss of empathy, depression, anxiety, sexual dysfunction, emotional volatility, slowed thinking, and impaired writing and reading skills.

Second Impact Syndrome generally occurs when an athlete returns to a sport too soon after sustaining even a mild concussion and gets hit in the head a second time. The second trauma is more debilitating than the first and can lead to significant and permanent deficits, and in some cases, death. A fall from as little as 60 centimetres (two feet) can cause permanent brain damage, and an accident at speeds as slow as 7 km to 10 km an hour is enough to shatter a deceptively fragile human skull.

Post Concussion Syndrome, which has sidelined a number of professional athletes in recent years, can last days, weeks, months and even years. Doctor’s are generally better at recognizing the symptoms of PCS than they were a few years ago, which can be thought-related, behavioral and emotional.

Next week: Education rather than legislation




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