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Head games, part II

Education rather than legislation

The B.C. Brain Injury Association is an umbrella organization for regional groups that assist persons with brain injuries while educating the public on safety issues.

One of their primary campaigns has been to advocate the use of helmets in cycling, and their testimony was key to the provincial government’s implementation of a bicycle helmet law in 1996. B.C. was the first province or state to introduce a bicycle helmet law, although most have followed suit.

The results were dramatic: according to a study by the Brain Injury Association, a bicycle helmet reduces the risk of head injury by 83 per cent and brain injury by 88 per cent. While bicycle helmets were already widely in use and accepted by the time the helmet law was brought in, the amount of people using helmets increased from 46 per cent in 1995 to 70 per cent in 1999.

Although you could argue that the same results could be achieved with mandatory helmet laws in skate parks and terrain parks, Dr. Brian Hunt believes that enforcement is negative.

A doctor’s perspective

"Personally, my feeling is this; as an owner or an operator of a recreational facility or recreational activity where there is a good risk of head injury, be it a skateboard park or ski or a snowboard park, or a mountain bike rental place, I would be insistent that a person could not take part in that activity without the proper head gear," says Hunt, a neurological surgeon at Lions Gate Hospital and a long-time Whistler skier.

However, "I do not believe it should be law, that you should be fined for not wearing a helmet. That’s where free choice comes in. If someone goes out and gets a helmet because they have to, they resent it. They leave it at home, or they don’t do it up properly. When you choose to wear a helmet, you’re concerned enough about safety to do the right thing. You made the right choice."

Convincing people to make the right choices means educating them at an early age. He points to an editorial by a colleague in Calgary as a good example of the reasons why education is at least as important as enforcement.

"The purpose of this editorial was not to provide another review of the literature and then wield the scientific sword in favor of helmet use," wrote Dr. R.J. Hulbert. "As Hentschel and colleagues have already demonstrated with skiers and snowboarders, the evidence continues to speak for itself. Instead, this editorial is intended to focus our despair and frustration over the tragedy that continues to accumulate. Tragedy that we all know can be prevented.

"These convictions and emotions should incite us, as a community, into further action through both education and political reform. We must step outside the traditional role of the caregiver. Our mission is not only to further science and fact, but to set an example through wearing helmets ourselves, to talk to our neighbourhood schools, to educate ski patrollers, to meet with local and provincial interest groups, and to hound politicians. Participation in local or national groups such as Think First can make our efforts more efficient."

"More and more, it’s important for doctors like me to spend our time working with governments and schools and sports organizations to encourage, promote and educate," says Dr. Hunt. "We can’t do it alone. We need people to know what a brain injury looks like so they can watch for it. We need more and better role models wearing helmets so the kids can see them and decide they need to wear a helmet, too."

He also believes that the term Post Concussion Syndrome is a misnomer because you don’t have to sustain a concussion to sustain a brain injury. Shaking or jarring the head is often sufficient enough to cause damage.

Dr. Hunt not only practices as a neurological surgeon, he has been involved with athletics as a volunteer doctor for the Canadian Alpine Ski Team, and as a volunteer medical ski patroller for Whistler Mountain. He was also a Director of the Provincial Program for Advanced Trauma Life Support, which offers trauma management courses to doctors around the province.

His interest in sports and trauma have enabled him to gain knowledge and experience in the management of concussions in sport. He is a co-chair for the injury prevention program, Think First, which travels to schools and communities to educate athletes, parents and coaches, and spends a lot of his time working with athletes who have to deal with the effects of repeated concussion and the persistent physical and psychological problems they suffer.

His list of patients include skiers, snowboarders, professional hockey players, and other high-performance athletes.

One thing he has seen is that while properly designed helmets can absorb a lot of the impact that causes concussions and protect the skull from injury, they do not prevent head and brain injuries.

"I was on ski patrol on Whistler when I was called down to an accident under the Emerald Chair," he recalls. "There was a little ski scamp sitting in the snow who had done a faceplant with her helmet on. She wasn’t crying, she wasn’t talking. I told her ski instructor that the girl should be taken down, she might have a head injury and the instructor didn’t believe me. She wasn’t willing to accept my diagnosis.

"Another time, a boy fell at the bottom of Green Acres. He had a helmet on, too. He just lay in the snow and didn’t move for about 30 seconds. The mother came along, and the boy looked up and asked her what happened. She said he just had a fall, even though he didn’t move for half a minute. I said he was injured and the she said ‘No he isn’t, he’s wearing a helmet.’ That’s the level of awareness that’s out there, and that’s what we have to change."

