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Helmet Use in PreventingInjury in the Alpine

Environment

Advocacy Morning Report, Feb2010

Dr. Gleich, Dr. Zimbric

http://www.facebook.com/photo.php?pid=217334&id=1174794290http://www.facebook.com/photo.php?pid=3308&id=100000151714710http://www.facebook.com/photo.php?pid=36058634&id=1304513&op=1&view=global&subj=1028568395

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Skiing is not new.http://history.fis-ski.com/

6300-5000 BC- Oldest (wood) skis found in Russia 1206 The Birkebeiners (Norway) rescued the 2-year-old

Prince Hakon Hakonson, heir to the throne, skiing over theDovre mountains from Lillehammer to Osterdalen.

1800s Ski troops fought in the war over Finland between

Sweden and Russia. 1812- Russian ski troops take on Napolean 1866- First ski school (Norway) 1860s First known ski competitions (Norway) 1908- First ski lift (Switzerland) 1928 Nordic skiing in winter olympics 1936 Alpine events in winter olympics 1959 First death in official Alpine championships causes FIS

to rule that helmets must be worn.

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Skiing is fun.

Avg 10 million US people skied > 1/yrfrom 1993-1997 (household survey,Nat. Sporting Goods Assoc.)

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Skiing can hurt.

84,200 ski-associated injuries in USEDs 1997 (Xiang 2004)

600,000 estimated total ski/boardinjuries per year in US (Cusimano2010)

http://www.facebook.com/photo.php?pid=1882619&id=637120915

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Ski/Snowboard InjuriesH Jiang et al. Downhill Skiing Injury Fatalities Among Children. Injury

Prevention 2004; 10:99-102

Fatal injuries at CO ski resorts 1980-2001

Info via death certificates

Total 149 fatalities assoc w/ downhill skiing

21/149 (14%)

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Helmets

First mandated in ski competitions 1959 2002 Lids on Kids (http://www.lidsonkids.org/home.asp)

Goal is to get kids to wear helmet but ski as though they are not

2008/09 National Ski Areas Association (NSAA) NationalDemographic Study (130,000 interviews of skiers and ridersnationwide), helmet usage among skiers and riders in the U.S.increased 12 percent over the previous season. 77% 65 32% 18-24 helmet usage increases with the skier's ability level: 26% beginners

wear helmets, 38 % of intermediates wear helmets while 55 % ofadvanced skiers and riders wear helmets.

In April 2009, Vail Resorts announced that from 2009/10, theywould require helmet use for all their employees on the snow

http://www.lidsonkids.org/home.asphttp://www.lidsonkids.org/home.asp

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Do helmets work?Russell et al. The effect of helmets on the risk of head and neck injuries

among skiers and snowboarders: a meta-analysis. CMAJ 2010

1st meta-analysis examining effect of helmets onhead & neckinjuries for skiers & snowboarders

Methods:

Search of electronic databases, conferences,

reference lists Head injury or head trauma

Helmet

Skiing or snowboarding

Studies included:

Used a control group

Compared skiers/snowboarders with & without helmets

Measured at least 1 objectively quantified outcome (headinjury or neck/cervical injury)

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Results: 10 case-control, 1 case-control/case-crossover,

& 1 cohort study included

Use of helmets by skiers/snowboarders significantly

reduced risk of head injury by 35% 2-5 of every 10 head injuries could be prevented

with use of ski/snowboard helmets

Pooled OR 0.65 (95% CI 0.55-0.79)

6 studies examined association betweenhelmet use and risk of neck injury

No significant increased risk of neck injury

Pooled OR 0.89 (95% CI 0.72-1.09)

Do helmets work?Russell et al. The effect of helmets on the risk of head and neck

injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010

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Do helmets work?Russell et al. The effect of helmets on the risk of head and neck

injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010

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Do helmets work?Russell et al. The effect of helmets on the risk of head and neck

injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010

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Limitations: Moderate methodological quality of included

studies

Insufficient adjustment for potential confounders

5 studies required crude OR calculations

Different definitions of head injury

No examination of design, quality, or fit of

helmets If helmets were of poor quality or worn

incorrectly, effect of helmet would beunderestimated relative to their true potential

Do helmets work?Russell et al. The effect of helmets on the risk of head and neck

injuries among skiers and snowboarders: a meta-analysis. CMAJ 2010

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wHelmets

Provides false sense of security More aggressive/dangerous skiing

Faster speeds

Increased risk of injury to other parts ofbody

Evidence mixed Several studies showed increased risk-

taking among helmet users

Others showed helmet users were morecautious group

After adjustment, meta-analysis(Russell 2010) showed no relationbetween helmet use and injury orseverity of crash

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Barriers to Helmet UseFinnoff et al. Barriers to Bicycle Helmet Use. Pediatrics 2001; 108

Perception it doesnt help Perceived discomfort Coolness factor

Cost Availability Sizing

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Lids on Kids

Picabo Street"Over 300,000 Americans suffer brain injuries a year. Don't be astatistic, wear your helmet. During my career the doctors fixed my

body several times. Luckily I never hurt my head because you onlyget one chance with your brain. Wear a helmet.

Bode Miller"When I was little, 6-years old, I got my first helmet. I've never hada more trusty or invaluable piece of equipment. Now that I'm racingand helmets are a requirement, it seems like I never go skiingwithout one. They're warm and comfortable, and they can save yourlife if you have an unlucky slip. When you see the pictures of theracers these days, one of the coolest parts are the lids. Some of thedecorations are awesome.

Gretchen BleilerI wear a helmet when I'm riding a halfpipe because I would rathernot risk it. There are too many things that could go wrong, so whytake a chance? It just makes sense to protect your head.

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Advocacy in the works

Legislative Efforts: Several states consideredmandatory helmet laws for youth

MA, MI, NJ, NY

No laws passed yet

Insufficient public support No enforcement agency

Need to institute further education & incentiveprograms well-rounded approach allows

recognition of protective value of helmets Similar to mountain biking (80-90% helmet use rate,

Kronisch 2002).

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What Can We Do?

Letter to ski resorts

Encourage employees, ski patrol to wear helmets

Consider free helmet use w/ rentals

Consider free helmet use for ski schools

Coupons for helmet with season pass? Helmet design/decorating competition

Wear a helmet yourself

Compliment kids on helmets on slopes

Discuss in WCC Encourage fellow boarders/skiers to wear them

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Works Cited http://alhazan.com/gallery/career/sonny_ www.gawker.com http://www.nsaa.org/nsaa/press/08

09/helmet-safety.asp H Jiang et al. Downhill Skiing Injury

Fatalities Among Children. InjuryPrevention 2004; 10:99-102

Russell et al. The effect of helmetson the risk of head and neckinjuries among skiers andsnowboarders: a meta-analysis.

CMAJ 2010 Finnoff et al. Barriers to Bicycle

Helmet Use. Pediatrics 2001; 108 Kronisch et al. Mountain Biking

Injuries: An Update. Sports Med2002; 32

http://history.fis-ski.com/ Facebook stalker tool http://www.ski-injury.com/prevention/hel http://www.lidsonkids.org/home.asp http://news.dipag.it/photo-Bode-

Miller-in-action-0000016716.html

http://alhazan.com/gallery/career/sonny_bono_450http://www.gawker.com/http://history.fis-ski.com/http://www.ski-injury.com/prevention/helmethttp://www.lidsonkids.org/home.asphttp://www.lidsonkids.org/home.asphttp://www.ski-injury.com/prevention/helmethttp://history.fis-ski.com/http://www.gawker.com/http://alhazan.com/gallery/career/sonny_bono_450