If it doesn’t prevent concussions, why wear a helmet?

"The answer is, the injury to the brain is directly proportional to the kinetic energy directed to the brain. A well-padded helmet diminishes that kinetic energy, softens it, dissipates it."

Dr. Hunt also advocates the use of mouthguards in contact sports or in sports where you’re prone to head and jaw injuries, such as soccer and snowboarding – "When the facial and jaw muscles are contracted through the use of a well-fitting mouthguard, the damaging energy from the blow to the head is redirected into the face, jaw and neck, and away from the brain," he explains.

Selling people on the use of mouthguards as well as helmets adds another level of challenge to the movement to increase safety, but Dr. Hunt feels that more awareness of the nature of brain injuries will make it easier to sell people on safety equipment.

"Some people are more genetically disposed to concussions than others," he says. "I’m one of those people, I discovered from a very early age. If I fell down or bumped my head, I would have a headache that lasted for days. It got to the point where I didn’t want play any sports where I would get hit, and I was lucky because my parents supported me. Other parents aren’t quite as supportive, and their kids go on playing these sports. We just didn’t know as much back then, and we’re still learning now."

Eric and Brett Lindros, two NHL players who have been sidelined with concussions over the years, are examples of athletes who are likely genetically prone to concussions, says Hunt.

No sport began with helmets, he points out, but they are adopted by a few players as a necessity and gradually become accepted throughout the sport.

In baseball, it took the death of Ray Chapman in 1920 and the death of five minor leaguers in the next three decades to make batting helmets mandatory – but not until 1955. In the NHL, helmets weren’t adopted until the 1979-1980 season, although European players and players who had suffered concussions began to wear them in the early 1970s. You can almost tell what era football footage is from by the differences in the helmets, which were introduced in the 1890s to prevent concussions, cuts and ear-loss – games and injuries were so violent in the days of Red Grange and Bronco Nagurski that on several occasions, the government threatened to banish the game forever.

Scrum caps are starting to become more common in rugby, prolonging the careers of players who might otherwise have been forced to retire.

On the verge of retiring himself, Dr. Hunt says he doesn’t do brain surgery anymore, although he continues to work on spines.

"It’s too sad. No one in their right minds would want to take on the rigours or the demands of a job, the long hours, the pointless brain injuries and deaths, the tumours. You have to teach some people how to walk, talk and think again."

According to Dr. Hunt there is currently a shortage of neurosurgeons in Canada.

Ski areas consider the helmet question

The truth is that at this point there is no definitive research on helmets in skiing and snowboarding.

First of all, head injuries only comprise about 1.5 per cent of all ski and snowboard related injuries, although that number will likely increase when the next statistical evaluation is completed. Meanwhile, approximately 30 per cent of biking injuries are head injuries.

Secondly, skiers and boarders who crash with their helmets on and walk away unhurt do not report the incidents. Some people who are hurt may not use ski patrollers or don’t check into the local hospital.

Thirdly, helmets can only be so effective at the speeds skiers and boarders travel at. They can prevent injuries up to 25 km/h, although average speeds in skiing are between 50 and 70 km/h. They do absorb and dissipate some of the kinetic energy even at these speeds, but not enough to prevent a head injury.

There was some concern that heavy helmets may actually cause neck and back injuries in children, but a subsequent study at the McGill University Health Centre found that there was no relation.

There is also some concern that helmets give people a false sense of security on the mountain, that they might try things beyond their abilities because they feel that the helmet is going to prevent a major head injury.

The Canada West Ski Areas Association has considered the helmet issue thoroughly in recent years, hosting seminars with Dr. Hunt, among others.

It’s a difficult problem to resolve to everyone’s satisfaction. If you’re going to make helmets mandatory in terrain parks, it could be argued that you’re discriminating against snowboarders (who are the majority of park users). Gladed runs and chutes are at least as dangerous as terrain parks. Besides, the majority of injuries happen to newbies on the beginner runs.

According to Brian Leighton, the safety manager for Whistler-Blackcomb, the mountains are about to get a lot more serious about helmets.

"The policy we follow is the Canada West policy, and from my understanding there are about to be some changes to it," he says. "It used to be that Can-West would encourage people to consider helmets, to go out and find out what they can do for you, and now they’re getting ready to take the next step."

Signs will be posted, and in all facets of mountain operations "it would mean that, in general terms, we think helmets are a good thing." Helmets would still be optional for visitors but would be more encouraged than in the past.

They are already mandatory for participants in the Whistler Kids program, although kids can get out of wearing a helmet with a signed waiver from their parents. Rental shops have been offering helmets to the general public, which has been receptive.

"We’re lucky in that we already have a lot of people here wearing helmets, compared to other resorts," says Leighton. "If you look at the lift lines, they’re fairly common out here. If you go somewhere else, you just don’t see that. It’s easier to get people into helmets when everybody’s wearing them."

Whistler-Blackcomb has entered into an agreement whereby the mountains will provide 300 helmets and the B.C. Injury Prevention Centre and the Vancouver Hospital will provide another 300 helmets to the rental shops. These helmets will be loaned to renters this season free of charge.

The mountains have also produced a safety video, in which helmets are prominently featured.

"I know from a retail perspective that helmet sales have been going through the roof," says Leighton. "There are a lot of different reasons. If you’re a parent and you want your kids to wear helmets and you’re not wearing one yourself, they’re going to want to know why.

"Some people have been injured in the past, some have had close calls. Then there have been a number of high profile cases, especially with Sonny Bono and Michael Kennedy dying the same winter after colliding with trees.

"For a lot of people, they’re not worried about their own skiing so much as they are about the other guy’s.

"Whatever the reasons are, people are wearing helmets with little or no encouragement these days, and that’s got to be a good thing."

The Skateboard Park – helmets strongly recommended

Elsewhere in Whistler the local skate community has started to take an interest in safety in the park. The Circle Skate and Snowboard Shop is running free beginner lessons in the skatepark for young boarders, which include a safety component that covers pads and helmets.

They have a vested interest in keeping their customers safe and the park open to everyone.

Helmets are a rarity, although they are on everyone’s mind.

"I don’t know if I need one yet," said Mark Didiuk, 15, who is visiting from North Delta. "It’s more for the pros who get all the air."

Like a lot of neighbourhoods, North Delta doesn’t have a skatepark and as far as Didiuk knows there aren’t any plans to put one in. If liability was an issue, he would agree to wear a helmet or sign a waiver.

"I already wear one snowboarding," Didiuk says. "I hit my head a few times and got a few concussions."

One father up from Surrey who was watching his 11 year old skate around the park explained why his son wasn’t wearing a helmet. He didn’t wish to be identified.

"I’m a bad, bad father," he jokes. "They should be wearing helmets. He’s already got a bike helmet, a hockey helmet. It’s expensive to get another skateboard helmet but they have to have the look. It’s got to be cool, or he won’t wear it.

"He took part in The Circle program with his friends earlier in the day, and that was really great because they talked a lot about pads and helmets and safety. The guys who were doing it were wearing their helmets, which is what parents need – role models make a big difference to these kids."

He also said that it’s in the best interest of the skate community to wear helmets if they want to sell them to the kids and keep the industry going.

"My son and his friends watch the videos and buy the magazines, and until they see these guys wearing helmets they’re going to be skeptical."

The son and his friends said they would wear helmets if they had them, whether it was mandatory or not. "It’s not a big deal, a lot of people are wearing them. I think it would make me a better skater because I’d try more."

Protecting what’s important

While we tend to think of the skull as a single bone, the skull of a fully-grown person is actually comprised of 22 different pieces that have fused together. A child’s skull, 25 per cent of the size of an adult skull at birth, is made up of 44 bones, which fuse together at suture points during their development.

All of this fusing isn’t completed until we’re in our early 20s.

We evolved as thinkers and problem solvers, and both the size of our brains and the shape of our skulls reflects this evolution. Our skulls had to start out small enough to make it through the birth canal and grow large enough to accommodate our brains. Yet they had to be light enough to allow us mobility, sacrificing strength for practicality.

Our heads are tough, but they’re not unbreakable.

I became aware of that this winter when a large and completely out of control skier cartwheeled passed me on a steep run on Blackcomb. I dodged him and his heavy ski boot whistled past my ear with less than 10 centimetres to spare. It probably would have crushed my skull.

Although friends had been telling me to get a helmet, I believed that it would weigh me down and ruin the experience of being on the slopes.

It took a while to get used to, but in the end I decided that wearing a helmet was better than a kick in the head.